Colonization often evokes imagery of white-masted ships bearing down on untamed lands, clashes of religion and tradition, and disease-riddled blankets passed amongst native peoples. A relic of the past ensconced in oil paintings and rough sketches, colonization seems to have faded to many from the modern era. 

Yet still, traces of colonization exist today, intertwined with scientific concepts that were once used to justify despicable actions. In fact, the term “colonial medicine” was coined to describe the field of study investigating the history of 19th-20th-century medicine. 

A Brief History of Colonial Practices

Colonization has often relied upon biological racism, the idea that “scientific” distinctions between ethnicities designated some populations as superior to others. In practice, this notion allowed researchers to extrapolate offhand observations to entire racial groups, relying upon flawed studies conducted by people looking to justify their bigotry through experimentation.

Above: Engraved by John Emslie and published by James Reynolds in 1850, “The Principal Varieties of Mankind” depicts commonly categorized racial groups. Image courtesy of the David Rumsey Map Collection.

For example, French colonial scientists in the late 19th century used observations to make flawed generalizations about entire races. Relying on a small sample size of mostly prostitutes, the researchers claimed that 80% to 100% of all Moroccans had syphilis and were thus more prone to hypersexual behaviors. Such studies still have lasting repercussions in the modern day: the ideas presented in the original study fed the notion that certain races were neurologically prone to syphilis, leading to the infamous Tuskegee Study that unethically tested a similar hypothesis on African Americans.

Above: The American Tuskegee Experiment, in which the United States Public Health Service unduly treated 600 Black Americans for “bad blood,” an umbrella term equated with syphilis, anemia, and fatigue, among other conditions. Medical historians often cite the abusive experiment as a cause of generational trauma among the participants’ descendants. Images courtesy of CDC.

Racism in Healthcare Today

Racism and colonization in medicine exist not only on the level of individual experiments but also across entire health care systems. Race—a concept proven to be biologically bogus—is often used as a justification for resource allocation in institutions. Jim Crow segregation of medicine and hospitals—albeit not explicitly a colonial relationship—provides a salient example of race-based medicine, wherein underfunded care centers mistreated racial minorities. Systematic racism also extended to segregated education and limited employment opportunities, leading to a smaller percentage of African American doctors relative to their makeup of the nation’s total population and medical textbooks that often ignore unique considerations that affect people of color.

Indeed, the lack of diversity in medical training—as well as the lack of diverse representation in physicians—has led to poorer health outcomes for minority groups. How might this affect patients? To diagnose skin cancer, for example, doctors must examine the melanoma level of a patient’s nails, hands, and feet; however, with textbooks that depict only lighter skin tones, many physicians aren’t prepared to diagnose and observe the cancer’s effects on people of various races.

Above: Infographic depicting the effects of sun damage on a woman with dark skin and appropriate guidelines for protection. Image courtesy of Melalogic.

In addition, the erasure of indigenous medicines and healing practices in favor of Western medicine perpetuates the same rhetoric of colonization—even in science. For instance, the British Empire often assigned health care for indigenous populations to Christian churches, further assimilating native cultures. Health centers run by colonial governments not only undermined traditional healing practices but also disproportionately worsened the health outcomes of these minorities.

In modern times, colonialism still affects the global order and health care infrastructure. For instance, massive inequities in COVID-19 vaccine distribution and access exist across the globe, resulting in high vaccination rates in rich countries and dispossession in the Global South. Studies reported that Africa, home to 17.5% of the global population, received only 3.1% of the world’s vaccine supply.

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Above: COVID-19 vaccine coverage varied based on a nation’s income. High and upper-middle-income countries averaged a higher vaccinated population compared to lower-income countries. Image courtesy of Pilkington et al. (2022).

What’s Next? Decolonizing Medicine

Many authors propose a potential solution for the systemic issue: decolonizing medicine. But what exactly is decolonizing medicine, and is it more than just a scholarly theory?

According to its leading scholars, decolonizing starts with gaining historical insight and spreading awareness. The more we understand about historically colonial structures (in the past and present), the better we can account for these legacies of imperialism. How are colonialism and Western thought deeply embedded into medical information, distribution, and treatment? How can research practices be exclusionary or ignorant of nuanced historical relationships? How can greater representation of minorities in medical spaces pioneer a more equitable future? Decolonization embraces these forms of questioning at the level of knowledge production.

Increasing diversity and representation in these health care structures is another way to decolonize medicine and dismantle systemic racism in healthcare. Though these hierarchical structures have long been embedded into society, recognizing and beginning to untangle them from critical infrastructure—such as the American health care system—is more vital now than ever.