Kividi Koralage, an independent researcher in international development and geopolitics examines how colonial legacies, economic models, and global health governance shape healthcare disparities.This blog post stems from Kividi’s research on global health inequalities as part of the global health politics session presented at the British International Studies Association’s (BISA) virtual conference in January 2025. She reflects on historical injustices and the need for equitable healthcare systems. Kividi addresses how these challenges require reform in global health governance to promote equitable access to medical resources, and prioritise healthcare as a universal right.
Global health disparities persist as one of the most pressing challenges in international development. While some regions benefit from cutting-edge healthcare, others suffer from poor infrastructure, inadequate medical access and preventable diseases. These disparities are deeply rooted in historical inequalities, particularly colonial legacies that shaped healthcare systems in the Global South. Additionally, economic models such as unregulated capitalism have exacerbated inequalities, prompting discussions on global degrowth as a potential solution. How has colonialism influenced global health in the Global South, and what roles do the World Health Organization (WHO) and regional bodies play in addressing health inequalities. We also look at comparative case study of North and South Korea to understand health inequalities and potential policy solutions. Finally, we look at providing recommendations to bridge these gaps.
Enduring the Consequences of Colonialism
The modern healthcare divide cannot be fully understood without acknowledging the impacts of colonialism. European colonial powers established healthcare systems in their colonies to serve their economic and political interest rather than the well-being of indigenous population. Colonial administration-built hospitals and medical facilities were mainly built in urban centres and neglected rural populations. Colonisers often used indigenous and colonised population as test subjects for vaccines and medical trials as seen in French and British African colonies. Many postcolonial nations inherited healthcare systems reliant on foreign aid, expertise and pharmaceutical imports, leaving them vulnerable to external shocks. The structural inequalities created by colonial rule continue today, manifesting in a lack of medical infrastructure, brain drain of healthcare workers to the Global North, and dependency on Western pharmaceutical companies for essential medicines.
Pharmaceutical Monopolies & the Struggle for Affordable HIV/AIDS Treatment
The glaring disparity in the cost of antiretroviral (ARV) drugs for HIV/AIDS in Africa compared to the US today is a direct reflection of the imperialist structure in global health governance, pharmaceutical monopolies and trade regulations.
For many years, lifesaving AIDS medication were significantly more expensive in Africa despite the continent being the most affected by the epidemic due to pharmaceutical companies’ interests and neocolonial economic dependencies. For decades, pharmaceutical companies charged substantially higher prices for AIDS medication in Africa than in the US, often two to three times more, despite the continent being the most affected by the epidemic as per Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Centre for Global Development (UNAIDS, 2021). This was mainly due to market-based pricing strategies, which meant pricing drugs according to a country’s perceived economic capacity. Ironically, despite having lower GDPs, African nations were paying more per unit. This reflects a neocolonial approach to global health in which access to essential medicine was controlled by Western firms, leaving African governments dependent on donor funding and foreign aid rather than fostering self-sufficient healthcare solutions.
Later in the 1990s, South African challenged these pharmaceutical monopolies by pushing for local production of generic ARVs. This led to a landmark legal battle against 39 multinational pharmaceutical companies in 2001. During this time, India’s generic pharmaceutical industry particularly companies like Cipla started to produce low-cost generic ARVs defying the international and treaty regulations and supplying to Medecins Sans Frontières (Doctors Without Borders), and other Global South governments with significant HIV/AIDS problems. Since, then the price of ARVs in sub-Saharan Africa has dropped significantly since generic options were introduced, with prices for generic ARVs falling to as low as $75 per person per year (UNAIDS, 2021).
COVID-19 Vaccine Diplomacy: Geopolitical Influence & Global Health Inequities
In 2020, COVID-19 vaccine diplomacy reshaped global geopolitics, highlighting the power struggles between major nations and their influence over the Global South. While China, Russia and India leveraged vaccines to expand their diplomatic reach, the West’s late but large-scale donations ensured its continued dominance in global health governance. The pandemic exposed inequalities in global health access but also set the stage for a more decentralised and regionally controlled vaccine production system in the future. China aggressively used vaccine diplomacy to expand its global influence, especially in Africa, Asia and Latin America. Sinopharm and Sinovac vaccines were exported to over 100 countries targeting countries in the Global South. China framed its vaccine aid as part of its global infrastructure development strategy, the Belt Road Initiative, reinforcing long-term partnership with other regions. Beijing promoted vaccine donations and sales at affordable prices, contrasting with Western nations that prioritised commercial contracts. China’s influence in Africa and Latin America depended on ties with the countries in the Association of Southeast Asian Nations (ASEAN) and positioned China as an alternative to Western-led health governance.
Strengthening Global Health Governance: The Role of the WHO & Regional Organisations
Since 1948, the WHO has played a crucial role in coordinating global health responses, but it faces criticisms for its slow response to crises, underfunding and influence from powerful states and private donors. Regional organisations such as Africa Centres for Disease control and Prevention (Africa CDC), founded in 2016, have strengthened pandemic preparedness and vaccine production in Africa. The Africa CDC strengthens pandemic preparedness across the continent through coordination, surveillance, and emergency response, while also championing local vaccine production to improve access and reduce reliance on external sources. Their efforts have enhanced public health systems and contribute to a more secure health future for Africa, through enhanced disease surveillance and early warning system and enhancing regional health cooperation and fosters cross-border collaboration and data sharing among African nations to tackle health threats collectively.
