Chapter 1. In the world, but not of it
p. 13-26
Texte intégral
“They are not of the world, just as I am not of the world… As you sent me into the world, so I have sent them into the world.”
John 17:16, 18 (King James Bible, 2017 [1769])
1Long after my Christian childhood, few lines in the Bible have stayed with me as much as the one about being in the world, but not of it. It is an invitation to do something near impossible. Like swimming without being touched by water; your entire body covered by a fine, transparent, waterproof fabric. In it, but not touched by it. Or what the African-American feminist scholar Patricia Hill Collins called the “outsider within” (Collins, 1986). This is how I have often seen my place in global health. In one telling of its history, what we describe as the field of global health today began as an enabler of the European colonisation of much of the rest of the world – as colonial medicine, missionary medicine, military medicine, or tropical medicine (Tilley, 2016; Keller, 2006; Anderson, 2021; Bruchhausen, 2020; Packard, 2016; Seth, 2018). In that telling, the field of global health was created by people who did not recognise my full humanity as a colonial “subject”, and did not have my best interests at heart. Even if I found myself in that field, I could not allow myself to be of it.
2The missionary strand in the origin story of global health involved European colonisers seeking to redeem and reclaim for their God the hell-bound souls of natives (Bruchhausen, 2020; Packard, 2016; Seth, 2018; Hardiman, 2006; Cattermole, 2021). Many of the Christian missionaries were health and care workers, out in the tropics to aid the colonial mission: the Bible in one hand, medicine in the other. Fully convinced their belief system was superior, they cast traditional health, knowledge, governance and belief systems as evil and proceeded with zeal to destroy and erase them. What they did was supremacist savagery disguised as civilising mission. It helped to excuse what else was going on – the invasion, the pillage, the theft, the dispossession, the horrors, the racism, the disrespect, the torture, the terror, the killings. Amidst all that evil, missionaries were busy saving lives and souls, often looking away from what else was going on. If they could show the inherent depravity of the natives, then the colonial mission was justified. In their support of the colonial mission, the missionaries were in the world, and of the world. They were agents of power.
3There is a saying that “All’s fair in love and war” (Smedley, 1850). It speaks to the notion that anything goes when one’s goals are pure – or, in fact, when you have managed to convince yourself and others, against the weight of the evidence right before your eyes and their eyes, that your goals are pure. That you can wreak havoc all you want in pursuit of something worthy – true love, winning a war, being kind, being generous, even preserving or imposing “civilisation”. No matter how appealing that sentiment may be, or how useful it is as an excuse for evil or for bad behaviour, we know that it is not true. All is not fair in love and war. In many ways, colonialism was and continues to be very much a combination of love and war; but the love is a special kind of love. I call it colonial love. If all is fair in love and war, especially in war, it is the job of colonial love to make it seem fair. Many colonisers managed to believe that colonisation was fair. Even more so, like many of their successors who do global health today, many missionaries believed that what they did was love. But theirs was the kind of love that made war palatable. Instead of justice, colonial love served to justify the evil of colonialism.
4The Pentecostal church in which I was raised, the Apostolic Faith Church, arrived in Nigeria in 1944. It came by way of the United States, through a long and branching line of British colonial misadventures and related missionary activities (Robeck, 2017; Anderson, 2005, 2006; Magbadelo, 2004). I was seven when my mother, Sola Abimbola – whom we nicknamed S.O. (her initials) – started to attend the church. What soon stood out for her and the rest of the family about the church was its commitment to the doctrine of divine healing, and its strong opposition to watching television. Unlike earlier colonial Christian missionaries, the church was determined not to be of the world. The church eschewed other worldly things too: wearing jewellery or makeup, using alcohol, tobacco, recreational drugs or therapeutic drugs, dating, body piercing, men sporting facial hair or styling their hair, women dressing in trousers or clothes that were skintight, cut with low necklines, above the elbow, or above the knee – even in the tropical West African climate. It was a grave sin of faithlessness to seek medical services. It was a sin to watch television, which was known among ardent church devotees as “the devil’s box”. But in our family, we did both wantonly, without a sense of transgression, fully aware that doing so meant we were of the world. Whenever fellow church members visited our home, some averted their eyes from the television; others joined in watching, with noticeable unease. But there was no hiding our mother’s work – she was a nurse-midwife at one of the two major hospitals in town.
