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1.
Soc Sci Med ; 351 Suppl 1: 116291, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38825383

ABSTRACT

The purpose of this article is to delineate the nature of the colonial mindset, which perpetuates gendered settler colonial structures of historical oppression in research and practice. By connecting a critical consciousness and living in alignment with agility (AWA), this work explicates pathways from gendered complicity to embodying praxis-or becoming gender AWAke. This article begins by describing the nature of the colonial mindset. Second, I critically examine the dominant discourse institutionalized by Western psychology. Third, I introduce the FHORT and critically analyze how the colonial mindset has affected and driven violence against Indigenous women. Examining how settler colonial structural sexism in its heteropatriarchal and heteropaternalistic forms has become imposed upon the lives of Indigenous women and gender-expansive peoples exposes subjugated knowledges; it provides an empirical scaffolding for people to become critically conscious of dominant gender norms that apply to people, institutions, and society more broadly. Finally, I propose living AWAke for personal and collective liberation.


Subject(s)
Colonialism , Humans , Sexism/psychology , Female , Gender Identity , Indigenous Peoples/psychology , Consciousness
2.
Hastings Cent Rep ; 54(3): 59, 2024 May.
Article in English | MEDLINE | ID: mdl-38842909

ABSTRACT

This letter responds to the essay "Digital Humans to Combat Loneliness and Social Isolation: Ethics Concerns and Policy Recommendation," by Nancy S. Jecker, Robert Sparrow, Zohar Lederman, and Anita Ho, in the January-February 2024 issue of the Hastings Center Report.


Subject(s)
Loneliness , Humans , Africa , Social Isolation , Colonialism , Digital Technology
3.
Health Aff (Millwood) ; 43(6): 813-821, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38830161

ABSTRACT

Public health surveillance and data systems in the US remain an unnamed facet of structural racism. What gets measured, which data get collected and analyzed, and how and by whom are not matters of happenstance. Rather, surveillance and data systems are productions and reproductions of political priority, epistemic privilege, and racialized state power. This has consequences for how communities of color are represented or misrepresented, viewed, and valued and for what is prioritized and viewed as legitimate cause for action. Surveillance and data systems accordingly must be understood as both an instrument of structural racism and an opportunity to dismantle it. Here, we outline a critique of standard surveillance systems and practice, drawing from the social epidemiology, critical theory, and decolonial theory literatures to illuminate matters of power germane to epistemic and procedural justice in the surveillance of communities of color. We then summarize how community partners, academics, and state health department data scientists collaborated to reimagine survey practices in Oregon, engaging public health critical race praxis and decolonial theory to reorient toward antiracist surveillance systems. We close with a brief discussion of implications for practice and areas for continued consideration and reflection.


Subject(s)
Public Health Surveillance , Humans , Oregon , Public Health Surveillance/methods , Racism , Public Health , Colonialism , Health Equity
4.
J Hist Ideas ; 85(2): 289-320, 2024.
Article in English | MEDLINE | ID: mdl-38708650

ABSTRACT

This article explores the uses of utopian rhetoric of food plenty in Italian colonial visions before the First World War. It examines the travel writings of three leading Italian journalists, Enrico Corradini, Arnaldo Fraccaroli, and Giuseppe Bevione, who visited the Ottoman provinces of Tripolitania and Cyrenaica and campaigned for their colonization by Liberal Italy. By reconstructing their utopian rhetoric of food plenty, this article seeks to show the relevance of arguments about food and agriculture produce to early twentieth century colonial visions, shedding light on an aspect of Italian political thought that has been hitherto marginalized in existing historical scholarship.


