Reading List: The Global Situation

This is a slightly modified version of the reading list put together by the group Decolonize Medicine of the University College of London, in which students and doctors take part. We are happy to provide it to you with their consent, because it gives an excellent, deep introduction to the situation in the anglophone countries. You’ll find the original version here and their blog here.

Contributors

Sarah Wong (sarah.wong.15@ucl.ac.uk), Tina Plowman (christina.plowman.15@ucl.ac.uk), Ife Nwibe (ife.nwibe.15@ucl.ac.uk), Hope Chow (hope.chow.15@ucl.ac.uk), Davina Puri (davina.puri.17@ucl.ac.uk) and many others who helped out in one way or another – thank you!

Introduction

While the term ‘decolonising’ has lent itself to multiple definitions across various post-colonial movements, in the context of its recent resurgence in higher education it broadly refers to (1) considering how forces of colonialism, empire and racism have shaped the world we live in today and (2) offering alternative ways of thinking about the world, particularly from the perspective of populations that have been historically oppressed and marginalised by these forces*. In response to recent events such as the murder of George Floyd in the US, global resurgence of the #BlackLivesMatter movement and the disproportionate burden of COVID-19 on ethnic minorities, the following resources have been compiled by medical students studying in the UK for anyone who is interested to learn more about how greater inclusivity, diversity and ethnic minority representation in medicine can be brought about through Decolonising the Medical Curriculum

The Decolonising the Curriculum (DtC) movement in higher education has primarily been led by the arts and humanities, with medical schools trailing behind in adopting a decolonising approach to their curricula. This inertia may in part be attributed to how colonial-era hierarchies are deeply entrenched in the infrastructure that supports the medical profession, perhaps unsurprisingly in light of the intricate relationship between medicine in the ‘West’ and colonial history. In this reading list, we have organised resources according to key themes that may be used to interrogate the structure, content and delivery of medical curricula through a decolonial lens.The resources below outline key issues such as the exploitation of ethnic minority and indigenous people groups in historical knowledge production in medicine, socially and culturally determined health inequalities, how these groups continue to be misrepresented or under-represented in medical research, discrimination against ethnic minority doctors within the medical profession, and negative attitudes against alternative health beliefs and practices. While issues of systemic racism, racial inequality and Black history feature regularly in this list, resources specific to #BLM are included in the final section and there are many amazing reading lists out there to explore. We hope this reading list will enable more of us to enter into the discussion of what needs to change and provide a starting point for reflection, learning and more effective conversations.

Decolonisation is not an event, but an ongoing process that involves everyone. We encourage participation, collaboration and welcome input and feedback on this reading list. One area we really want to work on is diversifying the types of voices represented here, beyond the Global North (and reviewing terminology around this), academic institutions and mainstream media, to make space for novel ways of learning and knowing to emerge. The list is also a work-in-progress and non-exhaustive – if you have any resources to contribute, you can do so via this form or get in touch with us directly.  For any other queries please drop us an email at decolonisingmed@outlook.com. Find us also on Facebook and Twitter to learn more about how you can get involved, wherever you’ are. 

* Bhambra, G.K., Gebrial, D. and Nişancıoğlu, K., 2018. Decolonising the University. London: Pluto Press. p.2.

Contents

  1. Navigating the topic
  2. Overview of the movement
  3. Historical awareness
  4. Intersectional determinants of health
  5. Cultural safety and clinical practice
  6. Decolonising bodies, deconstructing race
  7. Epistemic bias and medical pluralism
  8. Global health – changing the paradigm
  9. A practical guide
  10. Additional links

1. Navigating the topic

Decolonisation is a difficult topic. It can be both uncomfortable and overwhelming – in response to the violence the word connotes it is easy, even natural, for our minds to want to shut down. Reading around the subject may lead us to feel paralysed by guilt, anger or apathy, and act accordingly in ways that are defensive, combative or simply disengaged. The inertia to join the discussion about decolonising curricula may arise from multiple factors: the complexity of the debate, lack of familiarity with its semantics and identity politics that can overshadow the objectives of this movement: a more transparent, inclusive and equitable approach to education. And this must involve a confrontation of Britain’s colonial past and how its legacy continues to create inequities and injustices in the world we live in today.

Figure 1. Countries of the global North (coloured blue) and global South (coloured red) (Source: Wikimedia Commons).

