Q.G. Eichbaum is professor of pathology, microbiology and immunology, and director, Vanderbilt Pathology Program in Global Health, Vanderbilt University Medical Center, as well as professor of medical education and administration, Vanderbilt University School of Medicine, Nashville, Tennessee.
L.V. Adams is associate dean for global health, associate professor of medicine and epidemiology, and director, Center for Global Health Equity, Geisel School of Medicine at Dartmouth and Dartmouth College, Hanover, New Hampshire; ORCID: http://orcid.org/0000-0002-1303-2154 .
Acad Med. 2021 Mar 1;96(3):329-335. doi: 10.1097/ACM.0000000000003473.
Global health often entails partnerships between institutions in low- and middle-income countries (LMICs) that were previously colonized and high-income countries (HICs) that were colonizers. Little attention has been paid to the legacy of former colonial relationships and the influence they have on global health initiatives. There have been recent calls for the decolonization of global health education and the reexamination of assumptions and practices under pinning global health partnerships. Medicine's role in colonialism cannot be ignored and requires critical review. There is a growing awareness of how knowledge generated in HICs defines practices and informs thinking to the detriment of knowledge systems in LMICs. Additionally, research partnerships often benefit the better-resourced partner. In this article, the authors offer a brief analysis of the intersections between colonialism, medicine, and global health education and explore the lingering impact of colonialist legacies on current global health programs and partnerships. They describe how "decolonized" perspectives have not gained sufficient traction and how inequitable power dynamics and neocolonialist assumptions continue to dominate. They discuss 5 approaches, and highlight resources, that challenge colonial paradigms in the global health arena. Furthermore, they argue for the inclusion of more transfor mative learning approaches to promote change in attitudes and practice. They call for critical reflection and concomitant action to shift colonial paradigms toward more equitable partnerships in global education.
全球卫生常常需要中低收入国家(LMICs)和曾经被殖民的高收入国家(HICs)之间的机构合作。人们很少关注前殖民关系的遗留问题及其对全球卫生倡议的影响。最近有人呼吁对全球卫生教育进行非殖民化,重新审视全球卫生伙伴关系所依据的假设和做法。医学在殖民主义中的作用不容忽视,需要进行批判性审查。人们越来越意识到,HIC 产生的知识如何定义实践,并影响到 LMIC 中的知识体系。此外,研究伙伴关系往往使资源更丰富的合作伙伴受益。本文作者简要分析了殖民主义、医学和全球卫生教育之间的交叉点,并探讨了殖民主义遗产对当前全球卫生计划和伙伴关系的挥之不去的影响。他们描述了“非殖民化”观点为何没有得到足够的重视,以及不平等的权力动态和新殖民主义假设为何继续占主导地位。他们讨论了 5 种方法,并强调了资源,这些方法在全球卫生领域挑战了殖民范式。此外,他们还呼吁采用更多变革性的学习方法,以促进态度和实践的改变。他们呼吁进行批判性反思,并采取相应行动,将殖民范式转变为更公平的全球教育伙伴关系。