Subject(s)
Colonialism , Italy , History, 20th Century , Colonialism/history , Utopias/history , Agriculture/history , Food Supply/history , Ottoman Empire
5.
Technol Cult ; 65(2): 531-554, 2024.
Article in English | MEDLINE | ID: mdl-38766960

ABSTRACT

At the turn of the twentieth century, Russian imperial officials hoped to transform the Kazakh Steppe from a zone of pastoral nomadism into a zone of sedentary grain farms. They planned to accomplish this transformation by importing peasants from European Russia and settling them in the steppe along with advanced scientific agricultural practices, equipment, and infrastructure. It was a project that linked steppe settlement and the Russian Empire to a global story of settler colonialism, science, and technology in the first decades of the twentieth century. An examination of this project through the lens of the expansion of grain farming reveals that the changes it wrought were not solely due to European science and technology but were contingent, dependent on local knowledge, the vagaries of climate, and adaptation to the realities of the steppe environment.


Subject(s)
Agriculture , History, 20th Century , Agriculture/history , Russia , Colonialism/history , Grassland , Kazakhstan , Humans
7.
Uisahak ; 33(1): 191-229, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38768994

ABSTRACT

This paper examines the supply and utilization of traditional Chinese medicine (TCM) in Hong Kong during the influenza epidemics of the 1950s and 1960s. Existing narratives of TCM in Hong Kong have predominantly framed with within the dichotomy of Western medicine "Xiyi" and Chinese medicine "Zhongyi," portraying TCM as marginalized and nearly wiped out by colonial power. Departing from this binary opposition, this study views TCM as an autonomous space that had never been subjugated by the colonial power which opted for minimal interventionist approach toward TCM. By adopting diachronic and synchronic perspectives on Hong Kong's unique environment shaped by its colonial history and the geopolitics of the Cold War in East Asia, particularly its relationships with "China," this research seeks to reassess the role and status of TCM in post-World War II Hong Kong. In Hong Kong, along with other countries in East Asia, traditional medicine has ceded its position as mainstream medicine to Western medicine. Faced with the crisis of "extinction," Chinese medical professionals, including medical practitioners and merchant groups, persistently sought solidarity and "self-renewal." In the 1950s and 1960s, the colonial authorities heavily relied on private entities, including charity hospitals and clinics; furthermore, there was a lack of provision of public healthcare and official prevention measures against the epidemic influenza. As such, it is not surprising that the Chinese utilized TCM, along with Western medicine, to contain the epidemics which brought about an explosive surge in the number of patients from novel influenza viruses. TCM was significantly consumed during these explosive outbreaks of influenza in 1957 and 1968. In making this argument, this paper firstly provides an overview of the associations of Chinese medical practitioners and merchants who were crucial to the development of TCM in Hong Kong. Secondly, it analyzes one level of active provision and consumption of Chinese medicine during the two flu epidemics, focusing on the medical practices of TCM practitioners in the 1957 epidemic. While recognizing the etiologic agent or agents of the disease as influenza viruses, the group of Chinese medical practitioners of the Chinese Medical Society in Hong Kong adopted the basic principles of traditional medicine regarding influenza, such as Shanghanlun and Wenbingxue, to distinguish the disease status among patients and prescribe medicine according to correct diagnoses, which were effective. Thirdly, this paper examines the level of folk culture among the people, who utilized famous prescriptions of Chinese herbal medicine and alimentotherapy, in addition to Chinese patent medicines imported from mainland China. In the context of regional commercial network, this section also demonstrates how Hong Kong served as a sole exporting port of medicinal materials (e.g., Chinese herbs) and Chinese patent medicines from the People's Republic of China to capitalist markets, including Hong Kong, under the socialist planned or controlled economy in the 1950s and 1960s. It was not only the efficacy of TCM in restoring immunity and alleviating symptoms of the human body, but also the voluntary efforts of these Chinese medical practitioners who sought to defend national medicine "Guoyi," positioning it as complementary and alternative medicine to scientific medicine. Additionally, merchants who imported and distributed Chinese medicinal materials and national "Guochan" Chinese patent medicine played a crucial role, as did the people who utilized Chinese medicine, all of which contributed to making TCM thrive in colonial Hong Kong.