The goals of the decolonising agenda are extensive and all-encompassing, and applied to the context of the medical curriculum may involve the following: 

  • Challenging colonial-era paradigms of knowledge dominated by Eurocentrism, racism, ableism, sexism, heteronormativity across all aspects of the curriculum
  • Re-centering minoritised and marginalised narratives of healing within the curriculum and acknowledging the role that colonisation, imperialism and racism have played in their oppression
  • Promoting openness, curiosity and humility among future clinicians, enabling them to adopt a culturally safe and reflexive approach in patient care – re-connecting them with the communities they serve
  • Nurturing critical consciousness and political will among future clinicians to advocate on behalf of those who are most disadvantaged and disempowered by current health systems
  • Dismantling power hierarchies within medicine perpetuated through policies, systems and learning/ working environments, in order to promote power-sharing and equity

In this section, we hope to narrow down our resources to a few links that may be helpful to start with, which provide an initial look at what decolonising the curriculum means (and what it doesn’t) and demystifying the intricate relationship between colonial history and medicine today.

Where to begin

  • Read: Students want their curriculums decolonised. Are universities listening? (2019)  [Article], Dissipating historical medical inequity through decolonising healthcare education (2020) [Article]
  • Watch: Decolonising the Curriculum: A Global education (2019) – SOAS – [Video]
  • Listen: Radicals in Conversation: Decolonising the University (2018) [Podcast on Spotify] [Youtube]
  • Explore: What  is decolonising methodology? – Uni of Warwick – the further links they provide are useful overviews of what it means to decolonise a curriculum [web page]

THE SHORTLIST

Articles to skim:

  • Ekechi, C. 2020. How do we start a conversation about racism in medicine? BMJ opinion.[Article]
  • Kmeitowicz, Z. 2020. Are medical schools turning a blind eye to racism? BMJ, 368:m420. [Article]
  • Saini, A. 2020. » ‚The data was there – so why did it take coronavirus to wake us up to racial health inequalities?’«. The Guardian. [Article]
  • Greenhalgh, T., et.al. 2014. Evidence based medicine: a movement in crisis?. BMJ, 348, p.g3725.[Article]
  • Lokugamage, A.U., et. al. 2020. Decolonising ideas of healing in medical education. Journal of Medical Ethics, 46(4), pp.265-272. [Article] + [Intro]

Podcasts to add to your playlist: 

  • Radicals in Conversation. 2018. Decolonising the University. [Podcast]
  • NPR Code Switch, 2018. This Racism is killing me inside. [Podcast]

Books to start reading:

MedEd Resources

2. Overview of the movement

Decolonisation of the university is a struggle to enrich our ways of teaching and learning by listening to the plurality of knowledges of the world… relating to difference as an opportunity to enrich our knowledge practices instead of relating to difference as something that has to be reduced, moved out of sight or exhibited’ (Bhambra et.al, 2020:123) 

The following resources provide a helpful overview of the #RhodesMustFall protests and efforts to decolonise the curriculum by different higher education institutions across the global North and South (for want of better terminology) e.g. #WhyIsMyCurriculumWhite?, and recognition of the power hierarchies deeply embedded within and perpetuated through our medical curricula. They explain how universities have served throughout history as sites of social reform, and their central role in mitigating and exacerbating social inequalities beyond institutional walls.

Declaration of interest: articles marked with an asterisk (*) were co-authored by one of the student contributors, or the UCL group involved in Decolonising the Medical Curriculum.

S/NResource
1Swain, H., 2019. » Students want their curriculums decolonised. Are universities listening?«. The Guardian, 30.[Article]
2Camp, J.T. 2018. Radical Conversations – Decolonising the university. Pluto Press. [Podcast].
3Bhambra, G.K., Gebrial, D. and Nişancıoğlu, K., 2018. Decolonising the university. Pluto Press.  [Book – full text]
4*Gishen, F. and Lokugamage, A., 2019. Diversifying the medical curriculum. BMJ, 364, p.l300. [Article]
5Mgqwashu, E., 2016. Universities can’t decolonise the curriculum without defining it first. The Conversation, 22, pp.1-4. [Article]
6Le Grange, L., 2016. Decolonising the university curriculum: Leading article. South African Journal of Higher Education, 30(2), pp.1-12. [Journal article]
7Chow, H., Lokugamage, A.U. and Gishen, F., 2019. Diversity health checks in undergraduate curricula. The clinical teacher.
8Bleakley, A., Brice, J. and Bligh, J., 2008. Thinking the post‐colonial in medical education. Medical education, 42(3), pp.266-270. [Journal article]
9Arday, J. and Mirza, H.S. eds., 2018. Dismantling race in higher education: Racism, whiteness and decolonising the academy. Springer. [Book – full text here]
10Heleta, S., 2016. Decolonisation of higher education: Dismantling epistemic violence and Eurocentrism in South Africa. Transformation in Higher Education, 1(1), pp.1-8. [Journal article]
11Fanon, F.,, 1963. The wretched of the earth (Vol. 36). New York: Grove Press. [Book – full text here]

3. Historical awareness

The following resources provide insight into how the practice of medicine in Europe and America has been shaped by colonial concerns and the imperialist imagination. They delve into dark moments throughout history when medicine was weaponised as a tool of oppression, discrimination and violence against minority and indigenous people groups – moments that are overlooked and underplayed in mainstream medical curricula.