5Looking back, I wonder if these doctrinal prescriptions were somewhat convenient. That perhaps deprivations are easier to bear if the justification (to not use medical services, television and other "worldly" goods and services) is faith rather than poverty. In the 1990s, Owo, where we lived, was a typical peri-urban town in southwestern Nigeria. Televisions were expensive, and most people could not (and still cannot) afford the cost of health care. Like us, the relatively higher-income families in the church in Owo and elsewhere (there are about 600 branches across Nigeria) often had a television at home. As an astute student of power, and given her social status, my mother quickly gained influence in the church. Her influence also grew because she was a nurse-midwife. The few people in the church with similar social status to ours, people with relative wealth, position and power would consult her in secret when they or members of their family were ill. This was perhaps my earliest lesson in power. I was often there when the consultation started, or served as a go-between to relay messages and medicine. It was in the days before mobile phones were commonplace, and home phones were an extremely rare luxury in peri-urban Nigeria.
6Before my mother – I will refer to her hereafter as S.O. – joined the church, the branch in Owo, like other Apostolic Faith Church branches across Nigeria, had a team of untrained midwives who attended births. Women died during pregnancy or childbirth at a high rate, and so did babies soon after birth. There was no chance S.O. could change church doctrine so that women could seek medical services at any of the health centres or hospitals in town. Even if she did, there was little chance it would make a difference – other barriers, including cost, limited women’s access to health services. So she organised the women in the Owo branch of the church, some of whom already attended deliveries. To ensure her efforts would be accepted, she began with the wives of church elders. She trained the women to care for pregnant women and assist in deliveries more skillfully, ensure sterile procedures, conduct home visits, advise and support mothers during and after delivery, recognise danger signs, and when to consult her, especially in any indication of a potential emergency. She bought medical tools and equipment for use by church midwives. The only thing she had to leave out was the use of medicine. Every week, somewhere within the church premises, the midwives’ group would have training and refresher classes, followed by a prayer meeting, or they would have a group antenatal care session with pregnant women. She later helped to create and support similar women’s groups in Apostolic Faith Church branches across southwestern Nigeria, where she sometimes made consultation visits or accepted invitations to assist difficult deliveries several hours’ drive from Owo.
7Sometimes S.O. would disappear in the middle of the night, returning home in the morning to tell us that a church sister had a baby. Often, she would later mention that such home births involved the use of medicine she had provided freely. Initially done in secret, other midwives in the group soon got to know about such instances of violation of church doctrine, tacitly approved, and maintained a code of silence. This happened in a women-only space. In the broader church, it was still only the elite who would seek consultation and get treated using medicines. When others fell sick, if S.O. was consulted, she would often offer medicine or suggest they go to the hospital or health centre. Usually the patients or their families refused, which often meant that the person would die from the illness. It was never clear to me the extent to which faith, poverty or both was the reason for refusal. Church members died from inguinal hernia, tuberculosis, diabetes, HIV, stroke; children in particular died from malaria and pneumonia. Diarrhoea, once a frequent cause of death, became less so as S.O. trained mothers of young children in the church to use oral rehydration solution. This was accepted. It was neither expensive nor really a medicine, just salt and sugar in water.
8On Sundays, church began at 9:00 am, with 250 to 300 people in attendance, most of them church members. Bible study was led by a Sunday school teacher, followed by a sermon delivered by a church minister. S.O. was not allowed to become a Sunday school teacher, a step on the path to becoming a church minister, because she worked in the medical profession. But she was allowed to join the church choir. I sang in the choir as well. On Sunday evenings at 6:00 pm, we had an evangelistic revival meeting. We would invite as many non-members of the church as we could, even people on the nearby streets. During the Sunday evening service, the choir would sing songs of salvation and redemption and what the Lord can do for you, if you would only believe. After the singing, a minister would invite church members to give testimonies on what the Lord had done for them and could do for you. Church members would tell stories of miracles and answered prayers. Those who had chosen the medical route, consulting S.O. or accepting the help she offered, would give their testimony as though they had not, false evidence on which many other church members would hang their faith. The hypocrisy was never lost on me and my siblings.
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9Observing S.O. and eavesdropping on informal consultations that were often conducted in our living room gave me my first lessons on the social dimensions of health and ill health; on how poverty kills, not alone, but along with other forces. It was also my first lesson in governance – that rules are made for the public and are bent and evaded by the powerful as needed. And that they are often easier to change or evade by stealth, in practice, when no one is looking. In the late 2000s and the early 2010s, when I began to interact with people who do global health just as the “social determinants of health” rhetoric was beginning to gain traction (Marmot et al., 2012), I did not know what to make of the field. What my mother did (S.O. died in 2009) for much of her life was not in fact deemed “global health” because of who did it. It made little sense to me that global health often defined itself by who does it (white people or foreigners) rather than by what is done. If S.O. had been an Irish nun working in a rural or peri-urban town in Nigeria, it would have been global health. Had she been a nurse on a neo-colonialist medical mission from Europe or North America, her work would have been global health. That seemed wrong, conceptually, as a way to define a field of practice or research.
