Decolonising global health requires a systemic, multifaceted strategy that addresses policies, institutions, education, power dynamics and imperialistic drivers. Any initiative that ignores the racial, social, political, technological and commercial determination of health, or the historical and contemporary forms of colonialism, is likely to fail. Internal colonialism must also be considered, without abandoning established identity-based perspectives. Most of the existing literature focuses on organisational reform, institutions, philanthropies, governance and higher education, while leaving upstream conditions such as imperial power relations, neoliberal capitalism and its refeudalisation largely unchallenged. The discourse therefore risks perpetuating neocolonial conditions rather than eliminating them. A purely identitarian focus on Black people, particularly in North America, does not reflect the breadth of the global colonial legacy and cannot address the upstream causes of colonialism in health.

In his review Broadening the decolonisation of global health beyond identity-based approaches toward structural transformation published in the Journal of Public, Global and One Health, Jens Holst examines the phenomenon of neocolonialism, highlighting its role in the perpetuation of existing power structures and the obstruction of equitable outcomes. Countering it requires inclusive, locally driven, decentralised health initiatives that prioritise marginalised voices. Because the same drivers of neoliberal capitalism produce both health inequalities and climate catastrophe, decolonisation must also include an ecological dimension. The academic literature has yet to assess the rise of libertarian authoritarianism and its implications for global health. This emerging authoritarian-libertarian order, which pairs strict state control with free-market capitalism, stems from contradictions within the political West and its eroding credibility on democracy, human rights and multilateralism. It is likely to provoke greater resistance from powerful nations towards decolonisation efforts once tolerated or even endorsed. Its consequences reach well beyond reduced health aid, as it re-establishes colonial geopolitical relations. Decolonisation discourse and practice must therefore confront these geopolitical and economic challenges without delay.