Subject(s)
Epidemics , Influenza, Human , Medicine, Chinese Traditional , Medicine, Chinese Traditional/history , History, 20th Century , Influenza, Human/history , Influenza, Human/epidemiology , Hong Kong/epidemiology , Humans , Epidemics/history , Colonialism/history
8.
Aust Occup Ther J ; 71(3): 379-391, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38720120

ABSTRACT

BACKGROUND: Including Aboriginal and Torres Strait Islander people and communities through consultation has been a key feature of policy implementation throughout the Australian Government's "Closing the Gap" (CTG) strategy. However, consultation often reinforces power imbalances between government and local community and can undervalue or marginalise Indigenous knowledge and leadership. Occupational therapy has a short history of examining colonial power structures within the profession, but there has been limited progress to decolonise consultation and practice. METHODS: Drawing on decolonising research methodology and positioned at the interface of knowledge, comparative case studies were used to understand policy implementation in two regions. In Shepparton, Victoria, CTG policy was implemented predominately through an Aboriginal Community Controlled Health Organisation, and in Southern Adelaide, South Australia, CTG policy was implemented through mainstream state government and non-government providers in the absence of a local Aboriginal-controlled organisation. Findings were examined critically to identify implications for occupational therapy. RESULTS: Our case studies showed that policy stakeholders perceived consultation to be tokenistic and partnerships were viewed differently by Aboriginal and non-Indigenous participants. Participants identified the need to move beyond a rhetoric of "working with" Aboriginal and Torres Strait Islander people, to promote Aboriginal leadership and really listen to community so that policy can respond to local need. The findings of this research show that Aboriginal-controlled services are best positioned to conduct and respond to community consultation. CONCLUSION: A decolonising approach to consultation would shift the status quo in policy implementation in ways that realign power away from colonial structures towards collaboration with Indigenous leadership and the promotion of Aboriginal-controlled services. There are lessons for occupational therapy from this research on policy implementation on authentic, decolonised consultation as a key feature of policy implementation. Shifting power imbalances through prioritising Indigenous leadership and honouring what is shared can drive change in CTG policy implementation processes and outcomes.


Subject(s)
Health Services, Indigenous , Native Hawaiian or Other Pacific Islander , Occupational Therapy , Humans , Occupational Therapy/organization & administration , Health Services, Indigenous/organization & administration , Health Policy , South Australia , Leadership , Victoria , Cultural Competency , Referral and Consultation/organization & administration , Colonialism
9.
Can Rev Sociol ; 61(2): 153-171, 2024 May.
Article in English | MEDLINE | ID: mdl-38575385

ABSTRACT

Indigenous communities in Canada continue to feel the ongoing impacts of colonialism, including socio-economic disadvantage, high rates of violent victimization, systemic racism and discrimination, overrepresentation in the criminal justice system, and intergenerational trauma. Based on in-depth interviews with 10 gang-involved Indigenous young adults, using attachment theory as a guiding framework, we explore how colonialism continues to negatively impact the attachment these young people have to their families, communities, and social institutions, and leads to their gang involvement which perpetuates violence and trauma. Yet, they exhibit hope for a better future. Drawing on participant experiences we suggest key points at which provision of supports and resources can assist with increasing attachments and facilitating gang desistance. We share these insights while acknowledging the continued structural, embedded violence many Indigenous youth experience today that necessitates a commitment to decolonization at all levels of Canadian society.


Les communautés autochtones du Canada continuent de ressentir les effets persistants du colonialisme, notamment les désavantages socio­économiques, les taux élevés de victimisation violente, le racisme et la discrimination systémiques, la surreprésentation dans le système de justice pénale et les traumatismes intergénérationnels. À partir d'entretiens approfondis avec dix jeunes adultes autochtones impliqués dans des gangs, et en utilisant la théorie de l'attachement comme cadre d'orientation, nous explorons comment le colonialisme continue d'avoir un impact négatif sur l'attachement de ces jeunes à leurs familles, à leurs communautés et aux institutions sociales, et conduit à leurs implication dans des gangs qui perpétuent la violence et les traumatismes. Pourtant, ils gardent l'espoir d'un avenir meilleur. En nous appuyant sur les expériences des participants, nous suggérons des points clés où l'apport de soutien et de ressources peut contribuer à renforcer l'attachement et à faciliter la désistance des gangs. Nous partageons ces idées tout en reconnaissant la persistance de la violence structurelle et enracinée que subissent aujourd'hui de nombreux jeunes autochtones et qui nécessite un engagement en faveur de la décolonisation à tous les niveaux de la société canadienne.


