Decolonizing Global Health: Why Humanitarian, Non-Profit Organizations Need Reform
Political and non-profit leaders gather at an event co-hosted by UN Women. Photo by Ryan Brown.
In 1957, unstoppable hope rallied independence movements across the world. That magical year that kicked off success for independence struggles across Africa was dubbed “a wind of change,” and it continues to receive praise from leaders, non-profits, and the media alike. Indeed, many laud the achievements and statements of this time—in particular a speech made by British Prime Minister Macmillan on the “growth of national consciousness”—as testaments to the end of the “days of Empire.” The UN similarly portrays the 1960s and the next three decades as an era during which non-self-governing states transitioned to “self-determining states” supposedly free from dependence upon colonial powers.
But the past has a way of haunting those who claim to have overcome it. This colonial past has remained a specter that lingers within each aspect of our international political system, from political institutions to non-governmental organizations (NGOs).
At no time can this legacy be seen more clearly than this year. Many NGOs are currently advocating for billions of U.S. foreign aid investment into nations abroad to combat COVID-19 and other pre-existing public health crises. Upon first glance, their demands seem morally laudable and practically necessary to prevent future pandemics. But, upon further scrutiny, the work undertaken by many humanitarian groups is questionable in its ability to achieve their proposed aims. By upholding narratives of saviorism and failing to name institutions that create global inequality, their advocacy solves immediate crises but reinforces a power dynamic previously created by colonial relations and avoids addressing the neocolonial exploitation that keeps some countries rich and others poor.
The Underlying Causes of Global Inequality Today
Confusion about the causes of global inequality arises from the portrayal of decolonization as a simple process completed decades ago and the historical amnesia of the media, the public, and NGOs. Modern disparities between nations exist not because some are more adept in developing infrastructure and others are not, but rather because colonialism and its transition to neocolonialism debilitated the process of development.
Indeed, the colonization of Africa and South Asia in prior decades laid the groundwork for the structural issues facing many countries across these continents today. Through slave labor and resource exploitation, colonial powers extracted colonized nations’ wealth, diminished their populations, and prevented them from developing public infrastructure for their residents even after they gained independence from colonial rule throughout the mid-20th century.
It was around this time that many international NGOs were established. INGOs conduct international work, do not operate for profit, and are not a part of any nation’s government. The majority operate by providing monetary relief to populations in crisis or by lobbying governing bodies to invest more of their budgets into foreign aid during global disasters. Representatives of Western nations supposedly created these organizations in reaction to the widespread sentiment that governments and traditional state actors were responsible for many tragedies over the previous decades—a notion that was not unfounded given the violence perpetrated by the West in colonial states and the mass death during the Second World War.
Yet, this rise in NGOs conveniently occurred in tandem with the creation of policies by international political institutions—namely, the World Bank and the International Monetary Fund (IMF)—that reinforced global economic inequality in the ‘70s and ‘80s. As NGOs provided funds and relief to nations attempting to build up their public infrastructure after gaining independence, the IMF implemented dubious structural adjustment programs in the early 1980s that deteriorated public sectors in previously colonized nations and once again positioned them for disaster in moments of crisis like the current pandemic. Such structural adjustment programs, which constituted a new form of economic control that replaced the military control of the prior colonial period, have been dubbed “neocolonial” by experts to reflect their continuation of systems of exploitation.
These structural adjustment programs are critiqued by many as policies of the past, yet similar austerity programs continue today: the IMF and World Bank still require many nations to privatize their services, implement regressive tax policies, and delay the development of public infrastructure in order to receive necessary loans. Yet, previously colonized nations do not need more loans or policy advice—they need reparations from these international bodies to recover from the centuries of harm they faced in decades prior and continue to buckle beneath today. They also deserve equitable policy. As we continue to battle the pandemic, unequal health outcomes are reinforced by the failures of COVAX, an international policy that aimed to ensure equitable distribution of the COVID-19 vaccine but has failed as high-income nations purchase the majority of approved vaccines developed.
Previous global disasters also exposed the dependency bred by exploitative international policies. In the case of the Ebola crisis in 2008, the rapid spread of the ailment unveiled the sheer state of disrepair of public health institutions across West Africa. Despite the progress NGOs and governments claimed to have made in building up healthcare capacity, Liberia, the nation hit the hardest by the Ebola crisis, spiraled from the nation most lauded for its infrastructure development to that most burdened by the mounting public health emergency.
The Problematic Culture of Non-Profits
It isn’t just international political institutions that warrant critique. Rather, their miscalculations are exacerbated by similar missteps within non-profit organizations. While the intentions of these organizations may be sincere, the colonial frameworks of prior decades remain embedded in their hierarchies, culture, and public messaging. Without acknowledging this colonial past, working in collaboration with members of the Global South, or opposing this system of exploitation, NGOs cannot fulfill their own stated missions to alleviate the root causes of suffering globally or empower globally marginalized populations.