10Like its antecedents, the field of global health is often defined in a way that reserves it for foreigners, for outsiders. As if being an outsider is necessary for the work. Perhaps it is. I always saw S.O. as an outsider in the Apostolic Faith Church. She was in the church but not of it, just as the church is in the world but not of it. Like everyone who defines what they do as global health, S.O. too was working across a gulf – at a distance. The same is true for people who work in public health even within their own country or community. Their inevitably elite status defined by class, income, expertise by specialisation, or other markers of power and privilege means they too work across a gulf – at a distance. We are in a position to do this work locally or elsewhere because we are somewhat elite, or we inevitably become elite as we learn to do it. It is a distance that reflects inequity in society. It is a distance that is inevitably part of public health and global health work, and yet which both fields should, as a guiding star, continually seek to eliminate. This sense of what public health or global health means applies to our health equity or global health work everywhere, including work that takes place in countries and communities in Europe and its settler colonies.
11But during Europe’s colonial misadventure, “global health” was not created to close the gulf of inequity, but to aid and excuse the dispossession that created, widened or entrenched inequity (Acemoglu et al., 2001, 2002; Van de Walle, 2009; Chakrabarti, 2014). Even if some of those involved were unaware of what was implicit in what they were doing, they were inevitably agents of colonial power (Kim, 2021). Some, blissfully unaware; and others, wilfully unaware. Many others knew exactly what they were doing – they were aiding colonial conquest (Bruchhausen, 2020). Their work does not pass for global health as I would define it. Even today, at its most aspirational, global health is still framed as something done by people from the “West” or high-income countries or on their terms, as if they/we have it all figured out; as if people who are marginalised there/here – women, Indigenous peoples, migrants, sexually, ethnically and racially minoritised people – do not require local efforts as well as global solidarity to address inequities. It is a supremacist framing of global health that allows high-income countries to mystify the political origins of inequity at home and abroad.
12If high-income countries’ global health efforts focus on political decisions at home, they/we will have to own up to their/our role in creating, widening or entrenching the inequities they/we seek to address abroad in the name of “global health”. The dominant framing of global health as something that happens elsewhere, away from high-income countries, is also one that makes it possible to pretend that political problems are technical problems. That equity could be achieved through simple, one-off, downstream technical solutions introduced from outside. As a field designed to obscure or mystify the political origins of failures, global health (like public health, international development and development economics), has a clear bias for technical solutions. Yet at its roots, inequity is not, at any scale, a technical problem. It is a political problem, upstream. No matter what she did, S.O. could not save the lives of many of her friends and fellow church members who died avoidable deaths.
13Tropical medicine sought to keep white people on colonial missions healthy. It focused on infectious diseases, sought to explain them and developed drugs and vaccines against them. The focus was technical, but within the colonial political system that it served. The academic disciplines responsible for finding solutions to diseases – pathology, pharmacology, surgery, medicine, microbiology, parasitology – pre-date efforts to achieve equity and would exist without those efforts. The quest to prevent, treat or eliminate disease, even widespread disease, cannot be what defines global health. Sometimes these overlap, but not necessarily, and very often, they do not. Like tropical medicine, the fields adjacent, overlapping and overarching in relation to global health – public health, international development, development economics – default too readily to technical explanations or solutions, and to things that elites in high-income countries or elsewhere care about. They are often, without knowing it, instruments of power, looking after the “natives” (or the marginalised) only when not doing so threatens the security, position or wealth of the colonialists (or the powerful). Global health must therefore be in the world, but not of it. Rather than reenact and reflect the world back to itself in the varied forms of entrenched systems of injustice, global health must offer the world a better version of itself.
14It is in fact distance – and the gaps in knowledge that come with it – which, for me, defines global health: the distance between the helper and the helped. What makes global health peculiar is that decisions are made at a distance, removed from the reality of their targets, or supposed beneficiaries. This is not always physical distance. It is also social distance, even when physically proximate, marked by power differentials across divides of class, income, status, gender, ability, race, caste, ethnicity. It cuts across geographies. It exists inside and between countries. It is present when people with the resources to address inequity do not have the knowledge (or the incentive) to do so or to do it well. In the “public health elsewhere” sense of global health, the distance is even much wider. With distance, feedback and accountability between actors takes longer or does not even happen at all.
