Decolonising public health: from critique to practice in knowledge production and health systems strengthening
1
Medicine, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A708
ABSTRACT
BACKGROUND:
Global public health knowledge production operates through centre-periphery power dynamics that privilege high-income country institutions while marginalising local and indigenous knowledge.¹,² These asymmetries, manifesting as credibility deficits, interpretive marginalisation, and epistemic injustice, limit the relevance, equity, and sustainability of public health interventions in low- and middle-income countries.¹,³
METHODS:
This conceptual and practice-informed analysis draws on published literature, policy discourse, and professional experience in health systems strengthening. Key themes were identified through critical reflection on knowledge generation, guideline development, and implementation processes, examining power relations, authorship norms, partnership models, and local ownership within public health practice.³,⁴
RESULTS:
Persistent asymmetries are sustained by donor-driven funding models, academic incentive structures that reward northern authorship, and weak governance of partnership standards.¹,⁵ Knowledge extractivism and the erasure of local epistemologies undermine the legitimacy and uptake of public health interventions.²,⁴ Evidence indicates that co-production approaches, including shared leadership, participatory governance, community research advisory groups, and digital collaboration platforms, can redistribute authority and enhance contextual relevance.⁶,⁷ Structural reforms targeting funding criteria, academic metrics, and accountability mechanisms are necessary to support sustained equitable practice.⁵,⁸
CONCLUSIONS:
Decolonising public health requires moving beyond critique toward practical transformation in how knowledge is produced, valued, and applied. Embedding principles of epistemic plurality, reciprocity, and local co-leadership within health systems strengthening efforts supports more equitable, contextually relevant, and sustainable public health action. Operationalising decolonial commitments demands reflexive tools, reformed governance frameworks, and accountability to affected communities.⁴,⁸
Global public health knowledge production operates through centre-periphery power dynamics that privilege high-income country institutions while marginalising local and indigenous knowledge.¹,² These asymmetries, manifesting as credibility deficits, interpretive marginalisation, and epistemic injustice, limit the relevance, equity, and sustainability of public health interventions in low- and middle-income countries.¹,³
METHODS:
This conceptual and practice-informed analysis draws on published literature, policy discourse, and professional experience in health systems strengthening. Key themes were identified through critical reflection on knowledge generation, guideline development, and implementation processes, examining power relations, authorship norms, partnership models, and local ownership within public health practice.³,⁴
RESULTS:
Persistent asymmetries are sustained by donor-driven funding models, academic incentive structures that reward northern authorship, and weak governance of partnership standards.¹,⁵ Knowledge extractivism and the erasure of local epistemologies undermine the legitimacy and uptake of public health interventions.²,⁴ Evidence indicates that co-production approaches, including shared leadership, participatory governance, community research advisory groups, and digital collaboration platforms, can redistribute authority and enhance contextual relevance.⁶,⁷ Structural reforms targeting funding criteria, academic metrics, and accountability mechanisms are necessary to support sustained equitable practice.⁵,⁸
CONCLUSIONS:
Decolonising public health requires moving beyond critique toward practical transformation in how knowledge is produced, valued, and applied. Embedding principles of epistemic plurality, reciprocity, and local co-leadership within health systems strengthening efforts supports more equitable, contextually relevant, and sustainable public health action. Operationalising decolonial commitments demands reflexive tools, reformed governance frameworks, and accountability to affected communities.⁴,⁸
| eISSN: | 2654-1459 |
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