Indeed, one of the most well-known in this cohort, the Red Cross, claims its purpose is “to prevent and alleviate human suffering wherever it be found.” Yet, it does not acknowledge the causes of this suffering or its perpetrators—it operates, as Teju Cole states in the Atlantic, with “an expectation that we can talk about sins but no one must be identified as the sinner.” This logical fallacy remains an immense obstacle on the quest for global equity: it is nearly impossible for colonized nations to gain freedom while these groups neglect to recognize historical context, name the actors that have corrupted colonized nations for centuries, or hold these actors accountable.
By failing to identify a systemic cause for global inequality, INGOs also maintain the white saviorist narrative that Black and Brown individuals need saving from white ones. Their websites are laden with images of physicians and volunteers from the West assisting people of color without contextualizing this power dynamic. This imbalance is also reflected in their organizational leadership: they are largely led and funded by white, male philanthropists and lack representation from the people of color for whom they claim to fight. In other scenarios, those who lead and make organizational decisions are from Western nations and earn higher wages, and those from the Global South who volunteer to tell lobbying stories or execute the delivery of aid earn little to nothing.
As someone who has previously advocated as a member of multiple non-profit groups, I understand the moral allure these organizations have. My own participation in human rights advocacy arose from a desire to support global equity: as the daughter of two immigrants from Pakistan, a previously colonized country, I advocated for increased investment into global health because my parents had suffered in their home country. Despite knowing their experience in a previously colonized nation, I remained in groups founded upon racial and class-based hierarchy. It took months for me to uncover these problematic narratives and over a year to gain the courage to confront them.
When I spoke with the leaders of these groups to ask if we could publicly discuss the history of colonialism or at least change the images of people of color we showed to the world, the response was rejection and discomfort. “It’s not currently a priority,” one supervisor told me. If this doesn’t take priority now and has not taken priority for the past five decades, when will it? When meddling with the lives of others, it is more than just concerning that we do not prioritize our portrayal of their dignity or our impact on their liberation.
How to Move Forward Centering History and Empowerment
To address these issues, we must first name them. Changes in language can be performative, but in this context they are necessary; as Angela Davis has stated in Freedom is a Constant Struggle, “certainly we need a great deal more than talk, but it is also the case that we need to learn how to talk about race and racism. If we do not know how to meaningfully talk about racism, our actions will move in misleading directions.” Naming history has power: without discussing colonialism and its continued effects, we risk feeling as though there has been historical closure on an issue that remains alive and well today. Our language can also entirely change our understanding of modern crises. Nations are not in need of “aid,” they are in need of reparations. We do not need to fund nations that are “poor,” we must return wealth to nations devastated by extraction.
NGO leaders have told me that such language is difficult to center, fearing that it might sacrifice their relations with government officials or international leaders that view Western leadership and exceptionalism as the basis for foreign aid. While this may be true, NGOs must decide whether they are up to the challenge of changing this political climate and raising public consciousness for the issues at hand or would prefer to remain within the existing system to provide immediate relief during global crises.
Of course, this is not to state that all work of these organizations must be halted or that their achievements in the sphere of international development are not profound. Amid the COVID-19 crisis, NGOs have played a fundamental role in delivering supplies that have saved thousands of lives. But, if these organizations went a step further to accurately frame the situation using historical context, their work could address the systemic exploitation that creates dependency and, in doing so, provide developing nations the autonomy they need to eventually build infrastructure free of Western assistance.
Some groups have already taken the crucial step and created models that forefront the voices of those they claim to assist. Oxfam, after receiving extensive criticism for the structural violence it supported, has shifted to such a model: in a new statement, they write, “we [have shifted] the balance of the organization from one in which power was concentrated in the North to one in which it [is] truly shared across the world.” They certainly implemented the changes to back such powerful words: their headquarters moved from Oxford to Nairobi, and more of their leadership originates from the nation in which they work. The result of such a commitment to representation is the empowerment of populations that have long been disfranchised.
Such actions, if coupled with a change in our language, can spark a formidable movement to combat our current system of global governance and re-establish the meaning of global solidarity. Non-profit organizations must either actively advocate against the exploitation perpetuated by political institutions like the IMF or seek ways to fight with advocates on the ground in these nations.
This work cannot just be the burden of one organization either; there are thousands of NGOs, and it will perhaps take the action of the leading hundred of these organizations to change public consciousness of these issues. It is through accurately framing history, acknowledging modern exploitation, and advancing organizational structures that center the voices of those most impacted that we can create an equitable future.
Leena Yumeen is a rising junior at Columbia College studying Political Science. She was previously a Fellow with the Fund for Global Health and the Co-Advocacy Lead of the Partners in Health Engage chapter in New York City. She now serves as a Fellow with RESULTS, a non-profit organization that aims to alleviate global and domestic poverty.