15In a field defined by distance, its knowledge infrastructure, its academic arm – how it makes, uses, shares and values knowledge of all kinds – must intentionally bridge that distance and deliberately facilitate exchanges, conversations and connections that limit the distance. The values that underpin whose knowledge is valued, prioritised and privileged must begin from a place that wholeheartedly admits the ignorance that comes with power and privilege. Those values must be based on the recognition that in global health, as in other spheres of life, the only thing “the helper” certainly has more of than “the helped” is power. The helped have far more knowledge on how to intervene in their lives, even if they do not always have access to knowledge that is available within the spaces where they live and move and have their being. We may be in their world, but we are often not of it. We who find ourselves in a position to be helpers, in a position to do global health, must be willing to acknowledge and embrace our ignorance, and take it as the starting point of our work. Work that must begin by seeking, using and sharing knowledge already held by the people we seek to help.
16The helper is in the world of the helped, but not of it. As people who do academic global health, we often make, use and share knowledge about a world we are not of. In defaulting to the knowledge of the helper, the global health literature functions as an exercise in gaslighting. This faux benevolence can make the helped doubt their own thoughts, memories, experiences and sensemaking. What they know, but are told – or related to as if – they don’t. In the context of colonial love, the helped are made to question the validity of how they make sense of the world, and are unable to function fully in their capacity as knowers – as holders, makers, users, sharers of knowledge. There is always the risk of gaslighting in relations between the helper and the helped, given the inherent power differential (Abramson, 2014; Spear, 2019; Sinha, 2020; Ruíz, 2020). Gaslighting is easier in the context of love, especially colonial love, as in the missionary medicine kind of colonial love. But for the African-American activist and philosopher Cornel West, colonial love is no love at all. He asks that we “never forget” – because it is easy to forget – “that justice is what love looks like in public, just like tenderness is what love looks like in private” (West, 2011a, 2011b). In both public and private, love requires that we respect people’s dignity; that we hold them in high regard as knowers.
17It was clear to me while in medical school that I was being trained to be in the world of the helped, but not to be of it; to remain foreign to the realities of most people who will need or seek my care (Naidu & Abimbola, 2022). We were trained – as other medical students in most low-income post-colonial settings around the world – in hospitals that only look after people who could afford to be there, or people who had to impoverish themselves by coming there, many of whom came so late it was already too late. The space was also culturally distant by colonial design, foreign to the daily realities of its supposed users. Delay meant death, or a worsened condition that led to greater spending and further impoverishment. This awareness became intense in my penultimate year in medical school, while on paediatrics rotation and seeing children with malaria whose mothers had delayed coming to the hospital. By the time they arrived, things were very bad; the child was anaemic, in respiratory distress. Nurses, doctors and medical students would blame the mother: Why did you come so late? It’s your fault that your child may die! Send someone home for more money so we can care for your child. Sell your property. Dip into your savings. Do all you can to save your child!
18I joined in saying such things. I did not see what was right in front of me. But a phone call with S.O. helped me see differently. It was the mid-2000s, and mobile phones had become commonplace in Nigeria. I went to medical school at Obafemi Awolowo University, where most of the clinical rotations took place at the teaching hospital in Ile-Ife. But we traveled to a neighbouring peri-urban town, Ilesha, for parts of some rotations, including paediatrics. As I often did as a medical student, I called S.O., this time from Ilesha, to share my clinical experience. By this point, I had seen and learned enough clinically to really benefit from her extensive experience, which she would also share with me during our phone calls. But I was often much more interested in her political activities; how she won over or fought her colleagues at the hospital and the church. She would update me on the latest events. In that conversation, I told her that I had cried as I watched a grieving mother who had lost her child. The child had died three days after being brought in with respiratory distress from anaemia, and with other symptoms consistent with severe malaria. As I told S.O. the story, I went on to blame the mother for coming to the hospital too late.
19S.O. stopped me. She wondered if the mother was afraid to spend all the family’s savings or sell property to look after the child as the siblings at home would then suffer whether or not the child survived. It was far from certain that the child would survive. It is almost impossible for me to imagine such a scenario, but I should not have needed to be told of such possible calculations. S.O.’s insight made me consider an additional dimension to how poverty kills – the heart-breaking calculation a mother may have to make whether to commit all available resources to saving a child versus being able to feed and send the child and their siblings to school when the illness is over or the child is dead. S.O. had made me see that it was Nigeria, and the world, and politics, and history that failed the child, and not the child’s mother. It was a pattern I began to notice in other mothers who came late. I learned to ask the right questions, pick up on the right cues, and think about clinical events as political events. The lesson from S.O. was: we cannot truly help people without seeing the world through their eyes.
