Critical Reflexivity When Working With Marginalized Communities in Global Health

By Hyacinth B. Domingo, Perspectives Editor (2024-2025)

The trend of global health initiatives and programs in marginalized communities in the Global South comes with the potential to contribute to—and reinforce—a colonial framework. This risk emerges through the marketing of the community as an exotic experience, the inequitable “partnership” between the host institution and the high-income country (HIC) medical school, and the very fact that these programs often depend on the opportunities found in the inequities of low-income settings—settings marked by limited technology and high disease burdens—to provide work experience (Garba et al., 2021; Crane, 2010).

As the explicit integration of global health’s colonial legacy is still underway in medical curricula, it becomes the responsibility of participants—especially those considering going to a low- and middle-income country (LMIC)—to educate themselves on how to recognize, refuse, and reject colonizing systems, practices, and thought processes within global health initiatives. At the heart of this individual responsibility lies the need for genuine social transformation through critical reflexivity.

Image from Global Digital Citizen Foundation. Source: https://am.aals.org/wp-content/uploads/sites/4/2020/01/AM20LawMedicineHealthPovertyPierson-BrownGraphics.pdf

Critical reflexivity underlines the importance of shifting away from the self. It asks us to acknowledge our capacity to do harm in various forms, to identify and name that harm (i.e., racism, settler colonialism, white dominance), and to actively seek resolution (Badwall, 2016). This process is not without risk—particularly the risk that comes from relying on our own understanding of the harm we have caused. Doing so can position us in a place of power, while casting the individual or community we have harmed as powerless.

Blackstock (2009) emphasizes the importance of centering the person or community who has experienced harm. It is their right—not the offender’s—to define the harm that was done to them. The offender must take the initiative to adopt the position of a learner, recognizing the harmed individual or community as the expert. This means asking how they were impacted, rather than assuming or defining that experience. The offender is also not entitled to define the solution to the harm they caused. In conflict resolution, they must take on a supporting role—encouraging the person or community to identify the approach that aligns with their worldviews and knowledge systems, and providing the necessary tools or resources to help them achieve their goals.

For global health program participants, especially those from HIC medical institutions, the risk of reinforcing power and privilege is heightened. This is particularly true given that medical education often centers on identifying the problem and prescribing the solution. That framework does not easily accommodate a model of shared knowledge and community-defined priorities. All of this highlights that the risks within critical reflexivity do not exist separately from the person practicing it. These risks arise when we center ourselves in the process—an action that ultimately undermines the purpose of critical reflexivity itself.

Critical reflexivity must always center the person or community who has experienced harm. The acknowledgement of harm, its definition, and its resolution must be done in partnership. In the context of global health, participants must recognize that they are always at risk of causing harm due to the inherent power imbalances between themselves and the communities they enter—regardless of whether their work is described as “in partnership.” Participants must shift the role of expert onto the host institution and resist deferring to the systems and agendas set by the global health industry or by their HIC medical institutions.

Critical reflexivity bridges the way we think with the way we help. It is grounded in critical thinking: accepting different ideas and perspectives from the community and from non-traditional sources of knowledge, questioning all assumptions, and consistently interrogating our own roles, behaviors, and ways of thinking (Dumbrill & Ying, 2019).

In the context of global health programs, this means refusing to passively follow dominant systems or frameworks established by HIC medical institutions or funders. Instead, HIC participants must ask themselves: How do power differentials influence the way we provide services? Who drives our intervention strategies? What sources or voices shaped our planning and decisions?

These questions not only push participants to reflect on their impact on the people and environment they work in, but also help them to uncover aspects of themselves—such as their social location and identities—that may create barriers to building relationships or providing support in ways that are meaningful to the community or host institution.

Participants from HICs must cultivate critical reflexivity as a core skill to disrupt the ongoing colonizing practices embedded in global health initiatives and programs targeting LMIC partners. Critical reflexivity challenges colonial structures and practices by guiding HIC participants to move away from prioritizing the self and toward centering the community. It shifts unconscious patterns of thought and practice rooted in power and privilege—patterns that ultimately shape how help is offered and relationships are formed in global health spaces.

References 

Badwall, H. (2016). Critical reflexivity and moral regulation. Journal of Progressive Human Services, 27(1), 1–20. 

Blackstock, C. (2009). The Occasional Evil of Angels: Learning from the Experiences of Aboriginal Peoples and Social Work. First Peoples Child & Family Review, 4(1), 28-37. Retrieved from https://fpcfr.com/index.php/FPCFR/article/view/74. 

Dumbrill, G. C. & Ying Yee, J. (2019). Chap  3 Thinking Critically about Power and Practice in Anti-Oppressive Social Work: Ways Knowing, Talking and Doing, Oxford University Press, pp. 29-54 

Crane, J. (2010). Unequal ‘Partners’. AIDS, Academia, and the Rise of Global Health. Behemoth : A Journal on Civilisation, 3. https://doi.org/10.1524/behe.2010.0021. 

Garba, D. L., Stankey, M. C., Jayaram, A., & Hedt-Gauthier, B. L. (2021). How Do We Decolonize Global Health in Medical Education? Annals of global health, 87(1), 29. https://doi.org/10.5334/aogh.3220. 

Hyacinth B. Domingo

is a U1 Social Work student at McGill University. Her background as a private aid worker in older adult long term care residences sparked her passion for understanding the intersectionality between healthcare access/delivery and the social factors surrounding aging. She is currently an active volunteer at The Yellow Door Generations Program and has a passion for other local initiatives like food security with Community Cooks Collective. She served as an Editor for Perspectives in 2024-2025.