Decolonising undergraduate education is a national, arguably global, initiative that takes on different forms in different disciplines and communities of practice. Being based in a School of Medicine, as a Decolonising Academic Lead raising awareness about this initiative, I believe one way into this work is through reforming how we teach about health inequalities. Graduates of the undergraduate degree in the UK become qualified as doctors and I argue that decolonising their curriculum will equip this future generation to practice equitable and inclusive medicine. Decolonising the curriculum in medicine and health professions has the potential to address health inequalities because it develops the next generation of professionals to be critically aware of the impact that colonial legacies have on patient trust in professionals, research practices and healthcare itself.

However, decolonising in higher education has been challenging for several including:

a)      Colonialism and its epistemological, ideological and structural impacts remain today, underexamined and yet are not typically discussed except in certain acedemic disciplines.

b)      Competing demands on time and priorities and funding for those ‘on the ground’ means work is done in silos and not sustained or embedded across the curriculum, leaving the changes unstable and potentially incoherent and appearing as a ‘tick box’ exercise to students.

I want to share insights from my projects with medical undergraduates as student-researchers who conduct rapid literature reviews that focus on a specific review question. From these reviews, we identify colonial legacies, colonial principles and global perspectives that can be used to decolonising teaching on health inequalities. We learn from academic disciplines and countries that have researched colonialism.

I argue that we need focused investigations of the legacies that shape the profession (Naidu, 2021): how the profession sees itself (professional identity), how it provides patient care and the how it conducts health research that informs patient care. The reviews of literature provide a basis from which we can critically analyse colonial legacies and their impact on medicine historically and today in order to inform curriculum development (Sowemimo, 2023). There is a gap in the knowledge that underpins health professions curricula. The reviews address one of the ways that the guide produced by the Medical Schools Council in the UK (2025) has identified as an area for decolonising the curriculum.

To move the decolonising initiative forward we have to meet people where they are and build on their existing knowledge and priorities. Given that cultural competency and inclusion health are priority areas for medicine in the UK, we can start there and move the conversation to structural competency (Metzl and Hansen, 2014), considering inequalities due to structure in society. To decolonise, we would then explore ways of re-humanising healthcare and employ a Cultural Safety approach (Lokugamage and Marya, 2023).

The talk will argue for a decolonising approach that considers the education and support of educators to implement decolonial principles into their teaching and curriculum design. Based on the literature reviews and my experience as a Decolonising Academic Lead, I suggest principles and concepts that specifically analyse colonial legacies in relation to health inequalities. The outputs are intended to support educators in decolonising through conversations.

To decolonise a curriculum, educators need to reflect on colonial legacies and the related belief systems. Decolonising is not about imparting a particular ideology but aims to support learning that promotes reflection on how we are brought up in and taught a particular ideology. By diversifying our curriculum we widen the scope of ideas we can use to discuss and understand how belief systems have implications today. In medicine, the argument is that history matters for today’s health inequalities.

The literature reviews start with a question which directs the literature search strategy. The first review was looking at: 'what does the literature say about pain and how would reflections on colonialism help us understand current health inequalities where pain is a factor?' The reviews deliberately sought to identify researchers and studies from a diversity of backgrounds and contexts. This contributes to decolonising our research and addresses the underrepresentation of certain backgrounds and types of research. By incorporating a broad range of perspectives, the review aims to ensure that its findings open up our understanding and provide new ideas for solutions to the problem of health inequalities. PubMed and Scopus were the databases used for the first search. Our library also has a number of databases use for later reviews which access Global South databases. The articles chosen for analysis were identified through research team discussions and refinement of our review question to set the boundaries of each review project. We select papers that fulfill our inclusion criteria and set parameters such as being in English. While these and other exclusion criteria present limitations we have chosen to start the initatiave using available resources which involve UK-based medical students. The student-researcher thematically analyses the papers (10-20) and as a team we critically analyse the articles these to idnetify principles. We then identify further papers that are author-recommended or that we think are useful to advance the analysis of the topic. We specifically consider ways the themes and analysis can point to educational innovation in health professions education and inequalities teaching. The following principles were used to support the analysis and inform search terms we used alongside ‘decolon*’ and ‘colonial*’ terms: • Hierarchy (in knowledge and research methods and groups of people) • Race as a scientific or biological category (reviewing categorisations and whether or not the social construction of race is acknowledged) • Racism and its role in systemic inequalities (whether the health inequlity considers these systemic factors as arbitrary or has questioned the social, economic, cultural and historical facets that can be traced to colonialism as a way to enrich our understanding and hence our ability to redress inequalities). • Paradigms of knowing and knowledge that are valued (e.g. objective science) and the invisibility that occurs when one paradigm or culture or history is presented as ‘normal’ which creates different paradigms at the margins or ‘other’ and not valued.

To avoid criticisms of institutional responses being ‘strategic’ and superficial (Shain et al 2021), the decolonising initiative must do more than diversification of reading lists (Arday, 2021. It must consider pedagogy and our learning objectives in a contextualised way. The missing context has been our colonial history. While each nation will have their own colonial history and positionality in the global landscape, I hope that the ideas generated through these analyses of colonial legacies in health and medicine for UK undergraduate higher education can be adapted to apply in other disciplines. As teaching on health inequalities is not just done in medicine, we can use these ideas as the impetus for decolonising in other areas to start the ball rolling. I believe decolonial thinking will unfold in other areas of education over time, ultimately improving learning and teaching in higher education and improving research, by making it more inclusive, building up the next generation of researchers to have a wider global perspective. We start where people are in their understanding and their priorities. We promote dialogue amongst educators so they can bring these discussions to students confidently. Pedagogically, decolonising will require new approaches that support critical reflection on ideologies or belief systems and how they influence our practices, systems and values (Paton et al, 2020). In healthcare where equality is a priority (NHS, 2025) specific consideration is needed for how professionals engage with and treat their patients or service users and where colonial legacies may be influencing their practice and understandings of professional practice, including research. Research from other disciplines such as humanities and social sciences can help better integrate subjective accounts into what is largely an objective science subject.

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