Health equity and the global social contract: beyond incrementalism and illusionary solidarity

TL;DR

The paper argues that global health goals like the SDGs fail to address deep-rooted inequalities and colonial legacies, and proposes a reparative justice approach for true health equity.

Contribution

The paper introduces a reparative justice framework to address historical and structural inequities in global health governance.

Findings

Global health frameworks like the SDGs function as neocolonial placebos, entrenching power asymmetries.

Reparative justice is necessary to impose enforceable obligations and democratize health governance.

Debt and tax justice must be embedded to achieve structural restitution.

Abstract

The Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) have been celebrated as global social contracts, yet their reliance on voluntary commitments and aspirational targets conceals a structural flaw. By divorcing poverty and inequity from colonial histories, debt regimes, and extractive global finance, these frameworks function as a neocolonial placebo: soothing global conscience while entrenching asymmetries of power and resources. Drawing on examples from debt distress, vaccine apartheid, and intellectual property monopolies during COVID-19, this commentary demonstrates that global health governance operates less as solidarity than as economic containment. Reparative justice provides the necessary rupture. A post-2030 Global Social Contract must impose enforceable obligations on former colonial powers, embed structural restitution through debt and tax justice, and democratise health governance under the principle of Common but Differentiated Responsibilities. Anything less risks reproducing selective generosity while abandoning equity to the logics of extraction and impunity.