S/NResource
1Washington, H.A., 2006. Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. Doubleday Books. [Book]
2McKie, R., 2010. Henrietta Lacks’ Cells Were Priceless, But Her Family Can’t Afford a Hospital. The Observer (April 3, 2010) [Article]
3Skloot, R., 2017. The Immortal Life of Henrietta Lacks. Broadway Paperbacks. [Book]
4Keller, R.C., 2006. Geographies of power, legacies of mistrust: Colonial medicine in the global present. Historical Geography, 34, pp.26-48.[Chapter – full text online].
5Cooper Owens, D., 2018. Medical Bondage: Race, Gender, and the Origins of American Gynecology. University of Georgia Press. [Book – full text here]
6Newkirk II, V. R., 2016. A Generation of Bad Blood. The Atlantic. [Article]
7M’Charek, A. (2005) The Human Genome Diversity Project: an ethnography of scientific practice. Cambridge University Press [Book]
8Noko, K. 2020. Medical colonialism in Africa is not new. Al Jazeera. [Article]
9Goodman, A. 2020. Race is real, but it’s not genetic. Sapiens. [Article] Supplement with: Zakrzewski, S., 2020. No,“Racial Genetics” aren’t affecting COVID-19 deaths. Sapiens. [Article]

4. Intersectional determinants of health

The following resources tackle issues related to social, cultural and ethnic determinants of health. This includes the intersecting barriers of discimination that Black, Asian and minority ethnic populations face in Euro-America, and how these inevitably create disparities in health outcomes across socioeconomic and ethno-cultural divides. The intersectional lens challenges colonial-era binarism e.g. white vs. other, and exposes how the colonial legacy is kept alive in the power hierarchies within society today.

S/NResource
1Hatch, Anthony Ryan. 2016. Blood Sugar: Racial Pharmacology and Food Justice in Black America[Book – full text online]
2Kertesz, Stefan. (2020). Homeless Healthcare with Stefan Kertesz MD. The Curbsiders Internal Medicine. [Podcast]Lelkes, Jackie; Preston, Jo. (2020). Homelessness. MDTea. [Podcast] 
3WOOD, C. (2014). Criptiques. [Book] [Link to full text online] 
4Nguyen, V.K. and Peschard, K., 2003. Anthropology, inequality, and disease: a review. Annual review of Anthropology, 32(1), pp.447-474. [Journal article]
5. NPR Code Switch, 2018. This Racism is killing me inside. [Podcast]
6I, Daniel Blake (2016) [IMDB entry]
7Land of Silence and Darkness. 1971. Directed by W. Herzog. West Germany. [IMDB entry]
8. Marmot M (2015) The health gap: the challenge of an unequal world. Bloomsbury, London [Book] 
9.Ahmad WI, Bradby H. Locating ethnicity and health: exploring concepts and contexts. Sociol Health Illn. 2007;29(6):795-810. [Article]
10. Roberts, D. 2016. The problem with race-based medicine. TED. [Video]
11.The Indicator. 2020. Racism and Economics. NPR [Podcast]
12Lipsedge, M., Littlewood, R. 1997. Aliens and Alienists. London: Routledge, [Book]
13Farmer, P., 1996. On suffering and structural violence: A view from below. Daedalus, 125(1), pp.261-283. [Article]

5. Cultural safety and clinical practice

The following resources offer a critique on cultural education in medical schools, the relationship between professionalism and cultural humility, along with semantic approaches to discussing issues of culture, ethnicity and race. They also evaluate the efficacy of initiatives around the world, such as the Cultural Safety (CS) model, that aim to equip healthcare professionals with a level of cultural awareness that goes beyond a surface-level ‘competency’. They discuss aspects of patient-centered care that are often overlooked, barriers in cross-cultural communication and the importance of reflexivity in clinician-patient encounters. 

