In April, discussing how coronavirus vaccine trials might be carried out rapidly, two French doctors suggested conducting trials in Africa, where a lack of protective equipment, treatment or resuscitation would make it quicker and easier to see if the vaccine worked. The comments were widely interpreted as suggesting trials could be better done where ethics and regulations around medical trials were weaker.
Underpinning the response to Covid-19 are global health narratives that reflect longstanding assumed superiority of global north systems, norms and cultures. It is a reminder of how language, structures and interventions around global health remain embedded in colonialism. Certain regions and peoples are still seen as inherently dangerous to the global north: reservoirs of endemic disease or vulnerable to contagious outbreaks that could be ‘imported’ to the rich world.
The 2015 World Health Organization (WHO) guidance on the naming of newly discovered diseases or syndromes called for neutral generic names that avoided the use of geographic locations, people’s names, species of animal or food, or references to culture, populations, industries, and occupations The WHO highlighted the ways in which particular ethnic groups, members of religious groups or even entire national populations, could face backlashes during health panics. In continued (and deliberate) references to the ‘Chinese disease’, President Trump and his administration have been ignoring these guidelines, and engaging in damaging narratives about disease, race and place.
‘Decolonisation’ has taken root in many university social science and humanities departments in recent years (in rhetoric if not always in practice). Decolonisation calls for attention to be paid to how knowledge is constructed, how it can stigmatise and marginalise those outside the main sites of knowledge production, and how alternative (and critical) voices can be silenced through neglect.
Western biomedicine is as much a social construct as economics, politics and history. How people think of health and sickness, the assumed geographic distribution of particular health risks and even understandings of human bodies, are shaped and limited by social narratives. ‘Tropical medicine’, the term that emerged in the late 19th century to describe the types of disease environment that existed across the global south, was a product of European empires and imperial imagination. It helped create and underpin the view of these regions as ones where inhabitants still led Hobbesian poor, nasty, brutish and short lives. It justified colonial occupation and rule: the spreading of the benefits of western biomedicine was a key defence of imperial oppression, even as colonial occupation was associated with the spread of new human and animal diseases that killed in vast numbers.
Decolonisation of global health matters because the continuation of colonial models still shapes interventions. It has contributed to the ‘verticalisation’ of health systems as donors support specific diseases rather than general health, leaving regions such as sub-Saharan Africa highly vulnerable to Covid-19 as well as a huge number of other health risks. It creates different standards for achieving the human right to health: what is deemed ‘unacceptable’ in the global north is presented as ‘inevitable’ in the global south; and this allows for arguments to be made that ethics and safety have less priority in such areas in medical trials.
The global north, too, is underprepared for epidemics it thinks ‘belong’ to the global south. In the early phases of the Covid-19 epidemic in China, its spread was ascribed to poor regulatory systems, limited capacity for disease control and the limitations of the Chinese state and culture. It was a narrative that left Europe and North America complacent in their own abilities to limit the spread, and one that spectacularly failed to explain why parts of Europe were harder hit than China, despite more advance notice of the impending pandemic.
This idea that presents health crises in the global north as individual failures, whilst those in China are seen as systemic and inherent, also leads to failures to address underlying problems, putting us all at risk. The widespread contamination of prepared foods in the UK with horsemeat in 2013 was portrayed as a technical failure, and blamed on ‘foreign’ meat processors and suppliers, rather than as the inevitable result of weak regulation and cost-cutting. The thalidomide scandal was presented as one of negligence, a mistake, rather than symptomatic of capitalist modes of pharmaceutical production.
Decolonising health requires more than just thinking about the structures and systems of global health and the ways that colonialism is institutionalised within them. It also requires us to think about the language of global health. Sticks and stones do indeed hurt, but so too can names and labels cause actual harm: to individuals, to whole societies, and ultimately to the idea of global health itself.