Decolonizing Global Health Research: Perspectives from US and International Global Health Trainees

Abstract

Background: "Decolonizing global health" (DGH) may help global health trainees understand and remediate the effects of historical colonialism on global health, but little is known regarding how trainees perceive DGH. Understanding their perspectives is critical for designing educational interventions tailored to their needs.Objectives: To understand how trainees perceive DGH research and to determine if perspectives differ between trainees from high-(HICs) versus low-and middle-income countries (LMICs).Methods: An online survey of all 2017-2022 pre-doctoral and post-doctoral trainees (n = 111) and mentors (n = 91) within a multi-university program that supports US and international investigators in one-year mentored global health research. The survey evaluated individuals' self-reported knowledge and attitudes toward DGH and their perceptions of historical colonialism's impact on eight aspects of global health. Findings:The response rate to trainee surveys was 56%. Trainees from LMICs were less aware of the concept of DGH; 5/25 (20%) had never heard of DGH and 16/25 (64%) reported that they "know a little," whereas all HIC trainees had heard of DGH and 29/36 (81%) reported that they "know a little" (p = 0.019). For three aspects of global health (i.e., which research questions get asked; development of collaborative relationships; and data/statistical analyses), trainees from LMICs were more likely to report positive effects of colonialism. However, in open-ended responses, no thematic differences existed between how LMIC and HIC trainees defined DGH (i.e., actively eliminating power imbalances; prioritizing local needs; promoting local leadership; providing equitable opportunities; and ensuring programs are culturally appropriate).

Has Authorship in the Decolonizing Global Health Movement Been Colonized?

“…This finding aligns with opinion pieces that suggest the voices of representatives in LMICs have largely been absent in these publications [32,33]. Previous studies suggest that more than half of researchers affiliated with LMICs do not know or "have heard little" of decolonizing global health [34], which suggests that the dissemination of this narrative has not been geographically far reaching. Though it is possible that initial publications on these subjects were conceived of by authors in HICs and publications by authors affiliated with LMICs may follow, our findings provide a clarion call for more publications from authors affiliated with LMICs to provide a more balanced narrative of how global health can, and should, be decolonized.…”

Global Health Mentorship: Challenges and Opportunities for Equitable Partnership

“…In global health mentorship, one ethical concern is the potential for exploitation. Researchers from the Global South may face vulnerability to power imbalances and unfair treatment within the mentorship dynamic, especially when collaborating with mentors from high-income countries 12. It is essential for mentors to recognise privileges and approach these relationships with sensitivity and respect for the mentee’s autonomy and cultural context.…”

“…An indispensable facet of decolonising mentorship involves recognising the historical legacies of colonialism that have contributed to global health disparities 12. This recognition requires an introspective examination of the role that institutions and mentors from high-income countries have played in perpetuating imbalances and marginalising knowledge from the Global South.…”

An international partnership between a Canadian and Brazilian University: A descriptive report

“…These experiences are powerful as they provide learning space for students to focus on international health concepts and develop cultural safety and competencyvalues and skills that are increasingly required of new graduates by licensing bodies. Conversely, authors note that international experiences can perpetuate overlapping negative outcomes such as cultural othering (St-Amant & Sutherland, 2020), colonial influence (DeCamp et al, 2023), and power imbalances (Eichbaum et al, 2021). Despite these possible and avoidable drawbacks, most agree that authentic and mutually-beneficial collaborations supporting international student experiences can offer positive outcomes for learners, faculty, and organizations (Eichbaum et al, 2021;Matthews et al, 2021).…”