Subject(s)
Colonialism , Humans , Canada , Young Adult , Male , Female , Violence/psychology , Violence/statistics & numerical data , Object Attachment , Adolescent , Hope , Peer Group , Adult
10.
Med Anthropol Q ; 38(2): 224-239, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38642372

ABSTRACT

Puerto Rico (PR) is facing an unprecedented healthcare crisis due to accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing healthcare and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, our study analyzes the effects of spatial stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on 50 semi-structured interviews with physicians throughout PR and the US, we identified how stigmatizing meanings are attached to PR, its people, and its biomedical system, often incorporating colonial notions of the island's presumed backwardness, lagging medical technology, and lack of cutting-edge career opportunities. We conclude that in addition to economically motivated policies, efforts to curb physician migration should also address globally circulating ideas about PR, acknowledge their roots in coloniality, and valorize local responses to the crisis that are in danger of being lost to history.


Subject(s)
Anthropology, Medical , Colonialism , Emigration and Immigration , Physicians , Social Stigma , Puerto Rico/ethnology , Humans , Physicians/psychology , Female , Male , Adult , United States , Middle Aged
11.
Technol Cult ; 65(1): 63-87, 2024.
Article in English | MEDLINE | ID: mdl-38661794

ABSTRACT

This article questions the economic rationale of colonial experimentation and prison labor, arguing that for many administrators a prison-based experiment's success mattered less than its existence. It examines the position of convict labor and penal discipline within colonial industrial experiments in colonial India, where convicts performed experiments for what one administrator described as "the most penal" form of labor, papermaking. The belief that Indian fibers could open a new export market for global papermaking meant that prisons became prominent sites of experimentation with new pulps. Regional prisons gained state monopolies for handmade paper, often decimating local independent producers. Yet prison and industrial officers counterintuitively positioned the frequent failures of papermaking experiments as a continuing potential source for industrial improvement. They argued that the failures demonstrated the need to improve discipline and supervision. Prison experiments slotted convicts into repetitive, mechanized roles that served European investigations into the utility of Indian products.


Subject(s)
Colonialism , India , Colonialism/history , History, 20th Century , Prisons/history , Paper/history , History, 21st Century , Industry/history , Humans
12.
Lancet ; 403(10433): 1304-1308, 2024 Mar 30.
Article in English | MEDLINE | ID: mdl-38555135

ABSTRACT

The historical and contemporary alignment of medical and health journals with colonial practices needs elucidation. Colonialism, which sought to exploit colonised people and places, was justified by the prejudice that colonised people's ways of knowing and being are inferior to those of the colonisers. Institutions for knowledge production and dissemination, including academic journals, were therefore central to sustaining colonialism and its legacies today. This invited Viewpoint focuses on The Lancet, following its 200th anniversary, and is especially important given the extent of The Lancet's global influence. We illuminate links between The Lancet and colonialism, with examples from the past and present, showing how the journal legitimised and continues to promote specific types of knowers, knowledge, perspectives, and interpretations in health and medicine. The Lancet's role in colonialism is not unique; other institutions and publications across the British empire cooperated with empire-building through colonisation. We therefore propose investigations and raise questions to encourage broader contestation on the practices, audience, positionality, and ownership of journals claiming leadership in global knowledge production.