S/NResource
1Fadiman, A., 2012. The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. Macmillan. [Book]
2Curtis, et.al 2019. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International journal for equity in health, 18(1), p.174. [Journal article]
3Jowsey, T., 2019. Three zones of cultural competency: surface competency, bias twilight, and the confronting midnight zone. BMC medical education, 19(1), p.306. [Journal article]
4Hoberman, J., 2012. Black and blue: The origins and consequences of medical racism. Univ of California Press. [Book]
5Nazar, Mahdi, Kathleen Kendall, Lawrence Day, and Hamde Nazar. „Decolonising medical curricula through diversity education: lessons from students.“ Medical teacher 37, no. 4 (2015): 385-393. [Journal article]
6Galasinski, D., 2017. Language matters: a linguist’s view on medicine.
7Kleinman, A., Benson, P,. 2006. Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It. PLoS Med 3(10): e294. https://doi.org/10.1371/journal.pmed.0030294
8Maitra, B. and Krause, I.B., 2014. Culture and madness: A training resource, film and commentary for mental health professionals. Jessica Kingsley.
9The effect of racial concordance between patients and physicians in improving health outcomes:
a) Greenwood, B.N., Hardeman, R.R., Huang, L. and Sojourner, A., 2020. Physician–patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences. [Journal article]
b) Torres, N., 2018. Research: Having Black Doctor Led Black Men to Receive More-Effective Care. Harvard Business Review. [Article]

6. Decolonising bodies, deconstructing race

The following resources speak of the need to decolonise the body – a site of anthropological exploration and inquiry – and understand its role in cultural politics within medicine. This section highlights how forces of racism, discrimination and oppression are exerted on bodies, how our views of the body are influenced by culture and the need for the representation of bodily diversity in medical education. It also confronts the framing of race as a biological construct in medical literature, delves into critical race theory and questions how this masks health disparities among ethnic minority and indigenous populations perpetuated by institutional racism (#RacismNotRace).

S/NResource
1Behringer, A. 2020. Bodies Podcast, The Cost of Silky Soft. [Podcast] 
See also S1E02: Bleeding [Podcast]
2Lupton, D., 2015. The pedagogy of disgust: the ethical, moral and political implications of using disgust in public health campaigns. Critical public health, 25(1), pp.4-14. [Journal article]
3Douglas-Jones, R., 2017. ‚Silent mentors‘: Donation, education and bodies in Taiwan. Medicine Anthropology Theory, 4(4), pp.69-98. [Journal article]
4Numinous Games, 2016. That Dragon, Cancer [Website]
5Tseris, E.J., 2013. Trauma theory without feminism? Evaluating contemporary understandings of traumatized women. Affilia, 28(2), pp.153-164.
8Orcullo, J. 2017. What’s left of you? Performance, decolonisation & self-determination. TEDxUCLWomen. [Video]
9Coates, T.N., 2015. Between the world and me. Text publishing. [Book] [Audiobook]
10Purnell, K. 2020. The Body Politics of Covid-19. The Disorder of Things. [Article]
11Tsai, J., et.al, P., 2016. Race matters? Examining and rethinking race portrayal in preclinical medical education. Academic Medicine, 91(7), pp.916-920. [Journal article]
12Siani, A., 2019. Superior: The return of race science. Beacon Press [Book]
13M’charek, A. (2013) Beyond fact or fiction: On the materiality of race in practice.  Cultural Anthropology 28 (3), 420-442. [Journal article]
14Singh, N. 2020. Decolonising dermatology: why black and brown skin need better treatment. 13 August, Guardian. [Article]  

7. Epistemic bias and medical pluralism

The following resources concern the dominance of Western interests, voices and perspectives in academia, and efforts to decolonise medical knowledge. They shed light on the hegemony of the biomedical perspective, historically entrenched in colonial ideals and aspirations, in medical education. They discuss how privileging and enabling input from indigenous and minority voices, different disciplines and the Global South in mainstream academia is essential to promoting medical pluralism, inclusivity and diversity – a movement that requires decolonising the processes of production and prioritisation of knowledge in research.

Declaration of interest: articles marked with an asterisk (*) were co-authored by one of the student contributors, or the UCL group involved in Decolonising the Medical Curriculum.

S/NResource
1Lokugamage, A.U., Ahillan, T. and Pathberiya, S.D.C., 2020. Decolonising ideas of healing in medical education. Journal of Medical Ethics, 46(4), pp.265-272.* [Journal article] 
2Istratii, R. 2020.The LONG READ on DECOLONISING KNOWLEDGE: How western Euro-centrism is systemically preserved and what we can do to subvert it. Convivial Thinking. [Article]
3Guglielmi, G., 2019. Facing up to injustice in genome science. Nature, 568(7752), pp.290-294. [Article]
4Gaines, A.D. and Davis-Floyd, R., 2004. Biomedicine. Encyclopedia of medical anthropology, 1, pp.95-109. [Article]
5Czerniewicz, L. 2013. It’s time to redraw the world’s very unequal knowledge map. The Conversation. [Article]
6Greenhalgh, T., Howick, J. and Maskrey, N., 2014. Evidence based medicine: a movement in crisis?. Bmj, 348, p.g3725. [Journal article]
7Jenks, A. 2020. Culture(s) of biomedicine. Youtube. Part 1, Part 2, Part 3.

