Why is Eastern Europe missing from Global Health’s decolonization conversation?

In global health today, conversations about colonial legacies are gaining long-overdue traction. We’re reckoning with how tropical medicine served imperial interests, how aid and knowledge production reflect deep power asymmetries, and how colonial structures continue to shape governance and funding flows. This is more present now in conversations after the pullout of USAID health funding from multilateral and bilateral relationships, although talk of health sovereignty and regional self-sufficiency in health was present in multilateral spaces even before this year.

But there’s a blind spot I keep noticing in conversations among people surfacing power imbalances in global health, as well as Western institutions where anticolonialism requires self-reflection and learning about own social and institutional history.

Eastern Europe is almost entirely absent from these conversations about colonial legacies in health.

As someone who grew up in socialist Yugoslavia and later studied business and economics (first in Slovenia and then in the US in late 1990s) I saw the "transition" narrative unfold in real time. What struck me back then still feels unresolved now, 30 years later; the dominant story was about fixing inefficient economic or health systems, not about reckoning with the deeper histories of imposed ideologies, foreign domination, or collective resilience.

Eastern European countries were often colonized, but not in the way global health typically defines colonialism. Our region experienced centuries of domination by the Ottoman, Habsburg, Russian, and Soviet empires. Later, the Cold War divided the world into ideological blocs, casting Eastern Europe as the “Second World.”

In Slovenia, the history of subordination and foreign influence runs deep and I think it shows up in the stories and stereotypes Slovenians tell about ourselves: that we are "hardworking and industrious, albeit a bit melancholy, prone to jealousy and drinking too much". After Slovenia's declaration of independence, the government made efforts to recast the narratives about how "subordinate and obedient" we are or what we tell ourselves we are.

After World War II, the countries in Eastern Europe informed by their histories (see examples from Czechoslovakia, Hungary, Poland, and Yugoslavia) developed health systems based on social medicine, primary healthcare, health as a human right (see here for the story of Andrija Stampar, proponent of social medicine, and his influence of WHO constitution).

Yugoslavia took a particularly unusual path after World War II. It broke away from the Soviet bloc in 1948 and for 40 years built a self-managed socialist development model that was non-aligned, domestically participatory, and globally engaged. In 1961, Yugoslavia, India, Egypt, Ghana, and Indonesia founded the non-aligned movement, stating that they wanted to govern their country's independent of the power of the capitalist West and the influence of socialist counties. They wrote that the purpose of the organization was to help countries keep their "the national independence, sovereignty, territorial integrity and security of non-aligned countries" in their "struggle against Imperialism, Colonialism, Neocolonialism, Racism, and all forms of foreign aggression, occupation, domination, interference or hegemony as well as against great power and bloc politics."

And yet, after the Cold War, though 1990s and 2000s, the dominant lens on our region became one of transition. Donor-funded reforms emphasized privatization, decentralization, and cost-efficiency, often at the expense of continuity, access, and trust. Health systems were treated as technical challenges rather than political and cultural institutions shaped by layered histories of repression and solidarity.

Today, many countries in the region still wrestle with health workforce shortages, institutional distrust, and fragmented care systems. Public health systems often struggle for legitimacy, and population health indicators remain uneven. The legacies of both socialism and post-socialist reform are still playing out in our financing models, service delivery, and collective memory.

So why is Eastern Europe missing from the conversation on colonialism and its impacts in global health?

Partly because our experience doesn’t fit the neat colonizer/colonized binary. And partly because the West’s lens on us has often been technocratic, not historical or relational. But if we are serious about decolonizing global health, we need to broaden our scope to include ideological domination, economic dependency, and the erasure of knowledge traditions that don’t conform to dominant models.

Eastern Europe doesn’t need to be a footnote in this conversation. It deserves to be a chapter and one that challenges how we define colonial legacies, power, and reform.

I hope more of the conversation about how colonial legacies are shaping global health and regional and national public health systems think more along these lines:

"We define colonialism as one group of people having the power to dominate, subjugate and/or exploit another group or groups of people, thereby enabling the misappropriation and extraction of resources in a large-scale and systematic manner."

from McCoy D, Kapilashrami A, Kumar R, Rhule E, Khosla R. Developing an agenda for the decolonization of global health. Bull World Health Organ. 2024 Feb 1;102(2):130-136