Subject(s)
Colonialism , Prejudice , Humans , Colonialism/history , Leadership , Knowledge
13.
Int J Drug Policy ; 126: 104368, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38452423

ABSTRACT

There have been several recent commentaries which have highlighted the relevance of the postcolonial perspective to drug prohibition and called for the decolonisation of drug policy (Daniels et al., 2021; Hillier, Winkler & Lavallée, 2020; Lasco, 2022; Mills, 2019). While these are significant interventions in the field, sparse drugs scholarship has engaged more directly with well-developed literature and concepts from Critical Indigenous Studies (Moreton-Robinson, 2016) and Indigenous Standpoint Theory (Moreton-Robinson, 2013; Nakata, 2007) and reflected on its applicability to the drug and alcohol field. In contrast to the postcolonial perspective, which understands colonisation as a historical event with contemporary impacts, Indigenous scholarship conceptualises colonisation as an active and ongoing part of how the settler-state continues to impose itself. From this vantage point I explore coloniality as a system of power and reflect on the way prohibition acts as a key arm of the settler-colonial state. The paper explores the way concepts like vulnerability, marginality, overrepresentation, disproportionality and addiction involve colonial violence, knowledge practices and narratives which are central to the way coloniality is maintained and continues to assert itself in contemporary settler societies.


Subject(s)
Colonialism , Substance-Related Disorders , Humans , Drug and Narcotic Control/legislation & jurisprudence , Indigenous Peoples
14.
Aust N Z J Public Health ; 48(2): 100132, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38422582

ABSTRACT

OBJECTIVE: This research sought to expand on a set of core Maori hauora a-iwi/public health competencies initially designed for teaching and to enable their use in workplaces. METHODS: The research used a kaupapa Maori methodology in four stages including the development of draft levels of competence for all core competencies, consultation hui (meetings), analysis of feedback and redrafting, and respondent validation. RESULTS: Key themes elicited in relation to the content of the competencies included increasing language expectations, the importance of strength-based approaches and self-determination, and the need for individual responsibility to address structural racism. Reflective practice was identified as a fundamental cross-cutting competency. Participants suggested planetary health and political ideologies be included as additional socio-political determinants of health with equity impacts. Key concerns related to the application of the competency document included the need for cultural safety and ensuring that all public health practitioners are 'seen'. CONCLUSIONS: The Maori hauora a-iwi/public health competencies have been published under a Creative Commons licence. IMPLICATIONS FOR PUBLIC HEALTH: The process of drafting a set of Maori public health competencies elicited key themes potentially relevant for public health practice in other countries and resulted in a competency document for use by universities and workplaces.


Subject(s)
Cultural Competency , Native Hawaiian or Other Pacific Islander , Public Health , Racism , Humans , Racism/prevention & control , New Zealand , Professional Competence , Colonialism , Antiracism , Maori People
15.
Am J Community Psychol ; 73(1-2): 7-16, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38415777

ABSTRACT

In this special issue, we invited contributions that critically examined issues of imperialism, colonialism, power, justice, etc. to expand the canon of anticolonial scholarship and critical scholarship in community psychology. Our two objectives were: (1) to build on the canon of anticolonial and critical race scholarship to cultivate an empirical and theoretical body of work and conceptual frameworks about racism and colonialism within the field of community psychology and (2) to unpack the different manifestations of racism in society from the lens of community psychology and reflect on the implications of these varied forms of injustice in the contemporary moment. Rooted in African epistemology and methodology (Martin, 2012), we find the concept of the algorithm to serve as a potent metaphor for the ways in which these oppressive structures operate given the prevalence of algorithms in our daily lives and the algorithm is symbolic of the information age and predictive powers that seem to govern society beyond conscious control. In this sense, imperial algorithms are these structures, patterns, processes, and procedures that perpetuate imperialism. These imperial algorithms manifest as neo-colonialism, surveillance, social engineering, carcerality, reality warping of contemporary racism, health disparities exacerbated by COVID-19, and environmental grids of oppression.


