Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
Dept. Obstetrics and Gynaecology, The Aga Khan University, Nairobi, Kenya.
Ann Glob Health. 2022 Jul 27;88(1):61. doi: 10.5334/aogh.3714. eCollection 2022.
The growing awareness of colonialism's role in global health partnerships between HICs and LMICs and the associated calls for decolonization in global health has led to discussion for a paradigm shift that would lead to new ways of engagement and partnerships, as well as an acknowledgement that colonialism, racism, sexism, and capitalism contribute to inequity. While there is general agreement among those involved in global health partnerships that the current system needs to be made more equitable, suggestions for how to address the issue of decolonization vary greatly, and moving from rhetoric to reform is complicated. Based on a comprehensive (but not exhaustive) review of the literature, there are several recurring themes that should be addressed in order for the inequities in the current system to be changed. The degree to which decolonization of global health will be successful depends on how the global health community in both the HICs and LMICs move forward to discuss these issues. Specifically, as part of a paradigm shift, attention needs to be paid to creating a more equal and equitable representation of researchers in LMICs in decision-making, leadership roles, authorship, and funding allocations. There needs to be agreement in defining basic principles of best practices for global partnership, including a universal definition of 'decolonization of global health'; the extent to which current policies allow the perpetuation of power imbalance between HICs and LMICs; a set of principles, best practices, and models for equitable sharing of funds and institutional costs among partners; a mechanism to monitor progress prospectively the equitable sharing of credits (e.g., leadership, authorship), including a set of principles, best practices, and models; and, a mechanism to monitor progress prospectively the extent to which decolonialization will contribute to strengthening institutional capacity in the LMIC institutions.
人们越来越意识到殖民主义在高收入国家和中低收入国家之间的全球卫生伙伴关系中所起的作用，以及人们呼吁在全球卫生领域实现非殖民化，这促使人们讨论范式转变，以寻求新的参与和伙伴关系方式，并认识到殖民主义、种族主义、性别歧视和资本主义导致了不平等。尽管参与全球卫生伙伴关系的各方普遍认为，目前的体系需要更加公平，但对于如何解决非殖民化问题的建议却大相径庭，从言辞走向改革变得复杂。在对文献进行全面（但非详尽）审查的基础上，有几个反复出现的主题需要解决，以便改变当前体系中的不平等现象。全球卫生界在高收入国家和中低收入国家都需要讨论这些问题，才能在多大程度上实现全球卫生的非殖民化。具体而言，作为范式转变的一部分，需要关注在决策、领导角色、作者身份和资金分配方面，为中低收入国家的研究人员创造更平等和公平的代表性。需要就全球伙伴关系的最佳实践基本原则达成一致，包括“全球卫生非殖民化”的普遍定义；现行政策在多大程度上允许维持高收入国家和中低收入国家之间的权力失衡；一套公平分享资金和机构成本的原则、最佳实践和模式；以及一个机制，前瞻性地监测公平分享学分（例如，领导地位、作者身份）的进展情况，包括一套原则、最佳实践和模式；以及一个机制，前瞻性地监测非殖民化在多大程度上有助于加强中低收入国家机构的机构能力。
