The quest for equity in global health is underpinned by neocolonial discourses: A critical discourse analysis

Global health, as noted in the emerging decolonizing global health literature, is built on power asymmetries and inequities, is centred on individuals and organizations in the global north, and involves a north to south diffusion of ideas and resources. Despite increasing attention paid to the decolonization of global health, there is no universal understanding of what this entails, or what associated agenda(s) may be. We argue that decolonizing global health is not possible without interrogating its many power asymmetries. In this article we demonstrate one example, using a critical discourse analysis of a tremendously influential document, the final report of the World Health Organization's Commission on Social Determinants of Health, Closing the gap in a generation: Health equity through action on the social determinants of health. This report brought mainstream attention to health inequities and the broader forces that underpin them. We reasoned that a flagship report focused on equity and the social determinants of health would be sensitive to the many power inequities in global health. Our critical discourse analysis reveals normative views that presume inequity, such as Euro-American-centricity and portraying countries of the global south as behind or inferior to those of the global north and requiring support. Also, we find that many country comparisons exclude rich countries, which hides the full extent of global inequity. By drawing attention to the inequities presumed in language, we illuminate the persistence of neocolonial ideas that accept rather than contest unfairness.