Global South based regional health organisations are working together. ASEAN health cooperation and Southeast Asian nations have also collaborated on disease surveillance and joint medical research. ASEAN member states actively collaborate on health initiatives, exemplified by the ASEAN Emergency Operations Centre Network, which facilitates information sharing and coordinated responses to public health emergencies. This cooperation, along with joint medical research and other programs, strengthens regional preparedness and improves health security across Southeast Asia (US Mission to ASEAN,
2024).
To be effective the WHO must work closely with these regional bodies, ensuring equitable access to medical resources and empowering local governments. These regional bodies can act as bridge between the global and national policy levels.
A Tale of Two Koreas: Contrasting Healthcare Systems and Outcomes
North and South Korea offers a striking contrast in healthcare outcomes despite their shared history before the Korean War. South Korea, with a universal healthcare system advanced medical technology and high government spending on health, and ranks among the best healthcare system globally. In contrast, North Korea suffers from sanctions, political isolation and poor infrastructure which has left the country with limited medical supplies, malnutrition and preventable disease outbreaks. The key factor that influences disparity is South Korea’s rapid industrialisation allowing for investment in public health, while North Korea’s economic struggle hindered economic growth. South Korea also prioritises healthcare spending whereas North Korea’s resources are largely directed towards military development. As per the World Bank Report 2022, South Korea spends approximately 10% of its GDP on healthcare while North Korea spends only around 3.5% reflecting the disparity in their healthcare investment. In 2020 South Korea’s life expectancy was 83 years, compared to 72 years in North Korea.
Towards Equitable Global Health: Policy Reforms and Collaborative Solutions
Addressing global health inequalities need a structural reform. The following policy measures should all be implemented: reforming WHO’s funding model to reduce heavy reliance on Western donors, prioritising local production of essential medicines in developing nations, and empowering regional health organisations with decision-making authority. For example, the African Union’s Africa Centres for Disease Control and Prevention (Africa CDC) has made strides in strengthening pandemic preparedness and vaccine production across the continent. Additionally, regional health initiatives, such as the ASEAN Health Cooperation framework, have enabled Southeast Asian nations to collaborate on disease surveillance and joint medical research. The ASEAN+3 Field Epidemiology Training Network (FETN) enhances regional disease surveillance, outbreak response, and joint medical research, fostering collaboration among ASEAN nations to strengthen public health security.
Promoting sustainable healthcare policies that prioritise prevention over profit-driven treatment is essential, as evidenced by Costa Rica’s National Health System, which focuses on universal access to prevention and care rather than expensive curative treatments. Redirecting excess medical resources from overconsuming nations to underprivileged regions is already happening through Medicines Sans Frontieres , which provides essential treatments in resource-poor settings. Furthermore, developing regional health emergency response teams, such as the WHO’s Health Emergencies Programme (set up in 2016), and encouraging cross-border medical training programs, like the Global Health Fellowship Program which provides doctors with volunteer opportunities in Africa, can help build capacity in underserved regions.
Decolonising Global Health
Global health disparities are rooted in historical injustices, economic imbalances, and governance failures. Addressing these issues requires decolonising global health governance, implementing sustainable economic models, and strengthening regional cooperation. The contrast between North and South illustrates how political and economic choices shape health outcomes.
During the BISA 2025 virtual conference in January, I was fortunate to hear from other Global Health Politics researchers, including Katharina Krause and Katharina Wezel University of Tübingen, Ipek Z. Rucan from Yeditepe University, Istanbul, Turkiye and Devika Misra from Jawaharlal Nehru University who covered topics such as regional organisations in Latin America (CELAC) and South Asia (SAARC) fostered solidarity during the pandemic and care ethics approach to protective clothing in pandemic times. The session chaired by Simon Rushton from University of Sheffield.
My research has highlighted that health diplomacy between South Asian countries remains underdeveloped, with few formal alliances or collaborative efforts in addressing shared health challenges. This lack of cooperation underscores how fragmented regional health governance can perpetuate inequalities.
To build a more equitable world, international organisations, governments, and civil society must work together to ensure healthcare is a universal right, not a privilege. Strengthening regional health diplomacy, particularly in South Asia as discussed at BISA, would be a crucial step in addressing these disparities.
The views and opinions expressed in this blog post are solely those of the blog post author. These views and opinions do not necessarily represent those of Global Souths Hub and/or any/all contributors to this site.
About Kividi Koralage
Kividi Koralage is a graduate of Edith Cowan University (ECU) in Sri Lanka, specialising in International Business. She is currently pursuing an LLB and an International Relations program at Aberystwyth University in the UK. A CIMA passed finalist and an alumna of the Bandaranaike Centre for International Studies (BCIS), her academic and professional journey is driven by a deep interest in development, law, and global economic systems.
Passionate about understanding how historical inequalities shape modern economies, Kividi explores themes of international law, sustainable development, global degrowth, and the consequences of colonial legacies. She is particularly interested in how emerging economies navigate globalisation, trade policies, and regional frameworks such as the ASEAN Outlook on the Indo-Pacific. Through her LinkedIn blog, Navigating Asia, she examines Asia’s geopolitical and economic transformations, highlighting development challenges and opportunities in the region.
Her research has covered topics including Malaysia’s path to independence, the hidden consequences of Bretton Woods institutions, Thailand’s Bamboo Diplomacy, and China’s Blue Dragon Strategy. As an aspiring researcher in international relations, Kividi seeks to work and contribute to discussions on equitable development, policy innovation, and the evolving role of the Global South in global governance.
