Colonial Impact on Radiotherapy Access in Sub-Saharan Africa

Purpose: The movement to decolonize global health highlights the need to address structural inequities rooted in colonial legacies. This study examines how European colonial history influences access to radiological health services in sub-Saharan Africa (sSA), where over 90% of the population lacks radiotherapy and faces severe diagnostic imaging deficits. These disparities arise from a complex interplay of historical, socioeconomic, ethnic, and geopolitical factors, with this work focusing on the historical impact of colonialism on current radiological health access. Methods: Nations in sSA were categorized by their former colonial ruler (United Kingdom, France, Portugal, Belgium). Data on radiotherapy access came from the IAEA’s Directory of Radiotherapy Centers (DIRAC), while diagnostic imaging metrics (MRI, CT, PET, nuclear medicine, mammography) were sourced from the WHO’s Global Atlas of Medical Devices. Population-adjusted metrics and IAEA benchmarks estimated the proportion of the population with access to these services. Variations between groups were analyzed to explore potential influence of colonial heritage. Results: The analysis shows markedly greater access to radiological health services in former British colonies compared to those colonized by France, Portugal, or Belgium. For example, 27.2% of individuals in former British colonies have access to radiotherapy, compared to 8.2%, 6.0%, and 2.5% in former French, Portuguese, and Belgian colonies, respectively. Similar disparities exist in diagnostic imaging; CT access reaches 47.3% of the population in former British colonies but only 33.7%, 25.8%, and 6.9% in French, Portuguese, and Belgian colonies, respectively. This same trend holds across each imaging modality. Conclusion: The findings reveal the lasting influence of European colonialism on radiological health access in 2024 (six decades post-independence). Former British colonies have significantly greater access to these services than French, Portuguese, and Belgian counterparts, reflecting entrenched colonial-era institutional structures that continue to shape resource distribution and governance. Addressing these disparities requires targeted global health strategies focused on infrastructure, capacity-building, and culturally and linguistically tailored outreach in French- and Portuguese-speaking regions. Confronting these colonial legacies is essential for building an equitable framework for radiological healthcare. Citation Format: Joseph Weygand, Ann T. Nguyen, Eman Suliman, Gage Redler, Shalom Kpetsu, Daniela Branco, John M. Bryant, Peter Sandwall, Charles R. Thomas Jr. Investigating the Colonial Origins of Radiological Health in Sub-Saharan Africa [abstract]. In: Proceedings of the 13th Annual Symposium on Global Cancer Research; 2025 Sep 16. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(12_Suppl):Abstract nr 10.