Report: Shifting Power in Global Health – what will it take? Summary of dialogues

December 2022

The wake of the Black Lives Matter movement and the COVID-19 crisis lay bare the fault lines in global health. Reflecting on the uncoordinated global response to the pandemic and the exacerbation of inequalities in treatment and supply of essential goods, the international development sector has been primed to reconsider the structural flaws of its systems, rife with entrenched power asymmetries and stalled reform – heritages of its colonial origins, wherein global health was established as a field of research and practice that privileged the voices and goals of the powerful over the populations it purports to aid.

In response, the Shifting Power in Global Health: Decolonising Discourses dialogue series was convened as a three-part roundtable discussion on 2 November 2021, 1 March 2022 and 1 May 2022, in partnership with United Nations University – International Institute for Global Health, Wilton Park, and Development Reimagined. The dialogues serve as a contribution to the increasing calls for decolonization in global health by engaging a global cross-sectoral set of actors to identify the problematic rhetoric and approaches and to suggest practical next steps for reimagining the sector.

The dialogues involved 65 participants in total, where each roundtable in the series was run as a dual set of dialogues on each day, to facilitate engagement with stakeholders across a broad geography of 5 regions and time zones.

Key Takeaways

  • Global health power inequity stems from larger global systemic power differentials between the global North and South
  • Power structures in global health at multiple levels – individual, structural, and systemic – need to be shifted
  • Decolonizing global health will be a socially driven effort, not an academic one
  • Funding methods for global health can improve – or worsen – these decolonization efforts

As an opener, the first dialogue mapped out avenues for further discussion by articulating the ideas and visions about what decolonized global health would look like from differing points of view and identifying points of convergence.

As the existing knowledge base in global health –the ideas and principles of “equity”, “justice”, “rights”, “expertise” or “value” – were drawn from Eurocentric conceptions, coloniality perpetuates through the entrenchment of these epistemologies. Separating out coloniality from decolonization and reconsidering the hierarchy in the top-down matrices of knowledge, power and control is the first step toward comprehending the systematic flaws and decolonizing global health. Evidently, purposeful underdevelopment continues today through complex funding flows which had further institutionalized long-existing injustices. To advance from dialogue to action, the dialogue participants identified three imperatives: to call out structural violence and institutional damage; to mainstream a spectrum of epistemologies; and to collapse center-periphery divisions and dynamics.

Next, the second dialogue focused on the key themes that emerged from South-South collaboration and set forth the importance of mindsets, principles, partnership and careful use of language in efforts to decolonize global health.

A changed mindset is fundamental for more equitable, inclusive, and accountable partnerships. For genuinely sustainable and equal global development to be achieved, participants posited that the Global North must be prepared to cede power which permitted the exploitative regional and global interactions for centuries, while Global South actors need greater agency to set the decolonizing agenda and embrace a long-term vision for development. In that sense, partnerships should extend beyond the distribution of funding but also to the principles of trust, transparency, and reciprocity. Participants also addressed the synergies among communities, social movements, and academia. Communities are at the very heart of the push to decolonize from below while social movements are well-connected and have been at the forefront of the decolonizing agenda ahead of academia and international agencies. Actively seeking partnerships with – and learning from rather that co-opting – social movements and communities can help the academia in the Global South to dismantle the problematic practices of their Northern counterparts.

In closing, the third dialogue situated the core principles of decolonization in the source and power dynamics of funding mechanisms and carried out an inquiry into constructing new power dynamics, centering beneficiaries’ agency for more equitable and sustainable global health finance.

It was posited that through the extended period of colonization and in the current Eurocentric post-colonial world order, local communities have been disempowered, while dependency on imported structures and external resources has continuously been reinforced. Top-down governing institutions established during colonial rule deprived local communities of their sense of agency, while the disconnect from the grassroots accountability of leadership led to failed provision of contextually appropriate and effective services. It was recommended that local leadership and agency established via a bottom-up approach will be key to building adaptive, transparent and accountable health funding models. It also necessitates an inward-looking shift from over-reliance on external donors for financing to harnessing community agency over decision-making, sustainability and ownership/administration of resources. Other funding diversification options discussed included reform of tax and donor funding methods, reparations as a funding option, social impact bonds and blended financing.

What comes next?

  • Change in this sector is already in progress with many guiding policies and codes of practice in application globally, but more can be done on implementation.
  • Continuing the conversation and discourse to promote new ideas and spotlight initiatives that work.
  • Involving new and emerging voices in this space to prompt agency and the dismantling of power imbalances

In this regard:

Development Reimagined works to build on the decolonisation discourse with further dialogues around systemic change. These dialogues will be focused on more equitable, sustainable financing mechanisms and promoting decolonial collaboration in post-colonial states – at both local and national levels – to challenge existing power structures.

United Nations University works on building its unique position as a think tank within the UN ecosystem, applying a decolonial lens to all its work and has launched a programme of work dedicated to Decolonising Global Health, which aims to both continue these dialogues through its convening function and catalyse action through its evidence-to-policy pipeline, with a starting focus on coloniality in knowledge production.

Wilton Park works to embed many of the issues and themes that emerged in this series within its global health dialogues, while also engaging directly on how best to support the shift from rhetoric to action.

Download each dialogue summary here:

Shifting Power in Global Health: Decolonising Discourses – Dialogue 1

Shifting Power in Global Health: Decolonising Discourses – Dialogue 2

Shifting Power in Global Health: Decolonising Discourses – Dialogue 3

Shifting Power in Global Health: Summary – Available here

For further information on this body of work, please contact our team here:


December 2022

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