Whose health counts? Decolonising Global Health in a digitally connected world
In April's edition of our 12-part Decolonising Global Health blog series, MSc in Applied Digital Health student and management consultant Aditi Kapadia offers a thought-provoking reflection on what it means to truly decolonise health systems in a digitally connected world. Drawing on her lived experiences in India and Australia, she challenges the dominance of Western paradigms in global health and calls for a more inclusive, pluralistic approach.
About the author
Aditi Kapadia is an MSc in Applied Digital Health student, committed to advancing equitable healthcare. She is a management consultant with seven years of experience, primarily at KPMG in Australia. During the COVID pandemic, she spent six months with the Victorian State Department of Health, leading efforts to help the government respond to the rapidly evolving operational and strategic challenges. This experience ignited her passion for the health and human services sector, particularly in addressing large-scale health challenges. Aditi hopes to focus her career on improving health outcomes through strategic leadership, particularly in the integration of digital solutions in healthcare.
I grew up in India, where poverty was everywhere, visible in the bodies of children with bloated bellies, in rusted hand pumps and in overcrowded clinics. It was also hidden in plain sight, normalised in ways that made it easy to ignore if you had the means. Being sick and poor was not just about the body. It was about class, caste, geography and history. It was about who could afford clean water, who could rest when they needed to and who could afford to be seen.
At school, my history books were full of India’s struggle for independence from British colonial rule. But outside the classroom, I saw a different struggle. The brutal, everyday fight to survive. Witnessing this level of suffering, especially the urban child poverty I grew up around, deeply shaped the grooves and contours of my soul. It ignited within me a fiery passion that something had to be done. It shaped my understanding of health – not just as a medical issue, but as a social, political, and moral one. A human right.
When I moved to Australia at eighteen years of age, I was amazed by the country’s universal healthcare system and its high quality. However, I was also dismayed to see that even in Australia, there were significant health disparities, especially for rural and remote Indigenous Australians. The legacies of colonialism continue to ravage Indigenous communities, creating stark gaps in life expectancy and general health outcomes compared to urban, non-Indigenous Australians.
This is why I have been thinking increasingly about what it really means to decolonise global health, not as a buzzword or a checkbox, but as a radical reimagining of whose knowledge counts, whose wellbeing matters and who gets to shape the systems that define both.
Rethinking Evidence-Based Medicine
Let me be clear: I strongly believe in evidence-based medicine. I believe in vaccines, in antibiotics, in rigorous trials and in peer-reviewed research. During the COVID-19 pandemic, I was immensely grateful for the vaccines I had access to in Australia. However, I also believe that evidence has too often been defined in narrow, Western terms, terms that exclude other ways of knowing and healing, particularly those rooted in community, culture and tradition.
Western medicine excels at acute care. It can save your life in an emergency room, it can prevent diseases through vaccination and it can help manage chronic illnesses such as diabetes so one can live well. However, it also often falters when it comes to chronic illness, mental health and the complex realities that shape long-term wellbeing. The social determinants of health framework has helped global health practitioners recognise that illness does not arise in isolation. It is shaped by where we live, work and grow. However, when it comes time to act, these social realities are still often treated as background noise, rather than as central to care.
It stands to reason that both communicable and non-communicable diseases such as cardiovascular diseases, cancer, diabetes, chronic obstructive pulmonary disease and mental disorders, as well as HIV/AIDS, malaria, tuberculosis, acute respiratory infections, and diarrhoeal diseases continue to cause high mortality rates, especially in low- and middle-income countries.
The Marginalisation of Traditional Knowledge
In many parts of the world, especially in poorer communities, people turn to systems like Ayurveda, Traditional Chinese Medicine and shamanic healing practices not just because of tradition, but also because formal health systems remain expensive, alienating or inaccessible. These systems offer holistic approaches grounded in local knowledge, history and an understanding of the person beyond the disease. However, global health, shaped by colonial legacies has long dismissed them as unscientific or obsolete – or if not obsolete, then requiring monetisation to have any value, sometimes in the most ridiculous ways possible.
For instance, we saw this clearly in the controversy over turmeric. A few years ago, scientists in the United States attempted to patent the use of turmeric for wound healing – a practice embedded in Indian culture for generations. The backlash was swift. It was not just about the patent. It was about the audacity of claiming ownership over knowledge that had never been forgotten – only ignored by those in power, until of course, they realised it could be monetised. The Indian government successfully challenged the patent, leading to its cancellation. However, the case revealed a deeper truth about global health: that colonial dynamics still govern whose knowledge is recognised, protected, and valued.
Where profit is involved, Indigenous knowledge is not respected. It is exploited.
The Digital Health Divide: A New Frontier for Old Inequities
These dynamics do not just live in the past. We see them now in digital health. Apps, algorithms and AI-powered diagnostics are being hailed as the future of healthcare.
However, many of these tools are designed in Western nations, often without meaningful input from the communities they are meant to serve. They rely on datasets that exclude the poorest. They assume access to smartphones, connectivity and literacy. They promise universality but often replicate old exclusions in new forms.
If we are not careful, digital health will become the next frontier for the same inequities: high-tech solutions built on low context understanding. Tools that scale but do not translate. Platforms that collect data but do not return benefits.
Decolonising Global Health: The Path Forward
Decolonising global health means interrogating these patterns. It means asking:
Who decides what problems are worth solving? Whose bodies are seen as sites of intervention and whose ideas as sources of innovation? Who benefits from global health efforts and who is once again asked to adapt, to absorb, to be grateful?
Poverty sits at the centre of this conversation. Not just because it worsens health, but also because it renders people invisible – medically, politically and intellectually. Poorer communities are more likely to experience illness and less likely to have their experiences believed, their priorities centred or their knowledge recognised. Health injustice and economic injustice are two sides of the same coin. You cannot meaningfully address one without the other.
India’s eSanjeevani Platform: A Step Towards Integration
I believe India is making progress by using digital tools to integrate both evidence-based medicine and Indigenous systems like Ayurveda. Their eSanjeevani telehealth platform allows rural communities, who previously often had to walk kilometres due to a lack of transport, to access both Western and Indian Traditional Medicine via a telehealth platform. Those without phones can still access care through a hub and spoke model. This approach respects traditional knowledge while integrating Western and local paradigms into one system.
Health Must Consider the Whole Person
Decolonising global health is not about rejecting science. It is about expanding it. It is about embracing pluralism of knowledge, where biomedicine and traditional systems do not compete, but coexist. Where lived experience is valued alongside clinical data. Where interventions are co-designed with communities, not imposed from above.
I believe that to be healthy is to be holistically well across physical, mental, spiritual and social dimensions – and that health is not merely the absence of disease or infirmity. I did not learn this from textbooks or classrooms. I learned this from growing up in India, watching what poverty does to the mind, body and the spirit. Watching how systems respond – and often, how they do not. That experience drives me to ask harder questions about what we call ‘health’, who gets to define it and who gets to shape its future.
The answers are already out there, in communities, in culture and in conversation. We just need to listen. And we need to make space, not just in developing nations, but in Western nations, too.
We need to make space for Indigenous knowledge, integrate diverse healing systems and build a more inclusive body of knowledge, one that expands evidence-based medicine to consider the whole system, the whole person in mind, body, spirit and soul.
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