Colonialism as a Tool for Investigation in Healthcare

MedHums 101: The concept of colonialism can solve problems of intersectionality in medical humanities research, says Samuel Yosef.

Let’s start with a very necessary question: what is colonialism? As is usually the case with phenomena that are influential and pervasive, there are different ways to define this concept, especially when we take into account different worldviews and disciplines. Given the audience for this piece, and my own research, my approach is rooted in social sciences and humanities.

Colonialism resulted in social stratification through the creation of “the other” (Ashcroft, Griffiths and Tiffin 2008, 32), which is the basis for today’s inequities. This is reflected in the use of concepts like race in the colonial era to demark and categorise subjects of the Empire and create hierarchies and stratification (Ashcroft, Griffiths and Tiffin 2008, 181). But colonialism goes beyond race and affects other categories and identities as well. The colonial system succeeds in creating a hierarchy that puts at the top the white, cisgender (Elnaiem 2021; Mohan and Le Poidevin 2020), heterosexual (Meiu 2015), able-bodied (Soldatic and Grech 2018), Christian (Lachenicht, Henneton and Lignereux 2016), male (Lugones 2016).

Building on this literature, we can define colonialism as a process based on systemic violence, occupation, erasure and exploitation to create and justify the idea of “the other”, which reinforces and validates the idea of social stratification and hierarchies. This process creates a system which places at the top those that are born within the aforementioned categories.

A diagram with the heading 'Defining colonialism' repeating the information from the previous paragraph.
Image: S Yosef

Colonialism and healthcare

How does this affect the medical world? As illustrated in a recent Lancet series, racism, xenophobia and discrimination exist in every modern society, causing avoidable disease and premature death among groups who are often already disadvantaged (Devakumar et al. 2022). One way to address the health harms caused by these phenomena is to recognise, examine and undo the legacies of colonialism (Abubakar et al. 2022).

When I speak to people about this concept, I often hear comments along the lines of, “well yes, but it’s all in the distant past now,” or, “colonialism ended so many years ago!”. These comments are inaccurate, not only because formal colonial relationship ended less than thirty years ago, but especially because most colonial ties were re-established under a different guise within the frameworks of the current geopolitical landscape.

As a concept and a mindset, colonialism has informed how systems and knowledge have been built, implemented, and disseminated for the past 500 years, so it still has a very tangible influence on our lives and in particular on the medical world, patient care, and medical education (Naidu 2021). Let’s give some examples on the social identities I mentioned above.

There is increasing public awareness in the NHS, healthcare community, and academia of racism in medicine (BMJ 2023). Racism leads to a higher rate of adverse outcomes for people of racially minoritised backgrounds (Chauhan et al. 2020). Moreover, reports like the Marmot review (Marmot 2020), which was first carried out in 2010 and then reviewed in 2020, show that those from minoritised backgrounds are more likely to experience unemployment, poor housing and poverty, which all affect health outcomes.

The issues of racism, prejudice, and discrimination in healthcare are bifold: they not only affect people accessing services but also healthcare professionals working in the system. Research on differential attainment in medical education (Woolf 2020) shows those from racially minoritised backgrounds are negatively affected by discrimination at all stages of studying and training as well as in their professional careers.

The issue of inequality in access to healthcare for women, also known as the gender health gap, is well known (Winchester 2021). The effect of prejudice and stigma on access and experiences of trans and gender non-conforming people is also well documented, especially in the field of obstetrics and gynaecology (O&G). Studies have shown that there is little attention to the experiences of these groups in O&G (Light et al. 2014). We also know that “Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care […] systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications” (Jaffee, Shires and Stroumsa 2016).

There is also evidence that disability leads to poorer health, wellbeing and healthcare outcomes in the UK (Hackett 2020). And we know that religion affects the training and experiences of doctors in the NHS (Malik et al. 2019) and that religion plays a role in health disparities (Laird et al. 2007).

A close up photo of an old fashioned globe, the map browned and crinkled with age, the rim marked with the months of the year and the signs of the zodiac
Colonialism resulted in social stratification through the creation of “the other‘’ (Ashcroft, Griffiths, and Tiffin 2008, 32). Photo by Viktor Forgacs on Unsplash

Colonialism as a tool for investigation

Now that I have painted the picture of colonialism in healthcare, how can we use this concept in our research? Thinking about colonialism, as defined above, allows us a unique and thorough understanding of different social phenomena and is a gateway to including intersectionality of different minoritised identities.

Looking at studies analysing prejudice, discrimination and bias, in the limitations and suggestions for further research sections you can often see a call for more intersectionality. This is a common barrier and frustration for researchers. By using colonialism as a tool for investigation and as the background in which we situate our research, we can look at the root of the issue, instead of its branch. By finding the root, we can investigate what the solution might be at the source and (co)create solutions that will have wider and more impactful benefits across the board.

Moreover, using approaches that are aware of the impact of colonialism on knowledge production and dissemination and rely on post-colonial and decolonial theories, can inspire us to widen our horizons in terms of the knowledge and expertise that we rely on, value, and reference in our own academic work and to truly centre the lived experiences and knowledge of those that have been minoritised for so long.

About the author

Samuel Yosef is a first year doctoral student at King’s College London (KCL) in the Cultural Competency Unit. His project looks at the influence of colonialism on Obstetrics and Gynaecology training in the UK and is funded by the Economic and Social Research Council (ESRC) through the London Interdisciplinary Social Science Doctoral Training Partnership (LISS – DTP). You can connect with him on Twitter/X and LinkedIn or via samuel.yosef@kcl.ac.uk 

About MedHums 101

Our ‘MedHums 101’ series explores key concepts, debates and historical points in the critical medical humanities for those new to the field. View the full ‘MedHums 101’ series.

