Source: Review of African Political Economy (ROAPE) | Published: 2026-06-10
Category: ODA·개발금융 | Keywords: aid, health
Before there was a Commission, there were generations who died too young – not because of bad genes, but because of stolen land , unpaid labour, and a minority world that extracted everything it could and called it progress. This is a question of political economy: who owns what, who decides, and who is forced to pay the price in bodies.
The Walter and Patricia Rodney Commission on Reparations is named for the Guyanese revolutionary who wrote How Europe Underdeveloped Africa and his wife , Dr Patricia Rodney, herself a public health professional who has spent decades building health systems and demanding reparative justice. The Commission was formed to provide a multi-disciplinary and timely contribution to the reparations debate in honour of their radical scholarship. It was named with the kind permission of Dr Patricia Rodney.
The Commission’s findings, published in an open access special issue of BMJ Global Health , make a simple argument. As the lead article by myself and several other colleague s states, health inequities are “pathologies of power”. They are the direct result of centuries of seizure – of land, labour, dignity.
Five case studies, five modes of repair
The collection offers five concrete examples.
First, climate change as colonial debt. Here, the authors argue that the Global North’s emissions embody centuries of extraction. Majority world countries and Indigenous communities – who contributed least to the crisis – suffer first and worst. The discussion on reparations here encompasses loss and damage financing, technology transfer, and migration pathways.
Second, structural adjustment programmes. In this article, the authors show how the IMF and World Bank imposed austerity on borrowing nations: cut health spending, privatise water, open markets. The results: collapsed clinics, resurgent diseases, and generations of stunted children. Reparations mean debt cancellation and a binding end to conditional lending. As Roberta K Timothy shows, these haunt our bodies before they are born – a traumatic reproduction of intergenerational harm.
Third, sexual violence in conflict zones. Gilmore and Sandoval-Villalba examine conflict-related sexual violence – from Bosnia to the Democratic Republic of Congo. Survivors have long demanded more than criminal prosecutions. Reparations mean long-term healthcare, economic restitution, and community-based healing. The Commission insists these claims must be survivor-led.
Fourth, enslavement in the United States. The authors trace the health legacy of chattel slavery: maternal mortality rates (Black women dying at three times the rate of white women), medical apartheid, and ongoing diagnostic neglect. Reparations include medical debt forgiveness and the dismantling of racist protocols. Dr. Uché Blackstock documents how the myth that Black patients feel less pain is still taught in medical schools.
Fifth, Caribbean nations. Beckles, Chitre and Richardson detail Britain’s vast debt to the Caribbean: for slavery, for the brutal extraction of sugar wealth, for the Windrush generation’s exploitation and deportation. Reparations mean formal apologies, debt cancellation, and health system investments – particularly in mental health services for intergenerational trauma.
Across every case, the mechanism is the same: cumulative stress becomes pathology. Arline Geronimus calls this “weathering” – premature deterioration from repeated social exclusion. Her work measures this in cardiovascular disease, preterm birth, and early ageing. Reparations are not charity. They address the cause, not the symptom.
Principles for repair
The Commission’s fifth principle is the sharpest: those who benefited must pay. Not only the original perpetrators, but every institution unjustly enriched – banks, universities, pharmaceutical companies, and nations that continue to profit. Reparations aim for acknowledgement, redress, and closure. As Dr. Julieta Chaparro Buitrago warns, repair can reproduce colonial hierarchies if communities are not centred. Who decides when a debt is paid?
The 19 th century was abolition. The 20 th century was ‘ decolonisation ‘– clearly incomplete. The Commission argues the 21 st must be the era of repair.
Not because repair is noble. Because without it, people keep dying – now, slowly, in real time. The mother whose stroke follows a clinic closure under structural adjustment. The farmworker whose lungs fill with dust from land that was never his. These are predictable outcomes of a system designed to extract and discard.
Meanwhile, Western governments play semantics. “ Deep regret ” here. A few million in “development aid” there – repackaged as generosity. Apologies without accountability. Donations without restitution. The word “reparations” treated as a swear word. Reparations are not the obstacle. The obstacle is the refusal to name theft as theft.
“Equitable societies cannot come into being ”, the BMJ authors write, “without redress of the physical and social harms that have accrued generationally”. And they warn that deferring these demands “will not cause the underlying harms to dissipate – it will deepen them, widen inequities and leave us with a far greater burden of redress”.
Reparations will not bring back the dead. But they can stop adding to the body count. That is the urgency. Not a philosophical debate. A medical triage of a centuries-old emergency – while those responsible offer regrets instead of remedies.
The case studies are the evidence. The demand is simple: repair is a health issue. And the people dying in real time cannot wait for another insultingly banal statement of regret.
On behalf of all the Commissioners:
Sir Hilary Beckles (Co-chair), Eugene Richardson (Co-chair), Jacqueline Bhabha, Maxine Burkett, Mary T. Bassett, William A. (“Sandy”) Darity, Jr., Paul Farmer (deceased), Sunneva Gilmore, Joseph Gone, Jason Hickel, Salmaan Keshavjee, Sonja Klinsky, Margareta (Magda) Matache, Kirsten Mullen, Georges Nzongola-Ntalaja, Liepollo Lebohang Pheko, Clara Sandoval, Amit Thorat, and Sukhadeo Thorat .