My grandparents grew up in an India occupied by the British. My parents immigrated from this colonized land whose leadership has chosen to perpetuate settler-colonialism on Kashmiris. I was born on land that was stolen from the Kiikaapoi (Kickapoo), Ojibwe, Bodéwadmiké (Potawatomi), Illinois and Peoria peoples and now attend a University that was built on the Anishinaabe territories of the Odawa, Bodéwadmiké (Potawatomi) and Meškwahki-aša-hina (Fox) peoples. The effects of colonialism are inscribed in my DNA and are now necessarily intertwined with every aspect of my life, informing my worldview. It is because of this that I am motivated to mobilize my public health community to strongly advocate for decolonizing a field that we aim to pursue.
Near the peak of the second wave towards the end of April, it felt like nearly every phone call home to India was filled with distress and heartbreak. One day, I remember going downstairs and hearing my amma in an office call. The words “she was so young” and “what about her daughter” caught my attention. Once she had finished her call, my amma explained what had happened. She had a coworker who was in her early thirties that lived in New Delhi, India — a hotspot for COVID-19. Her colleague caught COVID-19 and was sent to the ICU where her health deteriorated and she passed away. She left behind a six-year old-daughter. The conversation with my amma lasted just a few minutes, but I couldn’t stop thinking about that little girl. Even hours later, I found myself wondering, “How do you tell a small girl that her mother will no longer be there to console her when she is sad, will no longer be there to tell her goodnight and read her a bedtime story, and will not be there at her graduation or wedding? How?”
I have heard countless stories of Indians struggling to find space in a hospital for their loved ones and people who could not get hold of an oxygen tank in time. I have to constantly remind myself of them because sometimes — when we talk about systemic issues in public health — we lose sight of the humanity behind these concepts. In the end, every tragic story recounted over tearful phone calls, written into headlines and broadcasted on television loudly declares our vulnerability as humans. Our body’s machinery functions like clockwork to ensure that our diaphragm works in conjunction with the intercostal muscles to expand our lungs. Oxygen enters the bloodstream through alveoli structures in the lungs, where it then binds to hemoglobin and gets delivered to cells and organs all over the body. Simultaneously, carbon dioxide exits the lungs through the same alveoli as we exhale. When something upsets this delicate system, hypoxia can set in and death becomes imminent. If you do not have access to oxygen you will die — no matter where you live, no matter who you are. However, being able to access oxygen quickly became a privilege that many Indians affected by COVID-19 could not afford. They could not afford to breathe.
How did this happen? If we are all the same on a cellular level, why are our fates so different? It’s a question that has haunted me as I continue to grieve for my family back home. The answer lies in the intertwining systems of oppression that span the globe and dictate all of our lives.
As with other fields of study, public health is rooted in neocolonialism. Neocolonialism can be defined as the use of economic or political pressure by powerful countries to control or influence other countries and stems from colonialism, which is the direct occupation of land. Neocolonialism is not just a term we see in history books, but a modern-day system of oppression that works in conjunction with capitalism and imperialism to disproportionately affect the health and livelihood of our most marginalized communities. Life-saving medical technology is reserved for high-income countries, as are vaccines. As students who intend to either go into the field of public health or utilize it in some way, shape or form in our career, we are taught that decolonization is an aspect of public health. However, I would go further to say that decolonization is the lens we must employ to design research projects, implement interventions, and advocate for policy changes.
The second wave of COVID-19 in India exemplifies the intertwining of neocolonialism with public health. Vaccine apartheid, a term used to describe the disparity in vaccination rates between people in high-income countries and their counterparts in lower-middle-income countries (LMICs), is a product of the free market as pharmaceutical companies profit off of high-income countries hoarding raw material. It’s maintained through the protection of intellectual property patents for the vaccine and the monopolization of vaccines by the global north. Long story short: high-income countries have a surplus of vaccines while many LMICs have not even vaccinated a single person. While countries like the United States have started implementing incentives to encourage COVID-19 vaccination, people in India and other LMICs are praying for the day they get to be vaccinated.
Due to inequitable vaccine distribution, LMICs are dependent on high-income countries to provide them with life-saving materials. This dependency exemplifies the long-held reality that LMICs never truly became “independent” from high-income countries. The wellbeing and freedom of the colonized and those attempting to recover from the lasting effects of colonization is wholly contingent on the resources given to them by the countries that once colonized them. This purposely inflicted harm is antithetical to the tenets of public health of promoting wellbeing and preventing disease.
As public health students, we understand the role systemic oppression plays in deleterious health outcomes. This could be via an indirect or direct pathway. For instance, police violence is a public health crisis that exemplifies the explicit way racism plays a role in health outcomes, with Black people dying at disproportionate rates at the hands of those who swear to protect us. Indirectly, we understand that racism induces a stress response in individuals that leads to an increased prevalence of cardiovascular disease, depression and a slew of other illnesses in this population. Undoubtedly, this is not the only way racism leads to a disproportionate burden of disease on marginalized communities. What we must also understand is that systems of oppression are universal because colonialism is universal. The same systems that allow for LMICs to be deprived of vaccines perpetuate the marginalization of Black and Indigenous communities in the United States, endorse the ethnic cleansing of Rohingya Muslims in Myanmar and permit the genocide of Palestinians and Uyghur Muslims in Palestine and China. While these examples may raise the question of relevance to public health, apart from the direct adverse health outcome — death — that comes with the cited examples, there are other health conditions that come about due to stressful, violent and dangerous living environments, such as a greater prevalence of malnutrition and anxiety. Therefore, our work as aspiring students in the field of public health necessarily encompasses global liberation.
Since these structural inequalities and oppression are inextricably linked and global in nature, public health activism cannot stop within the borders of the United States. We cannot pick and choose what populations “deserve” liberation and we cannot be selective in our activism. As long as systems of oppression are upheld, all marginalized communities will continue to suffer and health inequities will continue to run rampant. It is imperative that our pursuit of decolonization is not solely based on theory, but also found in practice: we must uplift the voices of activists and organizers in LMICs and spotlight issues that affect the most marginalized communities in these countries. Every decision we make must center on decolonization. It is our duty as public health students to view our work through the lens of liberation, through the lens of global equity and, of course, through the lens of hope.
CSG President Nithya Arun can be reached at email@example.com