20In fact, the distance between me and that deceased child’s mother exists at all scales: for clinicians, and for those who make, change, monitor, enforce or apply health policies, within local, national or international spaces. If we consider an academic discipline as a field in which people share the same assumptions about how the world works and engage in debates on how to build on those assumptions (Greenhalgh, 2014), then global health is not yet such a discipline. A discipline needs a set of shared assumptions. It is potentially transformative to build that discipline, what we currently call global health, on the premise that it is such distance that defines it, and that its mission should be to eliminate inequity in health and the circumstances that create ill health anywhere in the world.
21Starting here – with a quest for equity that attends to the gap between the helper and the helped – can help us foster, facilitate or forge a common language that links efforts across spaces. This does not yet exist. What we have now is a colonial form of gaslighting – talking past the helped, as if they do not know what they already know, as if they do not possess agency. To undo the colonial influence on global health is to see the world through the eyes of the helped, and to acknowledge the distance that makes it difficult to do so. We must localise the global. What should define global health is the mission and the nature of the relations involved, not the scale or location of activities or the identity of the people who fund it or do it. This inversion makes it possible to do what we currently call global health within a small community even in a high-income country, working with any local marginalised group. It means locals everywhere, like S.O., can “own” global health. It means learning can flow more easily across places, across issues, and across time about how to eliminate health inequity within or between countries.
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22I began with the narrative of global health that charts its origin in tropical medicine as an effort to keep white people and, subsequently, the labour force alive in the colonial tropics. It is a narrative that sees global health as a field in which people from previously colonising countries establish and lead health programmes in previously colonised countries. In this narrative, the next, if aspirational, stage is one in which people in previously colonised countries establish and lead health programmes in their own countries (Abimbola, 2018). What I have always found unsettling about this narrative is the assumption that what is so quotidian – people establishing and leading health programmes in their own countries – could be deemed aspirational; as if it was not already true. It reflects the foreign pose, the colonial position from which that narrative is crafted. Everywhere – coloniser or colonised – people have always established and led programmes to improve their own health. What may be unique about global health is the goal of equity and the acknowledgement of distance.
23There are two versions of global health, both of which I recognise. In the first, framed as an extension of colonial medicine, I see the parts of global health in which I currently work, but never want to be “of”. This is global health as necessarily international, as “public health somewhere else” (King & Koski, 2020), which takes for granted what the distance between here and there means for how we engage. The second version of global health is “public health everywhere” (Turcotte-Tremblay et al., 2020; Fischer et al., 2020; Herzig van Wees & Holmer, 2020), all the way down to the distance between the helper and the helped. This is the version I have known from childhood. From this vantage point, it is a version of global health that I can be “of”; that compels me to see the full humanity and complexity of the helped across that distance. It is a version of global health that trains my eyes to see the unjust structures that underpin inequity and commits me to undoing them. This version of global health could be mine, even if I never left Owo. It could belong to everyone. To define global health only by health issues that cross national borders is to exclude the vast majority of people around the world working daily across all kinds of distances to close equity gaps.
24As long as the world is run by colonial politics and forces intent on perpetuating inequity, global health will be in the world, but cannot afford to be of the world. As long as we live in that world – this world – there will always be people, groups, communities, districts, provinces, countries, regions, continents that need help. There will always be distance between the helper and the helped. But the helper must commit to reducing, and ultimately eliminating that distance, even as it infinitely regresses. As one distance is eliminated, another one surfaces; another line of inequity emerges that creates new helper-helped divisions. The previously helped become the helpers of someone or someplace else. And so, it repeats itself, over and over, until a time, as yet hard to imagine, when there will be no need for such help at all. But this infinite regression is neither expeditious nor inexorable. It requires vigilance. The current oppressors are very often the previously oppressed.
