Global Health is Still Colonial; It’s Time to Change That.

In a world where global health policies are often dictated by the wealthiest nations, recent events have laid bare the fragility and inequity of this system. Within the last month alone, the suspension of humanitarian aid, the disruption of critical health programs, and withdrawals from international organisations and agreements have not only compromised health systems but have also jeopardised decades of progress in global health.

This is not just a shift in policy—it is a stark reminder that global health governance is fragile, deeply political, and often indifferent to the needs of the Global South. For the Caribbean and many other nations, this is no longer an inconvenient reality—it is an existential threat.

A System Built to Keep the Global South Dependent

The current global health landscape did not emerge in a vacuum. It is the product of historical processes rooted in exploitation and inequality—a direct legacy of a financial and political order that, for centuries, has prioritised the interests of former colonial powers over the well-being of their former colonies.

Guyanese historian Walter Rodney, in How Europe Underdeveloped Africa, argued that colonialism was never just about political rule—it was an economic system designed to extract resources, limit development, and entrench long-term dependency. When political independence was won, these economic structures remained largely intact, ensuring that former colonies continued to rely on wealthier nations for financing, trade, and aid.

Nowhere is this more evident than in global health financing, where:

• Debt forces health cuts: Many Caribbean and African nations spend more on debt repayments than on healthcare. IMF and World Bank loan conditions often require budget austerity, forcing governments to reduce public health spending.

• Donor-driven aid weakens local systems; Global health funding, tied to political conditions, forces governments to align their health strategies to donor agendas rather than national priorities, leading to healthcare service delivery disruptions, reduced coverage, and increased risk of disease resurgence.

• Pharmaceutical dependency entrenches inequality: Africa and the Caribbean have long relied on imported medicines and diagnostics, leaving them vulnerable to supply chain disruptions and global market forces that prioritise wealthier nations, as evidenced during the COVID-19 pandemic.

The result? Health outcomes in the Global South are dictated not by local needs and expertise but by financial decisions made in Washington, London, or Geneva.

Barbadian Prime Minister Mia Mottley, in her recent address to the African Union in Addis Ababa, put it plainly: “We must forge a future where our people are seen, heard, and felt, ensuring that we determine how we cooperate, integrate, and invest, rather than remain victims of a past history.” The international order that governs health keeps developing nations locked in cycles of dependency—borrowing, waiting, and hoping for support that is often tied to the politics of the moment.

This cycle must end.

Moving Beyond the Rhetoric

Now is the time to decolonise global health. The rise of far-right policies and growing isolationism in the Global North are not just ideological shifts—they are actively stalling disease eradication efforts and eroding public health funding. With looming elections that could further weaken global cooperation, the urgency to claim agency over our health systems has never been greater.

Decolonising global health means acknowledging that the structures shaping policies, funding, and access to care were never designed for our success. Walter Rodney argued that the economic and political systems left in place after colonial rule were not just remnants of the past—they were deliberate mechanisms to keep former colonies dependent on foreign financing, imported goods, and external approval. Mia Mottley reminds us that this dependency is not just economic—it is about power. Who controls the terms of engagement in global governance, and whose interests do they serve? For decades, those decisions have been dictated from the outside, keeping our nations trapped in cycles of waiting—waiting for loans, waiting for aid, waiting for access to medicines that should never have been out of reach.

Breaking these cycles requires more than just reform—it demands new foundations. It means rejecting financial policies that prioritise debt repayment over disease prevention and exposing the hypocrisy of Global North nations that claim to champion health equity while undermining the very systems they say they support. It means recognising that aid, when dictated by donor priorities rather than national needs, entrenches dependence rather than fostering resilience.

Most importantly, it means accelerating what is already in motion: expanding regional financing, strengthening local pharmaceutical capacity, and forging new health alliances that put people before politics. The future of public health in the Caribbean and Africa should not be determined in Washington, Geneva, or London—it must be shaped in Bridgetown, Accra, Nairobi, and Port of Spain. It must be led by those who understand their communities, their histories, and their needs.

We Can’t Continue to Wait in Vain

For too long, we have been told to be “realistic”—to accept the status quo, to work within the limits imposed on us, to wait for change on someone else’s terms. But what if we refuse to accept that?

Today, the very nations that once dictated those terms are retreating into nationalism and abandoning the global commitments they once insisted upon. If their priorities can shift overnight, why should our future be tethered to their whims?

Some may call it naive to believe we can break free from these cycles of dependency—to demand more, to build more, to govern differently. But what if naivety is exactly what we need?

As Mia Mottley declared, “Some may call this the cry of a naive and romantic daughter of Africa. But if that is the case, I prefer to die being a naive and romantic daughter of Africa than one who is cynical and daunted by the actions and power of others.”

Decolonising global health is about refusing to be daunted by the power of others. It is about refusing to wait in vain for systems that have consistently failed us and instead creating the conditions for our own resilience. It is about ensuring that the future of our health is determined—not in reaction to crises or shifting glob.