Offline: Is Global Health Neocolonialist?

Reading copies of The Lancet from the 19th century will produce uncomfortable feelings among today's readers. The journal is littered with reports of disease and injury from parts of the world under British colonial rule. Authors of these papers were not discussing the health of the colonised. They were describing ailments suffered only by the colonisers. We can be grateful it is not like that now. Global health is about realising rights, delivering justice, and ensuring equity—not for us, but for poor people living in low-income and middle-income countries. Or is it? Just a few years ago at a Lancet peer review meeting, an author opened with a striking critique of the journal's review process. “The Lancet is a colonial journal and you are colonial editors”, he said. “Your reviewers are probably white and from the west. We will ignore them. Your review process is just another example of colonial power yet again being exerted on our country.” A difficult few days followed. Colonialism isn't confined to medical journals. I was standing at the back of an elevator a few years ago. A Minister from the UK's Department for International Development (DFID) stepped in and started explaining to a colleague the way the British Government worked. “The Foreign Office sets policy”, he said. “And DFID delivers it.” Development policy is simply one way for a government to satisfy its interests overseas. Global health is a product of nations whose histories are characterised by the struggle for power, wealth, and influence. Is 21st-century global health just a polite way to decorate these repackaged colonial ambitions? This was the question posed at last week's Global Health Lab, held at the London School of Hygiene and Tropical Medicine.