Decolonising Global Health: It’s Only ‘Global’ When It’s the ‘Global South’?

By Maisie Jeffreys

I’ve been thinking a lot about global health lately – not the glossy version presented in strategy decks or policy briefs, but the lived version: the relationships, the power, the knowledge production, the politics of who gets to ask the questions and who is expected to answer them.

And the more I look at it, the more one thing becomes impossible to ignore:

‘Global health’ seems only global when it applies to the ‘Global South’ (i.e. – the global majority).

When health systems in the UK or Europe falter, it’s called a crisis. A reform issue. A political debate. When health systems in the Global South falter, it’s called global health.

It’s a tiny linguistic shift with huge implications — because it reveals what the system really values, and who it really centres.

This framing may seem harmless, but it quietly reshapes the world in ways we rarely interrogate.

It homogenises entire regions.

By grouping vastly different contexts into one conceptual bucket (‘global health’), the field erases nuance, history, politics, and diversity.
It becomes easy to talk about strengthening health systems in LMICs as if:

• Lagos and rural Nepal face the same politics
• Haiti and India share the same colonial histories
• The Pacific Islands and Afghanistan have comparable health infrastructure
• The ‘Global South’ is a single organism rather than a mosaic of cultures, economic systems, and lived realities

This flattening of complexity is convenient for donors and institutions that want scalable solutions. But it is fundamentally dehumanising.

It subtly positions the West as the unnamed norm.

If global health is what happens ‘over there’, then the West becomes the invisible baseline – the place where health is assumed to be advanced, rational, evidence-based, modern.

And if global health = the ‘Global South’, the reverse also becomes implied:

Global = poor
Global = unstable
Global = diseased
Global = needing intervention

The West becomes the comparator, the judge, the architect of solutions.
Everyone else becomes the subject.

It obscures Western crises.

If ‘global health’ applies only to the Global South, then Western failures remain insulated from global scrutiny – as if antimicrobial resistance, mental health collapse, health worker burnout, racism in care systems, and political erosion of access aren’t part of global health too.

Why isn’t the opioid crisis framed as a global health emergency?
Why isn’t the privatisation of NHS services a global health concern?
Why isn’t vaccine hesitancy in Europe analysed through the same lens used in West Africa?

Because the system isn’t actually global.
It’s directional.

It reinforces colonial patterns of knowledge.

When global health = ‘them’, and health research agendas = ‘us studying them’, the power to define problems remains with institutions in the UK, EU, and US.

It becomes normal – expected even – that:

• Research priorities are set in London and Washington
• Ethical frameworks are exported rather than co-created
• Western methodologies are treated as universal
• Global South knowledge is ‘local insight’, not global evidence

A linguistic choice becomes a political tool- one that maintains who produces knowledge and who is required to justify their reality to the system. It allows harmful stereotypes to hide in plain sight.

When the Global South is constructed as the perpetual site of crisis, fragility, and intervention, it becomes easier to justify:

• Directing funds rather than shifting power
• Prescribing solutions rather than co-creating them
• Measuring deficits rather than strengths
• Focusing on technical fixes rather than political root causes

The language of ‘global health’ doesn’t describe the world – it performs a worldview.

One where the majority of humanity is framed as a problem space, and the minority holds the tools, logic, and legitimacy to intervene.

This isn’t a coincidence. It’s a design.

Localisation: A System, not a Slogan

Localisation in the humanitarian sector promised to shift power – resources, leadership, agenda-setting, decision-making, agency – closer to affected communities. But somewhere along the way, it became a checklist item. A reporting category. A feel-good banner at conferences.

Real localisation for global health and health research asks hard questions:

• Who owns the data?
• Who sets the priorities?
• Who decides what ‘good research’ and ‘good health’ looks like?
• Who is accountable to whom?
• Who benefits from the research and health interventions?
• Who controls the funding?
• Who gets authorship and recognition?
• Who holds the power to approve or veto decisions?
• What does collaboration look like when those closest to the problem are closest to the insight?

If we are serious about decolonising global health, localisation cannot just live in programme design. It must live in:

• Research governance
• Funding flows
• Evidence hierarchies
• Ethical frameworks
• Partnership contracts
• Knowledge dissemination

Otherwise, we get partnerships that look equitable on paper but maintain structural inequality under the surface – ‘collaborations’ where one side has all the flexibility and the other has all the compliance.

Decolonising Global Health Means Rewriting What We Think Knowledge Is

One of the biggest myths in global health is that knowledge is produced in universities and consumed everywhere else. But what if the most valuable knowledge sits in communities, health workers, informal systems, and lived experience?

What if expertise doesn’t sound like English-language peer-reviewed journals, but like a grandmother in Dhaka explaining how heat shapes daily life, or a nurse in Kampala innovating around supply shortages, or a community health worker in Caracas redefining resilience?

In a truly global system, these voices wouldn’t be ‘contextual insights’.
They would be the foundation of the evidence base.

So where do we go from here?

I think it starts with humility – real humility, not the performative kind that appears in project proposals.

It starts with organisations willing to ask:

• What knowledge have we overlooked because we weren’t trained to see it?
• What methodologies have we privileged because they were familiar, not because they were right?
• How do we build collaborative partnerships where learning flows in every direction – not just one?

Decolonising global health isn’t about fixing a system. It’s about admitting the system was never designed to be fair and building a new one with the people who have always been excluded from the table.

And maybe, if we’re brave enough, global health might finally become… well, global.