Are We Breaking or Reinforcing Colonial Legacies?

by Jon Scaccia February 28, 2025

Warning: This blog contains the words “racism” and “equity.” Please check with your federal supervisor to make sure you are protected again such dangerous ideas!

For decades, global health (GH) programs in the United States have sent medical trainees abroad, equipping them with clinical skills and cultural humility training. But there’s a glaring issue: much of this training still operates within a framework shaped by colonial legacies.

A recent study published in PLOS Global Public Health sheds light on a major gap in GH education: the lack of anti-racist and anti-colonial (ARAC) training. Researchers surveyed 148 GH programs across pediatric, family medicine, and emergency medicine specialties, with responses from 65 programs. The findings reveal a troubling reality—many programs neglect key discussions around power dynamics, white saviorism, and the history of colonialism in global health.

So, what does this mean for the future of global health? And how can we ensure that today’s trainees don’t unintentionally perpetuate the very inequities they set out to address?

Where Do Global Health Curricula Fall Short?

Despite a growing demand for GH training, many programs fail to include key ARAC topics:

• Only 45% of programs place a strong or moderate emphasis on anti-racism.
• 44% address white saviorism, a term describing well-intentioned but problematic interventions from Western actors.
• Only 36% emphasize the history of colonialism’s role in shaping modern health inequities.

This lack of ARAC content means that many trainees enter the field without fully understanding the systems of power that have long dictated global health interventions. Without this awareness, GH practitioners risk reinforcing rather than dismantling inequitable structures.

The White Savior Problem

White saviorism remains one of the most under-discussed yet prevalent issues in global health. Many GH programs continue to prioritize U.S. trainees’ experiences over the needs and leadership of local communities. The study found that while U.S. trainees often travel abroad for hands-on experience, visiting scholars from low- and middle-income countries (LMICs) face significant barriers when coming to the U.S. for training.

Consider this imbalance: for every four U.S. trainees sent abroad, only three LMIC learners are hosted in the U.S. And even when LMIC visitors do come, their experiences tend to be observational rather than clinical, offering them far less value than what U.S. trainees gain overseas.

The Faculty Diversity Gap

Another key issue uncovered in the study is the lack of faculty diversity in GH programs:

• 28% of programs had no faculty members from underrepresented racial minorities or international medical graduates.
• The voices shaping GH education are still disproportionately white and U.S.-based, limiting the perspectives that trainees are exposed to.

This matters because a more diverse faculty brings lived experiences that challenge the dominant narratives in global health. Without diverse leadership, GH programs risk reinforcing outdated, paternalistic models of care.

Beyond the Classroom: Institutional Barriers to Change

Even when GH programs recognize the need for change, they face significant barriers:

• Institutional policies often limit how LMIC partners can contribute to curriculum design and research.
• Funding structures prioritize outbound U.S. trainees over hosting LMIC scholars.
• Regulatory hurdles make it difficult for international trainees to receive meaningful clinical training in the U.S.

Addressing these barriers requires systemic change. Institutions must not only revise their curricula but also rethink policies that sustain global health inequities.

What’s Next? Steps Toward Equitable Global Health Training

If global health education is to truly promote health equity, it must integrate anti-racism and anti-colonialism at every level. Here’s how:

• Expand ARAC Curriculum: Programs should include dedicated sessions on the history of colonialism, structural racism in global health, and power dynamics in global partnerships.
• Diversify Faculty: Actively recruit and support faculty from underrepresented backgrounds to bring more diverse perspectives into GH education.
• Strengthen Bidirectional Exchanges: U.S. programs should allocate more funding to bring LMIC scholars to the U.S. and ensure they have access to meaningful learning experiences.
• Implement Partner-Led Evaluations: LMIC partners should have formal mechanisms to provide feedback on U.S. trainees and co-design global health programs.

Join the Conversation

How do we reshape global health education to center equity rather than perpetuate historical imbalances? If you’re a trainee, educator, or practitioner in global health, we want to hear from you.

• Have you noticed gaps in your own global health training? What was missing?
• What changes would you like to see in the way global health programs operate?
• How can institutions better support LMIC partners?

Drop your thoughts in the comments or share them on social media using #DecolonizeGlobalHealth. Let’s push for a future where global health is truly global—inclusive, equitable, and free from colonial legacies.

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