Understanding the context of global health policies : their post-colonial legacies and impacts on health service systems

The systemic inadequacies of models of health systems propagated by the advocates of global health policies (GHPs) have fragmented health service systems, particularly in middle- and lower-income countries. GHPs are underpinned by economic interests and the need for control by the global elite, irrespective of people's health needs. The COVID-19 pandemic challenged the advocates of GHPs, leading to calls for a movement for "decolonisation" of global health. Much of this narrative on the "decolonisation" of GHPs critiques its northern knowledge base, and the power derived from it at individual, institutional and national levels. This, it argues, has led to an unequal exchange of knowledge, making it impossible to end decades of oppressive hegemony and to prevent inappropriate decision-making on GHPs. Despite these legitimate concerns, little in the literature on the decolonisation of GHPs extends beyond epistemological critiques. This article offers a radically different perspective. It is based on an understanding of the role of transnational capital in extracting wealth from the economies of low- and middle-income countries resulting in influencing and shaping public health policy and practice, including interactions between the environment and health. It mobilises historical evidence of distorted priorities underpinning GHPs and the damaging consequences for health services throughout the world.