What do colonialism, racism and global health education have in common? We wrote a toolkit about it.

By guest contributors Amber Clarke, Emilie Koum Besson, Zainab Ismail, Sara Pensa, and Meskerem Aleka Kebede

Introduction

In March 2022, the Fight Against Institutionalised Racism (FAIR) Network at the London School of Hygiene and Tropical Medicine (LSHTM) published the “Introduction to Decoloniality and Anti-Racism in Global Health: student toolkit”. This work is a response to students consistently articulating that while they knew that racism and coloniality were pervasive in global health, they felt uneducated and ill-prepared to contribute to the change they felt was needed both at the School and in the sector. This toolkit is not a list of ‘dos’ and ‘don’ts’ to be followed in order to be a successful ‘anti-racist’. Simply following a such a list without critical engagement cannot impart the knowledge needed to transform ones thinking and practice.

Too commonly, the terms ‘decolonial’ and ‘decolonise’ are co-opted by institutions, used as metaphors, buzzwords or paid mere lip service, without a genuine understanding of their meaning, acknowledgement of what these concepts demand practically, or recognition of who generated this important scholarship. While this toolkit was written for a Global North institution, the objective was to bring literature emanating from scholars of the Global South into Western academic spaces and to recentre the voices of Global South actors in decoloniality and anti-racism practice.

The final document is an attempt to make the aforementioned material accessible to students of global health, but, given the subjects dealt with and the reality that all society and culture is informed by coloniality and its legacies, the toolkit is – in practice – relevant to a much wider audience. This toolkit will be used differently by every individual who engages with it and can be a powerful resource in starting conversations about ‘race’ and racism and its impacts to continuing to dismantle our internalised white supremacist thinking.

The work was co-led by founding members of the FAIR Network Emilie Koum Besson and Amber Clarke. They designed the outline informed by innumerate conversations with LSHTM students and staff as well as external actors over the previous 18 months. FAIR then hired Meskerem Aleka Kebede, Zainab Ismail and Sara Pensa – three LSHTM alumni with varied backgrounds and experiences of the Institution to contribute to the toolkit.

This short blog presents the needs for and goals of this toolkit, as well as motivations and ways of working.

Why do you think institutions like LSHTM need such a toolkit?

Global health institutions of education are currently not fit-for-purpose. Whilst many like LSHTM have publicly committed to addressing inequalities, true transformative justice goes beyond ‘equality, diversity and inclusion’. Public and ‘global’ health education should acknowledge that these fields and industries function within wider geo-political and socio-political contexts and are thus informed by them. Claims of neutrality preserve rather than disrupt the status quo; one in which the complex history and legacy of European colonialism is erased, denied and unaccounted for.

Sara: I have studied and worked in white-dominated institutions for my whole career, witnessing institutional racism at its core. I have followed with interest the attempts of these institutions to decolonise their curricula and increase equality, diversity, and inclusion, mostly with disappointment. Yet, it took me a long time to fully appreciate how much my academic knowledge is biased because of the racism and colonial legacies within academic institutions, how much university curricula are influenced by them and how the institutions themselves are founded on colonial ideas.

Emilie: Schools of global health, especially those with deeply embedded colonial legacies should declare moral bankruptcy or at least recognize that they are morally corrupt for systematically violating the moral values they claim to follow by denying or covering up entrenched racism. They owe more than they can pay by their self-defined goodness but while we can’t overhaul the system on our own, student movements who have always been at the forefront of this agenda should be supported.

What were your goals in writing this toolkit?

The toolkit aims to guide students on how to nurture inclusivity and interact in a diverse environment. FAIR wanted to create a reference material that they can use when they experience racial discrimination, discomfort in or outside class at their own pace and make postcolonial and decolonial literature and critical development studies theories and frameworks accessible.

Meskerem: It’s possible to mention several instances of ignorance, misunderstandings and circumstances I knew were wrong, I knew were a problem but didn’t know where one can find such information or if some of the things making me feel uncomfortable in class, as well as with my interactions with fellow friends had names, explanations and ways to be addressed. It can be isolating at times.

To do so, FAIR centralised the answers to commonly asked questions like how to diversify one’s reading list or choose a thesis topic that would not reinforce existing inequities and incorporated accounts from LSHTM students and diverse sources of knowledge to actualise the key concepts relating to racism and coloniality.

Amber: After finishing my MSc, I began re-educating myself on global health through postcolonial and critical development studies lenses. It transformed my perspective. Since, I have brought this understanding to my work in the humanitarian industry, think tanks, and government public health bodies. I wanted other students to have access to the resources they need to properly understand the health inequities they are trying to help resolve.

Why is this document aimed at students?

Global health schools cater to students from all over the globe with different backgrounds. Because racism and colonialism are complex and contentious topics, many are afraid to even broach the subject and also lack the tools to navigate these conversations.

Sara: I always experienced inner conflict while studying global health in institutions with strong colonial legacies, and I believe many students do. I didn’t have the tools to fully understand and talk about it, or how to deal with feeling that I might have been part of the problem.

This toolkit was written to encourage and equip students to critically engage with their education and the discourses and practices in their fields in an effort to support their journey to become active anti-racist professionals. It also supports staff and others with the knowledge and tools to welcome these exchanges.

Why is it global health specific?

Coloniality and racism characterise the entirety of our modern world, but manifest in unique ways in global health. Decolonising global health is about decolonising on one side and global health on the other. Consequently, the knowledge in this toolkit is not, for the most part, specific to global health but rather the contributors use global health examples to contextualise the way colonial legacies and racism permeate the sector.

