GLOBAL EMERGENCY MEDICINE
Rethinking Global Health: Actions for a Decolonized Future of Global Emergency Medicine By Monalisa Muchatuta, MD, MS; Sindhya Rajeev, MD, MPH; Shama Patel, MD, MPH; Sanjukta Dutta, MBBS, PGFEM, MEM, MBA; Stephanie C. Garbern, MD, MPH, DTMH; and Catalina González Marqués, MD, MPH on behalf of SAEM’s Global Emergency Medicine Academy
SAEM PULSE | JULY-AUGUST 2021
Tropical Medicine to Colonial Medicine to Global Health Today
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There is an uncomfortable, and seldom acknowledged dark history to global health. The field has deepseated roots in colonialism and racism in which mainly European colonizing powers dominated, exploited, and controlled colonized populations across Africa, Asia, and the Americas. Colonial medicine was primarily concerned with protecting the health and economic interests of European colonists and was a critical element of colonialism and imperialism. From its origins as colonial medicine, the field of “tropical medicine’’
arose in the 19th Century. Tropical medicine focused on finding solutions to infectious diseases in tropical regions that affected the health of colonists and soldiers, and to a lesser extent, colonized people (primarily only when diseases affected their labor potential). As simply stated by Richard Smith, former editor of The BMJ, “tropical medicine was primarily concerned with keeping white men alive in the tropics.” Subsequently, tropical medicine developed into “international medicine” and thereafter into what is now called “global health,” which is still largely defined by individuals/ institutions from rich countries “giving aid” to those in poor countries. This history perpetuates underpinnings
which employ a “savior mentality” of colonists towards colonized people. Unfortunately, this history and narrative is still omnipresent in the field of global health today, including its subdivisions such as global emergency medicine (EM). This approach concentrates power, resources, and research in highincome country (HIC) institutions at the expense of low- and middle-income country (LMIC) partners, often with little or no acknowledgement of the voices, expertise, resources, and human capital provided by LMIC partners. Recent calls to “decolonize global health” seek to challenge persistent power imbalances, to undo colonial notions of supremacy, and to build true equity and bidirectional exchanges