Subject(s)
Racism , Humans , Racism/psychology , Colonialism
16.
World Neurosurg ; 185: 314-319, 2024 May.
Article in English | MEDLINE | ID: mdl-38403018

ABSTRACT

Since the first African country attained independence from colonial rule, surgical training on the continent has evolved along 3 principal models. The first is a colonial, local master-apprentice model, the second is a purely local training model, and the third is a collegiate intercountry model. The 3 models exist currently and there are varied perceptions of their relative merits in training competent neurosurgeons. We reviewed the historical development of training and in an accompanying study, seek to describe the complex array of surgical training pathways and explore the neocolonial underpinnings of how these various models of training impact today the development of surgical capacity in Africa. In addition, we sought to better understand how some training systems may contribute to the widely recognized "brain drain" of surgeons from the African continent to high income countries in Europe and North America. To date, there are no published studies evaluating the impact of surgical training systems on skilled workforce emigration out of Africa. This review aims to discover potentially addressable sources of improving healthcare and training equity in this region.


Subject(s)
Colonialism , Neurosurgery , Africa , Humans , Neurosurgery/education , History, 20th Century , Neurosurgeons/education , Emigration and Immigration/trends , History, 21st Century
17.
Bull World Health Organ ; 102(2): 130-136, 2024 Feb 01.
Article in English | MEDLINE | ID: mdl-38313156

ABSTRACT

Colonialism, which involves the systemic domination of lands, markets, peoples, assets, cultures or political institutions to exploit, misappropriate and extract wealth and resources, affects health in many ways. In recent years, interest has grown in the decolonization of global health with a focus on correcting power imbalances between high-income and low-income countries and on challenging ideas and values of some wealthy countries that shape the practice of global health. We argue that decolonization of global health must also address the relationship between global health actors and contemporary forms of colonialism, in particular the current forms of corporate and financialized colonialism that operate through globalized systems of wealth extraction and profiteering. We present a three-part agenda for action that can be taken to decolonize global health. The first part relates to the power asymmetries that exist between global health actors from high-income and historically privileged countries and their counterparts in low-income and marginalized settings. The second part concerns the colonization of the structures and systems of global health governance itself. The third part addresses how colonialism occurs through the global health system. Addressing all forms of colonialism calls for a political and economic anticolonialism as well as social decolonization aimed at ensuring greater national, racial, cultural and knowledge diversity within the structures of global health.


Le colonialisme, qui implique la domination systémique de terres, de marchés, de peuples, de ressources, de cultures ou d'institutions politiques dans le but d'exploiter, de détourner et d'extraire des richesses et des ressources, affecte la santé de nombreuses manières. Ces dernières années, la décolonisation de la santé mondiale a suscité un intérêt croissant, l'accent étant mis sur la correction des déséquilibres de pouvoir entre les pays à revenu élevé et les pays à faible revenu, ainsi que sur la remise en question des idées et des valeurs de certains pays riches qui façonnent la pratique de la santé mondiale. Nous soutenons que la décolonisation de la santé mondiale doit également aborder la relation entre les acteurs de la santé mondiale et les formes contemporaines de colonialisme, en particulier les formes actuelles de colonialisme d'entreprise et de colonialisme financiarisé qui opèrent par des systèmes mondialisés d'extraction de richesses et de profits. Nous présentons un programme d'action en trois parties destiné à décoloniser la santé mondiale. La première partie porte sur les asymétries de pouvoir existant entre les acteurs de la santé mondiale des pays à hauts revenus et historiquement privilégiés et leurs homologues des pays à faibles revenus et marginalisés. La deuxième partie concerne la colonisation des structures et des systèmes de la gouvernance mondiale de la santé elle-même. La troisième partie traite de la manière dont le colonialisme se manifeste à travers le système de santé mondial. La lutte contre toutes les formes de colonialisme nécessite un anticolonialisme politique et économique ainsi qu'une décolonisation sociale visant à garantir une plus grande diversité nationale, raciale, culturelle et des connaissances au sein des structures de la santé mondiale.