Amber: Without thoroughly educating students, many of whom are white and from the Global North, on the colonial origins of this industry and current global architecture, global health schools are sending them out to work with a dangerous lack of unawareness of their white saviour or subject-object complex mentality.

What did you personally want to contribute to this toolkit?

The LSHTM student community is one of the most diverse of any UK university in terms of life and career experience, and most background characteristics. FAIR wanted to draw on each contributors’ experience to highlight the importance of pluralism – especially in academic environment – in creating a resource that would speak directly to the student body. In order to do this, the Network recruited exclusively from the LSHTM student alumni community*.

Sara: The burden of the work to decolonise academic institutions, to create a constructive anti-racism dialogue, to provide the knowledge to dismantle structures and biases, shouldn’t all be on the shoulders of minoritized people. As I white person, I felt it would be hypocritical to just watch and support from the side lines.

Zainab: Having access to a similar resource whilst I was studying would have been invaluable in expanding my understanding of anti-racism and decoloniality concepts and being able to hear similar lived experiences and have honest conversations about racism.

Meskerem: It can help racially minoritized students as well as others who lack an understanding of their actions and sometimes are worried about how they should properly address these topics and are genuinely seeking resources and pointers.

How did you write this toolkit, and what did you gain from the experience?

The authors of this toolkit are not decolonial scholars. They joined this project with different experiences of LSHTM, global health industries and careers and built from these perspectives, their lived experience of racism and their self-directed learning on anti-racism and the legacies of colonialism. The group never tried to “compromise or agree” but focused on discussing everything that was perceived differently with the aim of capturing those differences in the final output.

Zainab: Reflecting on certain questions such as ‘How do I intentionally show up as an anti-racist?’, ‘How do I face the facts about racism, white privilege, and white supremacy?’, ‘How do I challenge racial stereotyping?’ ‘How do I champion equality and fight for equity?’ helped me to realise that collectively, we must not only stand in solidarity with our colleagues, but also act to create long-lasting systemic change to address racial injustice and inequality.

Sara: I often found myself questioning my own views, the source of my own beliefs. This work has become part of a journey to recognise and address my own biases, my own privilege.

What is the overarching message you want people to take away from this work?

Global public health industries and their institutions require a transformation, stemming from an engagement with the critiques of their work from Global South scholarship, if they are to be fit for their declared purpose.Until everyone is able to clearly identify coloniality and racism, applying a decolonial and anti-racist praxis in our lives and work will be challenging.

On scholar-activism

Scholar-activism can have negative mental health consequences when institutions don’t provide the right environment for the development of meaningful decolonial and anti-racist work. For this work to not be performative, FAIR needed full autonomy over the content, a commitment that the document would be embedded in LSHTM students onboarding in the future and a proper budget for the team to develop something fit-for-purpose that would do justice to both students’ learning, and the scholarship being drawn from.

Amber: Education is supposed to be emancipatory, but with so much hidden from students it is often the very opposite. Fighting for change is arduous, and messy, but it’s critical.

Emilie: Racialised people often feel obliged to lead on decolonial and/or anti-racism work but until they have the proper support, they should know that they don’t owe anyone their time and energy.

Acknowledgment

We are eternally grateful and indebted to all the scholars, thinkers, intellectuals, activists, and individuals, past and present, who paved and continue to pave the way for our understanding of the colonial histories that shape our world, and who fought for change, forging new traditions and reimagining what is possible. Our work is made possible by these great traditions of scholarship and activism.

*Note: We received a number of applications from alumni based outside of the UK but were legally limited in our ability to recruit alumni without the right to work in the UK. We recognise that working to embed decoloniality but not being able to hire individuals in the Global South can be counterproductive, and we are continuing to work with the Institution to try to overcome this barrier for future projects.

About the authors:

Amber Clarke completed her MSc in Nutrition for Global Health (2017/18) at LSHTM. She is an advisor and coordinator of the Fight Against Institutional Racism (FAIR) Network at LSHTM, a health improvement and disparities researcher at the Department of Health and Social Care (DHSC) and a post-graduate student in ‘Culture, Diaspora, Ethnicity’ at Birkbeck, University of London. Amber is committed to rooting her work in disrupting legacies of coloniality in service of social justice. Twitter – @AmberRose_T

Emilie Koum Besson is a health economist and scholar-activist working to advance gender equity and anti-racism in health science, promote ethical and decolonial research practices and bridge the gap between researchers, policy makers and communities, especially in Africa. Emilie has an MSc in Public Health – Health Economics (2017/18) from LSHTM. Twitter – @emilie_skb

Zainab Ismail studied the MSc in Demography and Health (2019/20) at LSHTM and is a Methodologist at the Office for National Statistics currently working to measure and understand integration outcomes of refugees in the UK, using this evidence to inform future policies for both resettled and asylum route refugees. 

Dr Sara Pensa is a Senior Research Associate at the University of Cambridge, and recently completed an MSc in Public Health Promotion (2018-21) via distance learning with LSHTM. Sara’s passions lie in her research to develop early detection and treatment strategies for breast cancer, and in work directed to address and reduce inequalities in health research and science. Twitter – @Dr_SaraPensa

Dr. Meskerem Aleka Kebede is a Medical Doctor with an MSc in Health Policy Planning and Financing from LSHTM and LSE (joint programme). She is currently working as an overseas consultant at the Global Surgical Policy Unit at the London school of Economics. Twitter – @AyalMeskeremAk