TY - JOUR T1 - Working in the wake: transformative global health in an imperfect world JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2022-010520 VL - 7 IS - 9 SP - e010520 AU - Rochelle A Burgess Y1 - 2022/09/01 UR - http://gh.bmj.com/content/7/9/e010520.abstract N2 - The problems with global health are many. They are as old as the discipline itself, inherited from colonial projects and paradigms that have existed as long as there has been exploration into other lands. In her recent work In the Wake: On Blackness and Being, Christina Sharpe1 asks us to imagine, and acknowledge, that the world and life of Black people, exist in and are shaped by the enduring afterlife of slavery, colonialism and racism. This moment in global health is highly attuned to this fact. There is an ‘awakening’ to the fact that every dimension of global health praxis has been inexorably shaped by its past. Undoubtedly, there has been an underappreciation of the consequences of the productive power of the ever-expanding body of knowledge, praxis and practice that determines the why, what and how of our discipline.This is the power of what historians dub the archive—the collection of records, documents and evidence that define an institution. And our archive has locked us into something we desperately need to change.A glimpse into the archive reminds us of the longevity of global health’s problems that have been faced by every generation, often hindering efforts to improve the health of others. For example, in 1978, global powers had the opportunity to institute and fund a health systems model founded in the scaling up of local power, resources and capacity, in the form of primary healthcare.2 The wide sweeping changes were a response to calls for social justice from millions of people in resource poor settings driven to their position through the extractive policies of colonialism, expansionism and cold war politics. Alma Ata and its 134 signatories were called to build opportunities for communities to build health enabling environments as part of eradicating illness. Almost immediately, powerful countries … ER -