25Long after global health as a field began to self-consciously define itself, it is now time to admit that we have likely looked in the wrong places for what is or should be at the core of global health. If we take the meaning of our field seriously – that it is about distance and equity; about being in the world, but not of it; about trying hard to change the world so that we can be free to be of it – and if we go where that meaning leads, we will do things differently. That road leads to a place where we can imagine the helped at different scales, the people alongside and on behalf of whom we work, as the people who should define what global health means for them and decide how it is studied, practised and reported. Who decide how knowledge is made, used and shared, and whose knowledge is valued, prioritised and privileged. But there is one more stop along that road, where we reexamine not just what global health means and how we do it, but also why we do it, what is in it for us, for “the helper”. To transform global health is to see it, imagine it and build it from that place. Where “the helped” have the space to say to all would-be helpers what the Indigenous Australian elder and philosopher Lilla Watson and her fellow activists once said to would-be helpers: “If you have come here to help me you are wasting your time, but if you have come because your liberation is bound up with mine, then let us work together” (Watson, 1985).
26What this offers to a field such as global health is an invitation to a form of enlightened self-interest, but not the material kind. A self-interest which is about one’s own liberation, emancipation. Why do you want to help me? Is it because you recognise a certain pain, or something missing in yourself, or something you are desperate to make right, something that affects you deeply, personally, even historically? What is it? Can you own up to it? It is like being in love. You both need each other in a deep way. Each of you knows that there is something the other person fulfils in you. It is a two-way need. The “helping” is reciprocal, not charity. It is mutual liberation; the opposite of colonial love. It is justice. Lila Watson and her colleagues’ invitation offers global health a transformational way of knowing itself. It invites global health to define what it does in ways that go beyond distance and inequity. Each person, group, community, district, province, country, region, continent with power will have to confront their own brokenness, the pain, the weakness, the complicity they are most desperate to ignore. The sin of dispossession harms the coloniser and the colonised, the oppressor and the oppressed, the master and the enslaved, the rich and the poor. The two parties – we – must get to a place where we both acknowledge that we need each other to be made whole.
27But to love you, I must respect you. I cannot love you only on my terms. In academic global health, it is colonial love when the knowledge of marginalised people is not taken seriously, when their learning needs and perspectives are not what define our research questions, when they are not the primary audience of the knowledge that we produce. It is colonial love when our work does not begin from a place of emancipation and liberation; when instead of undoing the systemic, structural injustices that create inequity, we are content with tinkering on the edges. It is colonial love when we play along with a system that extracts knowledge, disregards and destroys local and Indigenous knowledge; a system that harms even while tries or claims to help. We have to find ways of being in global health, while not being of it – for now. All is not fair in love and war. We cannot legislate or compel love. But we can work together to craft rules that govern what we do, how we do it, what kind of knowledge we make, whose needs or knowledge take precedence, and how knowledge is made, used and shared. We can craft rules that default to justice in how we relate with one another across distances marked by inequity. Rules that help make our own motives for doing global health clear to us. Rules that set our eyes on working primarily to remove unjust structures that create distances between us.
28We are a long way from that version of global health. When we get there, we will no longer need to say “global” before we recognise and act as though health equity is inherently global. The word “global” would have done its job, and we would be well served to do away with it. Health (inequity) is always global, in the same way that climate (change) is global. We do not say “global” climate change. We understand, implicitly, that it is a global phenomenon. So is health. As with climate change, what matters are the unjust structural origins of health inequity, for everyone in the world, wherever they live. The origins of health inequity are so connected globally that to undo one is to significantly impact the others; to study one is to make a dent in understanding the others; to work on one provides lessons for the others. Connecting social systems and social realities across the globe can help us see one another more clearly. It could also help to build a much larger and more diverse coalition for change. That, above anything else, is what is “global” about health and what the term ought to mean. The sooner we see and build those connections, the sooner the label “global” will become redundant.
29When colonial love persists, as it does in global health, the aggrieved cry for justice. This is well illustrated in the Ifá verses, which make up the literary corpus at the heart of the Yorùbá knowledge and belief system. In a set of precepts elicited from these verses and translated by the Nigerian writer and philosopher, Wole Soyinka, Ifá says: “Justice is the mortar that kneads the dwelling-place of man” (Soyinka, 1991). Ifá asks: “Can mere brick on brick withstand the bloodied cries of wrong from the aggrieved?” Ifá answers: “No more than dark withstands the flare of lightning or roofs of straw the path of thunderbolts. Sàngó [the Yorùbá deity of justice] restores.” Ifá sees justice as restorative, as a path to healing. Ifá says there cannot be peace without justice; that our dwelling place, the house of global health, is weak without justice; justice in how we make, use, share and value knowledge; justice in how we relate to one another. We cannot work together without justice. We cannot live together without justice. We cannot love one another without justice. We cannot do global health without justice.

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