On the Western universal ontology of Global (Public) Health

The terms ‘global’ and ‘public’ which are underpinned by ideas of what is and what it means to be human,1 emerged from a Eurocentric imaginary of a world system and a western concept of the human. This conception of the human which can be traced as far back as Grotius’ ‘of things which belong in common to all men’,3 in defining who exactly can be considered human and under which circumstances, fails to recognise and/or erases the existence of other peoples, categorisations of humanity and geopolitical and historical realities. This has two main consequences.

First is the portrayal and framing of Eurocentric references as neutral and as the norm. These references, guaranteeing themselves through self-erasure, self-appropriation and self-referentiality, present(ed) provincial logic as universal rationality and reject(ed) and constrain(ed) other ways of being and knowledges as peculiar or inferior.1

Second and most importantly, in this Eurocentric conception of the human, humanity is hierarchised4 and separated into Man and the liminally deviant category of Other, that is, male and female racialised people who are not-humans-as not women/men.1 The (western) Man is, in so doing, represented as what is and what it means to be human. This conception of the human, which was central to the colonial venture and supported assertions of moral claims related to the concept of a civilised man, led to processes of dehumanisation which tacitly justified colonialism, imperialism and the civilising project.5

Since Global (Public) Health (International Health, Tropical Medicine and Colonial Medicine in its previous incarnations) was, ab initio, created to look after the (western) Man, and further empire expansion and the colonial project.6 It is inextricably linked to the Eurocentric conception of the human, and inevitably (re)produces processes of othering and dehumanisation. These processes of dehumanisation and othering have continued beyond the dismantling of many direct colonial administrations, because of the replacement of colonialism by coloniality7 i.e. the patterns or matrix of power, born of colonialism, which define and control the economy, culture, knowledge production, body and psyche, and authority, beyond the limits or end of colonialism.

The legacies of these processes of dehumanisation and othering are still being felt in Global (Public) Health, with significant consequences. One example is the racial bias in pain management which is linked to ideas of Black people having ‘thicker skin’ or less sensitive nerve endings than white people, and being less likely to feel pain. Another is the ‘Yellow Peril’ trope which others Chinese people and characterises them as carriers of disease. This othering, which was/is evident in the discourses of many in the West, led to hubris and complacency in Western countries, and explains their initial responses to the pandemic. Othering, and in this case, the characterisation of Africa as a disease-ridden continent, is also the reason why many are puzzled by the relatively low COVID-19 case and death rates in Africa. A third example is the dehumanising comment made by Camille Locht during the French TV debate about clinical trials to investigate the use of the BCG vaccine for COVID-19.

Towards pluriversal and decolonial ontologies in Global (Public) Health

There is emerging consensus about the need to decolonise Global Health. This is evidenced by a proliferation of seminars and conferences in recent times, including those organised by the Karolinska Institute, the School of Global Health at the University of Copenhagen, the Harvard TH Chan School of Public Health, the Decolonize Global Health Working Group at the University of Edinburgh and the Duke Decolonizing Global Health student working group at Duke University. One also sees a rise in the number of publications on the subject.8–11 In many cases, however, the focus and scope of efforts to decolonise Global Health are on the Global South and on representation (diversity and equality), practice and the (re)production of knowledge. Yet decolonisation is not ‘merely about altering the content but also very much the term on which we are having the conversation’. This requires engagement with all the issues ‘that maintain the present asymmetrical global relations’.12

Global (Public) Health, as currently conceptualised, reflects, produces and reproduces the hierarchies of humanity on which it is based. These hierarchies operate in a way that ensures that the Other cannot be potential subjects of rights and citizenship, define their own interests, self-determine, intervene in the relations of power, or participate in global society.5 They also reproduce the various dehumanising structures that infuse the historical and ‘geopolitical conditions through which diverse bodies and experiences are socially and politically produced’.13 The concept therefore reflects a global racist, heterosexist, capitalist, ableist system which is unresponsive to the realities of many peoples, and therefore serves very few (sections of the Global North).

Since the coloniality of being and the coloniality of knowledge are both central to decolonial theory and integral to the arguments that follow,14 the decolonisation of the concept of Global (Public) Health must take place at the epistemic AND ontological levels. Doing this requires addressing the lack of ontological pluralisms in the conceptualisation of humanity (that underpins the concept), redefining what is and what it means to be human and reimagining humanity in the pluriverse. This must necessarily begin with a deconstruction and dismantling of the concept of humanity as currently conceived, the uncoupling of Man from human and the unsettling of the hegemonic western universalist conception of the human which normalises and over-represents the (western bourgeois) Man.