How a 125-year-old medical institution is confronting its colonial legacy

Health · Published 18 October 2026 Swipe more like this →

In short: Founded to train physicians for Britain's tropical empire, the London School of Hygiene and Tropical Medicine has been a global leader in epidemic response. Today, however, the institution faces a profound internal reckoning as it grapples with evidence of structural racism and the complexities of decolonising global health research.

Established in 1899 by Sir Patrick Manson, the school was originally designed to prepare doctors for service within the British colonial empire. Supported by a £6,666 donation from the philanthropist B. D. Petit, the institution's early mission focused on treating those working throughout Britain's tropical territories. This historical foundation has shaped its long-standing research presence across Africa, including permanent units in The Gambia and Uganda. The school's current director, Professor Liam Smeeth CBE, oversees a massive operation that includes roughly 4,000 students, many of whom study via distance learning. This global reach is supported by a significant annual income, which reached approximately £251.7 million for the 2024–25 period.

While the school has achieved monumental scientific milestones—such as demonstrating the link between smoking and lung cancer and developing the 'sisterhood method' for maternal mortality data—it is currently navigating a period of intense scrutiny. An independent 2021 review revealed evidence of structural racism within the institution, noting that staff of colour faced barriers to promotion and were more likely to hold short-term contracts. The school's leadership has since apologised and committed to addressing these systemic issues. The institution's scientific legacy is vast, ranging from the first randomized controlled trials in 1948 to the discovery of the link between asbestos and lung cancer in 1955. Even during the height of World War II, the school continued to provide essential training for medical personnel serving the Allied Forces.

The challenge of decolonisation extends beyond internal policy to the very nature of global health science. Researchers are now exploring how to dismantle the dominance of Western-defined knowledge models and address 'epistemic injustice' in partnerships. While individual efforts like equitable authorship and knowledge co-production are emerging, scholars note a persistent lack of institutional appetite to overcome the structural barriers that define much of the field's current funding and power dynamics.

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