References

Abubakar, Ibrahim, Lu Gram, Sarah Lasoye, E Tendayi Achiume, Laia Becares, Gurpreet Kaur Bola, Rageshri Dhairyawan, Gideon Lasco, Martin McKee, Yin Paradies, Nidhi S Sabharwal, Sujitha Selvarajah, Geordan Shannon, and Delan Devakumar. 2022. “Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems.” The Lancet 400 (10368). https://doi.org/10.1016/S0140-6736(22)01989-4. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01989-4/fulltext.

Ashcroft, Bill, Gareth Griffiths, and Helen Tiffin. 2008. Post-Colonial Studies: The Key Concepts. London: Routledge.

BMJ. 2023. “Racism in Medicine Collection.” BMJ Publishing Group Ltd. Accessed 20/12/23. https://www.bmj.com/racism-in-medicine.

Chauhan, Ashfaq, Merrilyn Walton, Elizabeth Manias, Ramesh Lahiru Walpola, Holly Seale, Monika Latanik, Desiree Leone, Stephen Mears, and Reema Harrison. 2020. “The safety of health care for ethnic minority patients: a systematic review.” International Journal for Equity in Health 19 (1): 118-25. https://doi.org/10.1186/s12939-020-01223-2.

Devakumar, Delan, Ibrahim Abubakar, E. Tendayi Achiume, Kui Muraya, Yin Paradies, Angela Saini, Sujitha Selvarajah, and Geordan Shannon. 2022. “Executive summary.” The Lancet (British edition) 400 (10368): 2095.

Elnaiem, Mohammed. 2021. “The ‘Deviant’ African Genders That Colonialism Condemned.” 14/12/2023. https://daily.jstor.org/the-deviant-african-genders-that-colonialism-condemned/.

Hackett, Ruth A. 2020. “Disability discrimination and well-being in the United Kingdom: a prospective cohort study.” BMJ, Mar 12;10(3):e035714. doi: 10.1136/bmjopen-2019-035714

Jaffee, Kim D., Deirdre A. Shires, and Daphna Stroumsa. 2016. “Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery.” Medical Care 54 (11): 1010-1016. https://doi.org/10.1097/MLR.0000000000000583.

Lachenicht, Susanne, Lauric Henneton, and Yann Lignereux. 2016. “Spiritual Geopolitics in the Early Modern Imperial Age. An Introduction.” Itinerario 40 (2): 181-187. https://doi.org/10.1017/S0165115316000309.

Laird, Lance D., Mona M. Amer, Elizabeth D. Barnett, and Linda L. Barnes. 2007. “Muslim Patients and Health Disparities in the UK and the US.” Archives of Disease in Childhood 92 (10): 922-926. https://doi.org/10.1136/adc.2006.104364.

Light, Alexis D., Juno Obedin-Maliver, Jae M. Sevelius, and Jennifer L. Kerns. 2014. “Transgender Men Who Experienced Pregnancy After Female-to-Male Gender Transitioning.” Obstetrics and Gynecology (New York. 1953) 124 (6): 1120-1127. https://doi.org/10.1097/AOG.0000000000000540.

Lugones, Maria. 2016. “The Coloniality of Gender.” In The Palgrave Handbook of Gender and Development: Critical Engagements in Feminist Theory and Practice, edited by Wendy Harcourt, 13-33. London: Palgrave Macmillan UK.

Malik, Abida, Hafsah Qureshi, Humayra Abdul-Razakq, Zahra Yaqoob, Fatima Zahra Javaid, Faatima Esmail, Emma Wiley, and Asam Latif. 2019. “‘I Decided Not to Go into Surgery due to Dress Code’: A Cross-Sectional Study within the UK Investigating Experiences of Female Muslim Medical Health Professionals on Bare Below the Elbows (BBE) Policy and Wearing Headscarves (Hijabs) in Theatre.” BMJ Open 9 (3): e019954-e019954. https://doi.org/10.1136/bmjopen-2017-019954.

Marmot, Michael. 2020. “Health Equity in England: The Marmot Review 10 Years On.” BMJ (Online) 368: m693. https://doi.org/10.1136/bmj.m693.

Meiu, George Paul. 2015. “Colonialism and Sexuality.” In The International Encyclopedia of Human Sexuality, edited by Patricia Whelehan and Anne Bolin. Chichester, West Sussex: Wiley-Blackwell.

Mohan, Megha, and Olivia Le Poidevin. 2020. “Pre-Colonial Communities’ History of Gender Fluidity.” [Video]. Accessed 21 December. https://www.bbc.co.uk/news/av/world-53573764.

Naidu, Thirusha. 2021. “Modern Medicine Is a Colonial Artifact: Introducing Decoloniality to Medical Education Research.” Academic Medicine 96 (11): S9-S12. https://doi.org/10.1097/ACM.0000000000004339.

Soldatic, Karen, and Shaun Grech. 2018. Disability and Colonialism : (Dis)Encounters and Anxious Intersectionalities. London: Routledge, Taylor & Francis Group.

Winchester, Nicole. 2021. “Women’s Health Outcomes: Is there a Gender Gap?”. House of Lords Library. Accessed 21 February 2024. https://lordslibrary.parliament.uk/womens-health-outcomes-is-there-a-gender-gap/.

Woolf, Katherine. 2020. “Differential Attainment in Medical Education and Training.” BMJ (Online) 368: m339-m339. https://doi.org/10.1136/bmj.m339.

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