Krugman Daniel W, Bayingana Alice
Department of Anthropology, Brown University, Providence, Rhode Island, United States of America.
School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
PLOS Glob Public Health. 2025 May 28;5(5):e0004622. doi: 10.1371/journal.pgph.0004622. eCollection 2025.
In the proliferating conversations about decolonizing Global Health, a basic assumption has been that global South actors should be the conceptualizers, leaders, and makers of change with global North counterparts thought of as allies or accomplices. This article complicates assumptions about whose responsibility it is to "decolonize" Global Health and how different actors should go about it. We do this through a qualitative anthropological investigation on resource structures and material flows and the ways that global North actors relate to and make sense of them. By outlining the financial structuring at a major American school of public health and faculty experiences within this system, we show how the "soft money" structure reproduces colonial relations, elite dominance, and capture of popularized words connoting change. While acknowledging the necessity of promoting knowledge and discourses from the South, we demonstrate how Global Health academics in this powerful institution hide or overlook their structurally advantageous positions to create change by deploying discourses such as "following the South" or "centering Southern voices." Grappling with how needed material changes fundamentally go against institutional and personal interests of powerful global North institutions and actors, we introduce "ruinous solidarity" as a paradigm of praxis. Ruinous Solidarity is elite actors thinking and acting in ways that embraces the possibilities that emerge in loss of resources and prestige. Ruinous solidarity seeks to move elite actors subjected to funding structures such as those described in this article away from passivity and obscuring the material bases of the imbalance of power in Global Health. Pushing for long term, ethical transfers of wealth and responsibility, ruinous solidarity explicitly reorients the political commitments of those who affiliate with Global Health in imperial cores, and thus offers important considerations in the wake of Trump Administration attacks on the field.
在关于全球卫生去殖民化的大量讨论中，一个基本假设是，全球南方的行为体应该成为变革的概念化者、领导者和推动者，而全球北方的行为体则被视为盟友或同谋。本文使关于“全球卫生去殖民化”责任归属以及不同行为体应如何去做的假设变得复杂。我们通过对资源结构和物质流动以及全球北方行为体与它们的关系和理解方式进行定性人类学调查来做到这一点。通过概述美国一所主要公共卫生学院的财务结构以及该系统内教师的经历，我们展示了“软资金”结构如何重现殖民关系、精英主导以及对意味着变革的流行语的掌控。在承认推广南方知识和话语的必要性的同时，我们展示了这个强大机构中的全球卫生学者如何通过部署诸如“跟随南方”或“以南方声音为中心”等话语来隐藏或忽视他们在结构上的优势地位以实现变革。由于应对所需的实质性变革从根本上违背了全球北方强大机构和行为体的机构及个人利益，我们引入“毁灭性团结”作为一种实践范式。毁灭性团结是精英行为体以接受资源和声望丧失所带来可能性的方式进行思考和行动。毁灭性团结旨在使受本文所述资金结构影响的精英行为体摆脱被动，并消除全球卫生权力不平衡的物质基础。它推动财富和责任的长期、道德转移，明确重新定位帝国核心地区那些与全球卫生相关的人的政治承诺，因此在特朗普政府对该领域的攻击之后提供了重要的思考方向。
