Tuning into a Zoom class during my master’s in One Health, this quote encapsulated the imperial and didactic attitudes embedded in Global Health* that homogenise local realities. It made me realise that Global Health scientific writing and teaching is a form of storytelling, but that narratives are not locally controlled. I wondered: can re-imagining the role of inter-species relationships in achieving or derailing health extend efforts to decolonise Global Health by unsettling species, national, and racial hierarchies fundamental to Global Health’s colonial structure? Global Health evolved into One Health in response to an ecological collapse that made the interdependence of human, animal, and ecosystem health starkly apparent, but the colonial structure persists. The lecturer, referring to a queue of people in rural Tanzania awaiting rabies vaccinations, proceeded to suggest that “their local voodoo doctor or traditional healer or whatever” significantly hinders treatment access.

The lecturer set up a scenario in which ‘we’ as early career researchers are complicit in the coercion of an unspoken ‘them’, the people and their cultural practices. The forms of care presented by the lecturer seem more akin to coercion—manipulating inter-species relationships, dictating social behaviours, and ridiculing cultural practices of care and ownership. Global Health is in urgent need of a radical restructuring, as demanded by the Decolonise Global Health movement. This piece does not fully cover Global Health’s colonial legacies, as covered by Abimbola, Affun-Adegbulu and Adegbulu, or Büyüm.

Briefly, Global Health evolved from colonial medical practices, the primary function of which was to sustain the colonisers’ health and the colonised populations’ productivity. Colonial structures are still embedded in Global Health: health care is provided across a distance along global circuits of capital inscribed by transatlantic slave trade and colonisation, and this care is delivered by exploiting local labour forces within the infrastructure of colonial outposts. Practitioners continue to profit from intellectual and institutional advancement through the extraction of information on inequalities in access to healthcare. Such extraction is representative of both slave-plantation and settler-colonial era extraction and commodification of physical bodies, resources, and reproductive labour; and the extraction of biopolitical knowledge and healthcare labour. In calculating how much care is delivered, where, and to whom, Global Health actors and researchers make an auxiliary decision of who can be left to die, crystalising racialised structures of oppression put in place during colonial rule. This results in narratives produced by structural violence, racialized politics, and globalised extractive capitalist systems.

Decolonial scholars, Clara Affun-Adegbulu and Opemiposi Adegbulu, draw on Sylvia Wynter’s ‘over-representation of Man’ to unsettle Global Health’s current conceptualisation of humanity as “hierarchised and separated into Man (researcher/practitioner) and the liminal deviant category of Other (patient)”. Ticktin furthers this by suggesting that focussing on biosocial ecologies—from microbes to megafauna—rather than ‘humanity’ would centre relational care in Global Health. Citing Audre Lorde and Sara Ahmed, Ticktin writes that “for those who are marginalized, care is a form of political warfare: to engage in care is to uphold the right to survive”. Decolonising Global Health requires a paradigm, knowledge, and leadership shift driven by local authorship.

In the opening quote, “people do believe they own them” evokes the question: What constitutes knowledge versus a belief? This disregard for local realities pervasive in Global Health is challenged by local, tech-based rabies transmission monitoring and surveillance program conducted by Mtema et al. in Southern Tanzania. Over 300 frontline veterinary and health care workers reported dog bites and vaccinations in real-time across Southern Tanzania to map the social networks of dog-human interactions. This illuminated a complex picture of rabies transmission and will contribute to interventions that replace current top-down control methods—dog culling and unaffordable post-exposure treatment. Mtema’s project builds local capacity in the resource gaps left by post-colonial Structural Adjustment Programs that deregulated and privatised veterinary and human health services, valuing market-structures over human and animal health.

Multi-species interactions entail not only our love of a companion animal or the small wealth of wild things in the garden, but also our relationship with industrialised food production. This relationship is deeply enmeshed with economy, microbial biomes, globalised transport, climate change, and non-communicable and infectious disease alike. Consider the industrial pig lots in the midwest, USA, which are modelled off colonial and slave-era plantation and function through intensive resource extraction performed by underpaid migrant labourers working in a high-risk and homogenised environment.

The lots, known as concentrated animal feeding operations (CAFOs), reek of decomposing bodies; they produce, slaughter, and sell 7 million pigs annually and create vast quantities of excrement, dubbed locally as ‘lagoons’. Chronic exposure to toxins in lagoon overflow, land-applied and airborne waste, is linked to heightened infant mortality, antimicrobial-resistant microorganism infections, and death from kidney disease, tuberculosis, and anaemia in a sickly halo surrounding each lot.

Multi-species anthropologist Alex Blanchette, traces how—when dried and dislodged by machinic pounding of pig and cattle hooves—the virally loaded faeces become airborne and intermingle with dust upturned by the Great Depression in the 1930s. Blanchette reveals how these time-travelling, part-geological-part-animal particles are deposited on migrant workers’ bodies, transported out of the farm, and carried into local residents’ homes. Dust is an artefact of the 1930s ecological and financial collapse that accelerated industrialised agriculture. It dissolves temporal boundaries, locating the geological past in the present, and forces a recognition that consequences of colonial and extractive structures in the past have social lives in the present. This reminds one that the colonial infrastructure of knowledge generation, and human and animal healthcare can, and do, still shape health globally. Global Health must attend to these complex multi-species interactions to decolonise.

Animal health, veterinary care, and agriculture are integral to people’s cultures, livelihoods and survival, and thus are inherently political. Studying One Health this year left me conflicted about its relevance in decolonial conversations. On the one hand, One Health as a framework to view ecosystem, human, and animal health as interdependent offers a potentially decolonial approach to Global Health by dissolving institutional boundaries and redefining health as biosocial and disease as ecosyndemic; where diseases arise from the distinct assemblage of social, biological, and material conditions that facilitate host-pathogen relationships. On the other hand, One Health reduces species boundaries as interfaces at which to manage potentially pandemic causing zoonotic pathogens. The high-risk nature of animal-human interfaces is weaponised to secure the political economies and agro-industries of Global North against the perceived threats to health from interspecies intermingling in the Global South. However, the analysis of pig lots in the USA highlights that these perceived risks are pervasive in high-income countries. USAID itself states that its Global Health projects protect the most vulnerable “while advancing American security and prosperity”. Framing One Health as security highlights a tension between the surface-level intention to provide care for all and dissolve institutional boundaries from an ethical position; and its laser focus on infectious disease to ensure nation states’ survival.

Although the scene Alex Blanchette describes is not the archetypal Global Health scene of a Global North-based NGO practicing healthcare in a Global South country, it is both global and a matter of health. It reveals the necessity for new forms of care by collapsing temporal, national, and species delineations that sustain hierarchies fundamental to Global Health’s colonial structure. Supremacy of the Global North over the Global South fuels the direction of care and extraction in Global Health but relies on national borders to construct this hierarchy. The farms’ migrant workforce and the dust’s ability to transgress national borders on the wind challenge the finitude of the nation-state while viruses muddle species boundaries in their movements from human to animal hosts and unsettle the present conception of ‘human’. In the opening quote, the lecturer solely conveyed the disease risk to us, erasing context-specific and nuanced relationships between animal and carer and undermining their capacity to determine their own forms of care. Complex, multi-vocal narratives of rabies and humans’ social lives with dogs, as presented by mobile-health surveillance, highlight the importance of being sensitive to local realities and the decolonial power of local story-telling tools and authorship.

*I refer to ‘Global Health’ as a discipline and practice developed in the Western world that attempts to achieve health equity globally, but in reality reinforces inequities by maintaining the colonial and racialised power dynamics within its institutions and extractive research practices.