The singular insight in global health is that absolute reductions in morbidity and premature morality are not robust indicators of success in the absence of equity. That is, we can achieve high levels of global health but still lag in justice. What would be truly transformative is to achieve both overall population health and fair distribution of the benefits—in other words, Global Health with Justice. What would global health with justice look like? That is the critical problem I explore in Global Health Law (Harvard University Press, 2014, Chinese Translation Forthcoming 2016). Before answering this pivotal question, consider contrasting narratives, showing how global health can exist in a state of inequality.
Global Health Narratives
Gates Foundation/ONE. The Living Proof: Real Lives, Real Progress campaign champions once unimaginable global health achievements. Success stories are pervasive, and with good reason. International assistance has skyrocketed, while child and maternal mortality has plummeted and millions are accessing treatment for HIV/AIDS. Polio eradication is on the horizon, with game-changing vaccines within reach for AIDS and malaria.
This narrative of success is true and inspiring, but also consider the voices of two young people living in poverty, abridged from, Global Health Law:
Namubiru (Gaba, Uganda). I live in a rowdy place, with no clean water, no good toilets or bathrooms. At night, the conditions worsen, with hardly any electricity. The mosquito noise fills up the place. Cockroaches move around me. My mother would help me with medication fees, but she is dying of AIDS. A lot of sexual violence happens to me. I want to get an education and a job. I am so sad. I need a new life.
Johnny (Blackfeet Tribal Reservation, Montana, USA). I start my day with a cup of Joe, then corral and break horses, and smoke a bowl of weed. My father snorts coke and gets drunk, taking my birthday money. He beats all the kids. When your family is broken due to drugs and alcohol everyone is hurt. What I mean is what little kids get to eat or not to eat, did they get the shoes or clothes they needed, it depends on whether adults do drugs. I want to shout, “when you do meth hey, don’t let your kids be here.” What about the kids?