Decolonising global health remains a widely invoked goal with no shared roadmap
A scoping review of contemporary writing on decolonising global health found a field that is crowded with urgency but thin on consensus. Across 129 included papers, the dominant message was familiar: colonial power structures continue to shape global health priorities, authorship, funding, partnerships, and institutional authority. Yet the literature still lacks a settled definition of what decolonisation means in practice, who should lead it, and where implementation should begin.
Most of the included papers were commentary or opinion pieces, not empirical studies. That matters because the debate is still being driven primarily by interpretation, critique, and moral argument rather than by tested interventions or outcome data. The review therefore captures the language, assumptions, and proposals that currently shape the conversation, but it also exposes how much of the agenda remains conceptually unsettled.
A literature dominated by commentary from high-income countries
The review identified 129 papers. Of these, 95 were commentary or opinion pieces, leaving a much smaller body of work that could be described as evidence-generating rather than discursive. Authors were affiliated predominantly with institutions in high-income countries, including the USA and the UK. The geographic pattern is important because the literature is trying to interrogate global power imbalances while still being produced largely within the very systems being critiqued.
This imbalance does not invalidate the arguments being made, but it does frame them. A movement centered on redistribution of authority cannot ignore who is writing, whose institutions confer legitimacy, and whose perspectives are still missing or underrepresented in the published record. The review’s findings suggest that global health scholarship has begun to question those asymmetries, even as its own publication ecosystem still reflects them.
Colonial legacies remain central to how global health is described
Across the papers reviewed, decolonising global health was linked to the historical and continuing influence of colonialism on global health structures. Authors examined how colonial history has shaped present-day hierarchies, created enduring power gaps, and influenced which health priorities receive attention. The literature also explored how these dynamics appear in current partnerships, governance arrangements, and research relationships.
One sentence captures the practical problem behind the rhetoric: global health can reproduce the same unequal relations it claims to challenge.
The review found repeated discussion of epistemic justice, a concept that places knowledge production at the center of the decolonisation debate. In this framing, the issue is not only who gets to participate, but whose knowledge counts, whose methods are privileged, and whose experiences are treated as authoritative. The argument reaches beyond representation. It asks whether global health still assigns intellectual leadership primarily to institutions in the global North, while treating institutions and communities elsewhere as collaborators after the fact rather than equal architects of the agenda.
Suggested remedies cluster around partnership, structure, and individual duty
The included papers did not offer a single operational definition, but they did converge on several broad lines of action. These included partnership working, restructuring global health institutions, and clarifying individual responsibility. Some papers argued for changes in how collaborations are formed and maintained, while others called for shifts in institutional design and accountability. Still others placed responsibility on individual researchers, clinicians, and leaders to examine their own roles within unequal systems.
The review’s synthesis suggests that decolonising global health is being framed simultaneously as a structural project and a personal one. Institutions are expected to change, but individuals are also expected to change how they think, write, fund, partner, and lead. That dual demand creates a difficult operational burden. Without clear priorities, the term can function as both a diagnosis of injustice and a catch-all label for almost any reform effort.
The field agrees on urgency, not on sequence
The literature reviewed in this scoping exercise makes one point unmistakable: action is necessary. Yet the same literature does not offer a clear hierarchy of interventions. There is no consensus on whether reform should begin with authorship, funding, institutional governance, educational curricula, or partnership models. The absence of a shared starting point is more than an academic inconvenience. It slows translation from ethical position to concrete change.
A blunt reality follows from that uncertainty. A movement can be widely endorsed and still be hard to implement.
That tension explains why the review ends with recommended approaches and next steps rather than a fixed blueprint. The authors used the available literature to organize the debate around four broad domains: epistemic justice, partnership working, the structure of global health, and individual duty. Those categories are useful because they separate the problem into levels of action without pretending that one reform will resolve the entire system.
What this review adds to the decolonisation debate
By assembling 129 papers into a narrative synthesis, the review offers a contemporary map of how decolonising global health is being discussed. It shows that the concept has matured enough to generate a substantial literature, but not enough to produce a single operational consensus. It also reveals how heavily the field still relies on commentary, and how strongly the authorship base remains concentrated in high-income settings.
The review is especially valuable because it does not treat decolonisation as a slogan. It treats it as an unresolved scholarly and ethical project with competing definitions, uneven participation, and incomplete implementation pathways. The resulting picture is one of momentum without closure.
For now, the literature appears to agree on the need to confront colonial legacies, redistribute authority, and widen epistemic participation. It does not agree on the order in which those changes should happen, who should be accountable for them, or how success should be judged. Those gaps will likely define the next phase of the debate, and they leave global health with a challenge that is as practical as it is political: convert a shared imperative into a workable sequence of reforms without letting the language outrun the action.