• Delivette Castor and Luisa N Borrell.
• Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, Columbia University, New York, NY, USA. Electronic address: dc2022@cumc.columbia.edu.
• Prev Med. 2022 Oct 1; 163: 107227.

AbstractWe discuss the evolution of terminology, beginning with colonial medicine and ending with global health. We describe how global health's definition evolved to include language on autonomy, power, and health equity. Specifically, we studied the websites of the twenty-five‑leading national (N = 5), multilateral (N = 5), philanthropic (N = 5), non-governmental organizations (N = 5) in research, health service delivery, and advocacy, and academic institutions (N = 5) within global health to understand their history, places of critical operations, budget, organizational structure, leadership, mission, policies, and representation of the global south. These illustrative examples showed organizational structures and bureaucratic processes persisting unchanged as linguistic changes on equity occurred. We posit that within this global health framework of equity, non-convergence of language purporting global health equity with static praxis is damaging on many levels. We underscore that the epistemological-praxis disconnect creates organizational psychology akin to cognitive dissonance within individuals, particularly among practitioners from the global south. This dissonance perpetuates inequity across global health organizations uniquely structurally impedes decolonization by and in the institutions that promote global health, and undermines the achievement of current goals across the global health system. To truly decolonize global health, researchers must measure and study changes in how organizations operationalize their goals, structures, policies, and administrative processes to address equity and social justice across all sectors of the global health system.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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