El colonialismo, que implica la dominación sistémica de tierras, mercados, pueblos, bienes, culturas o instituciones políticas para explotar, apropiarse indebidamente y extraer riqueza y recursos, afecta a la salud de muchas maneras. En los últimos años ha crecido el interés por descolonizar la salud mundial, en particular para corregir los desequilibrios de poder entre los países de ingresos altos y los de ingresos bajos, y para cuestionar las ideas y los valores de algunos países ricos que influyen en la práctica de la salud mundial. Sostenemos que la descolonización de la salud mundial también debe abordar la relación entre los actores de la salud mundial y las formas contemporáneas de colonialismo, en especial las formas actuales de colonialismo corporativo y financiarizado que operan a través de sistemas globalizados de extracción de riqueza y especulación. Presentamos un programa de acción dividido en tres partes para descolonizar la salud mundial. La primera parte se refiere a las asimetrías de poder que existen entre los actores de la salud mundial procedentes de países de ingresos altos e históricamente privilegiados y sus homólogos de entornos de ingresos bajos y marginados. La segunda parte se refiere a la colonización de las estructuras y sistemas de la propia gobernanza de la salud mundial. La tercera parte aborda cómo se produce el colonialismo a través del sistema sanitario mundial. Abordar todas las formas de colonialismo exige un anticolonialismo político y económico, así como una descolonización social destinada a garantizar una mayor diversidad nacional, racial, cultural y de conocimientos dentro de las estructuras de la salud mundial.


Subject(s)
Colonialism , Global Health , Humans , Income , Poverty , Organizations
18.
BMJ Glob Health ; 9(2)2024 02 27.
Article in English | MEDLINE | ID: mdl-38413105

ABSTRACT

The advancement of digital technologies has stimulated immense excitement about the possibilities of transforming healthcare, especially in resource-constrained contexts. For many, this rapid growth presents a 'digital health revolution'. While this is true, there are also dangers that the proliferation of digital health in the global south reinforces existing colonialities. Underpinned by the rhetoric of modernity, rationality and progress, many countries in the global south are pushing for digital health transformation in ways that ignore robust regulation, increase commercialisation and disregard local contexts, which risks heightened inequalities. We propose a decolonial agenda for digital health which shifts the liner and simplistic understanding of digital innovation as the magic wand for health justice. In our proposed approach, we argue for both conceptual and empirical reimagination of digital health agendas in ways that centre indigenous and intersectional theories. This enables the prioritisation of local contexts and foregrounds digital health regulatory infrastructures as a possible site of both struggle and resistance. Our decolonial digital health agenda critically reflects on who is benefitting from digital health systems, centres communities and those with lived experiences and finally introduces robust regulation to counter the social harms of digitisation.


Subject(s)
Colonialism , Digital Health , Humans , Delivery of Health Care
20.
World Neurosurg ; 185: e299-e303, 2024 May.
Article in English | MEDLINE | ID: mdl-38244680

ABSTRACT

BACKGROUND: As a result of gradual independence from colonial rule over the course of the past century, Africa has developed and evolved 3 primary surgical training structures: an extracontinental colonial model, an intracontinental college-based model, and several smaller national or local models. There is consistent evidence of international brain drain of surgical trainees and an unequal continental distribution of surgeons; however there has not, to date, been an evaluation of the impact colonialism on the evolution of surgical training on the continent. This study aims to identify the etiologies and consequences of this segmentation of surgical training in Africa. METHODS: This is a cross-sectional survey of the experience and perspectives of surgical training by current African trainees and graduates. RESULTS: A surgeon's region of residence was found to have a statistically significant positive association with that of a surgeon's training structure (P <0.001). A surgeon's professional college or structure of residency has a significantly positive association with desire to complete subspecialty training (P = 0.008). College and structure of residency also are statistically significantly associated with successful completion of subspecialty training (P < 0.001). CONCLUSIONS: These findings provide evidence to support the concept that the segmentation of surgical training structures in Africa, which is the direct result of prior colonization, has affected the distribution of trainees and specialists across the continent and the globe. This maldistribution of African surgical trainees directly impacts patient care, as the surgeon-patient ratios in many African countries are insufficient. These inequities should be acknowledged addressed and rectified to ensure that patients in Africa receive timely and appropriate surgical care.


Subject(s)
Colonialism , Internship and Residency , Humans , Africa , Cross-Sectional Studies , Surveys and Questionnaires , Surgeons/education , Neurosurgery/education
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