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Global Public Health, Colonialism, And Why So Many People Die Of Preventable Diseases

Headstones line the Waterloo Ebola graveyard in Waterloo, Sierra Leone on Dec. 14, 2017. (Hugh Kinsella Cunningham/AFP via Getty Images)
Headstones line the Waterloo Ebola graveyard in Waterloo, Sierra Leone on Dec. 14, 2017. (Hugh Kinsella Cunningham/AFP via Getty Images)

With the COVID-19 pandemic still raging around the world, people are still dying of other preventable diseases like HIV/AIDS, tuberculosis and Ebola.

That’s especially true in underdeveloped countries, places physician and anthropologist Eugene Richardson calls the “global south.” Richardson, author of “Epidemic Illusions: On the Coloniality of Public Health,” has worked in the Democratic Republic of Congo, Sierra Leone, South Africa, Peru and elsewhere.

The global public health system is broken, he says, because it perpetuates an imbalance of power rooted in colonialism. Reparations and economic investment are needed to improve public health and medical care in these countries, he says.

Why do so many people around the globe still die of preventable diseases? He says that’s the No. 1 question of our century.

While technological resources to prevent disease and death are available, Richardson says little is done to globally extend those assets.

Excuses plague the advancement of global public health. People push a variety of justifications, such as believing certain cultures will reject modern technology or thinking logistical and infrastructural issues will stand in the way, he says.

“But I think when you look at the history, it can be boiled down to a primary logic of othering people and then extracting from those other people,” he says, “whether it’s in the form of slavery or colonialism or now neo-colonialism — economic extraction and colonization of the mental universe of former colonies.”

Richardson sees humanitarian relief and academic research as a Band-Aid to the wound. Emergency humanitarian aid serves as “transitional justice” — a roadmap beginning its way toward true global equity solutions, he says.

“They do great work and they save a lot of lives,” he notes. “But to me, that can’t be the solution.”

He observed this transitional justice approach firsthand while working to combat the West Africa Ebola outbreak, for example.

“At least for me, the realization slowly dawned that these are not methods that are ever going to solve the problem,” he says. “In fact, they may be methods that perpetuate it.”

Interview Highlights

On how his own experience showed him the ways in which global aid methods are temporary solutions

“From my very first experience on a Doctors Without Borders [MSF] mission 17 years ago in Sudan to working in the West Africa Ebola outbreak and then the one in DRC, you’re witness to the suffering and much of it preventable. … Aid, global health science [and] academic work, you start to watch the ways these are employed. … You could look at a report called Illicit Financial Flows, I believe, in conjunction with the Jubilee campaign. In 2017, they showed that on the continent of Africa that $160 billion went into the continent in the form of aid and loans and remittances. But $200 billion came out in illicit flows, illegal extraction, tax evasion, trade misinvoicing, resource theft. And so it really shows that extraction continues to this day under different guises.”

On why he believes public health has been purposely underfunded in some countries

“Using the example of Sierra Leone or the Democratic Republic of Congo, we calculated in a paper, first for Sierra Leone — where there’s lots of diamonds, a very diamond-rich country — most of it’s been thefted out. And just the taxes alone on 90 years of diamonds would have provided enough money to build a health infrastructure that would have stopped Ebola in its tracks back in 2014. So you can really trace these histories of extraction to the modern outbreaks.

“To say that people are responsible for the outbreaks because of their ignorance and calling them super spreaders, instead of calling the mining companies that steal the diamonds super spreaders, is to me just a perspective choice. And so the intervention is not MSF. It’s actually reparations for these colonial legacies.”

On what reparations should look like

“It can take different forms around the world. … You can use Malcolm X’s metaphor of when a knife is stabbed into someone’s back, you pull it out just a little bit. And that might be a metaphor for the aid industry. The patient still suffers. You have to pull it all the way out and heal the wound. And so reparations can be thought of as healing the wound.

“In some places, it is [money reparations]. The people working on reparations for descendants of people enslaved in the U.S. are mostly focusing on the wealth gap. But for our colleagues in South Africa, they’re actually looking more at land reform, the returning of land that was stolen by settler colonists. So it can take a different form and in different settings.”

On the consequences of colonialism, the global COVID-19 pandemic, and how rich countries have access to vaccines while poor countries are far behind

“Each outbreak provides a different lens on two forms of coloniality. The most striking one in the COVID pandemic is the one of vaccine apartheid. It can be looked at as tragic for a number of reasons. One, morally, it’s disgusting. Two, it’s economically leaving the majority of the world to continue to suffer from lockdowns in collapsed economies [which] is bad for the entire globe. And then the variants that could be produced in under-vaccinated areas will come back to haunt the vaccinated areas. A vaccine equity plan could actually be a first step on the road to various global reparations programs.”

On how we keep people around the world from dying of preventable diseases

“I think we have good examples of what I called transitional justice, the MSFs and the Partners In Healths of the world, and they need to continue to do good work. But the focus has to be beyond them to achieve global health equity. There’s got to be real economic change so that countries in the global south can use their riches to actually procure some of the lifesaving, transforming medical findings of the past century — from vaccines to antibiotics to everything we do in the hospital. That’s why I keep coming back to this notion of reparations. Only through repairing these legacies can there be more of an equal footing to then move forward to achieve global health equity.”


 Julia Corcoran produced and edited this interview for broadcast with Tinku RaySerena McMahon adapted it for the web.

This article was originally published on WBUR.org.

Copyright 2021 NPR. To see more, visit https://www.npr.org.