8. Global health – changing the paradigm

The following resources highlight key developments in a movement to mitigate the effects of colonial legacy on health systems across the world, through ground-up health initiatives and transnational health partnerships. They also look at how global health must be integrated into medical curricula to educate students about disparities between health systems worldwide, alongside global health challenges and the crucial need for stronger networks of collaboration. This also encompasses education around refugee and migrant health, and how we can act to safeguard the rights of foreign-born patients within our healthcare system. 

S/NResource
1Bhatti, Y.A., et. al 2017. The search for the holy grail: frugal innovation in healthcare from low-income or middle-income countries for reverse innovation to developed countries. BMJ Innovations.[Journal article]
2DePasse, J.W. and Lee, P.T., 2013. A model for ‘reverse innovation’ in health care. Globalization and health, 9(1), p.40. [Journal article]
3Nelson, A., 2011. Body and soul: The Black Panther Party and the fight against medical discrimination. U of Minnesota Press. [Book – full text online] 
4Peluso, M.J., et.al, 2017. Reframing undergraduate medical education in global health: Rationale and key principles from the Bellagio Global Health Education Initiative. Medical teacher, 39(6), pp.639-645. [Journal article]
5Battat, R., et.al 2010. Global health competencies and approaches in medical education: a literature review. BMC Medical Education, 10(1), p.94. [Journal article]
6Keidar, O., et.al. 2019. Health of Refugees and Migrants—Where Do We Stand and What Directions Should We Take?. [Journal article]
7de los Reyes, I., 2015. The Bolivian Women Who knit Parts for Hearts. BBC News Health, 29. [Article]
8Harris, M., Bhatti, Y., Buckley, J. and Sharma, D., 2020. Fast and frugal innovations in response to the COVID-19 pandemic. Nature Medicine, pp.1-4. [Article]


9. A practical guide

This section lists some useful resources that outline practical implications of adopting a decolonising approach in our everyday lives – whether in responding to racism in healthcare settings, having more productive discussions with people around you and getting more involved in the movement.

Clinical implications

  • Race & Health, 2020. Building Back Better. [Online seminar]
  • BMA, 2020. Racial harassment guidance for medical students. BMA website. [Article]
  • Medact, 2020. Patients Not Passports: an advocacy guide. [Online toolkit]
  • BMA, 2020. Racism in medicine. BMJ special issue.  [Journal issue]
  • Munn, F., 2017. Reporting racism on the wards. BMJ, 359, p.j5178. [Article]
  • BMJ Sharp Scratch, 2020. Racism in medicine. [Podcast]
  • The Curbsiders Internal Medicine Podcast, 2020. Trauma-informed Care with Megan Gerber MD. [Podcast]
  • The Curbsiders Internal Medicine Podcast, 2020. Refugee Health with Tanuja Devaraj MD. [Podcast]
  • Women’s Hour, 2020. Race issues in the nursing profession with Carol Cooper. [Podcast]

Having difficult conversations

  • Rankine,  C. 2019. How Can I Say This So We Can Stay in This Car Together?. On Being. [Podcast]
  • Resnick, B. 2020. How to talk someone out of bigotry. Vox. [Article] ~ ‘deep canvassing’
  • Carson, Q. 2017. Pedagogy of the Decolonizing. TEDxUAlberta [Video] 

Getting involved


Further reading lists:

  • Global Social Theory: Decolonising the University [Link] (an extensive resource of reading lists compiled across different disciplines)
  • “How to Learn About Racism and Do Something About it” – SfGH Barts – [Link]
  • The Alternative Reading List Project – [Link]
  • Institutionalised Racism: A Syllabus – [Link]
  • Modernity + Coloniality Summer Course Reading List – [Link]
  • The Charlottesville Syllabus – [Link] (last updated 2017 in response to the white supremacist gatherings in Charlottesville)
  • Race and Health – multimedia hub of race and health resources [Link]
  • Antiracism Reading List for Epidemiologists and Public Health researchers  – [Link]
  • Decolonizing Global Health Conference Reading List [Link]
  • UoB Decolonising and Diversifying Resource Lists – [Link
  • Cambridge HSPS decolonial reading list – [Link]
  • The Research Companion – anti-racist reading list [Link