Decolonizing global health: a scoping review of its key components, proposed actions, and contributors

INTRODUCTION: Although there has been attention paid to decolonizing global health, there is no consensus around the concept. To act in the face of various crises, including neocolonialism, there is a need to understand the key components of this concept within mainstream global health, how it can be acted on, and who is contributing to these discussions. METHODS: A scoping review was undertaken to assess the academic literature for discussions on decolonizing global health. The PRISMA guidelines for Scoping Reviews (PRISMA-ScR) were used to guide reporting. OVID Medline, OVID Embase, EBSCO CINAHL Plus, Web of Science Core Collection, PAIS Index, Worldwide Political Science Abstracts, and the International Bibliography of the Social Sciences databases were searched from inception to August 8, 2023. The inclusion criterion was that texts had to: (i) use the exact phrasing of "decoloni* global health" or "anticolonial global health," (ii) include substantive discussion of what decolonizi* global health or anticolonial global health means (i.e., single mentions that do not include an explanation, elaboration, or context were excluded), and (iii) be published in English. RESULTS: When analyzing how scholars understand "decolonizing global health", its meaning is rooted in three key components: (i) power asymmetries between the global north and south; (ii) a legacy of colonialism in global health or neocolonialism; and (iii) epistemic injustice. The second part of the analysis looked to understand if decolonizing global health can be acted on, and if so, how? The analysis demonstrated that decolonization of global health involves: (i) overhauling existing power structures; (ii) establishing agency and self-determination of the global south; (iii) epistemic reformation and epistemic and ontological pluralism; (iv) education; and (v) inclusivity, solidarity, and allyship. Lastly, in assessing which scholars' work was retrieved in this systematic search of the literature, most first authors were situated in the Americas Region (n = 45/99; 46%), followed by the European Region (n = 29/99; 29%). When combining these two regions, this accounted for almost 75% of all included articles. Notably, only 22% of first authors of retrieved articles had an affiliation in a low- and/or middle-income country. CONCLUSIONS: The findings from this scoping review are anticipated to bring much needed clarity to discussions around decolonizing global health, in terms of key components, gaps, and possible actions. For instance, this review presents ongoing challenges faced in coming to a comprehensive and agreed upon definition of decolonizing global health in mainstream global health.