'Fire from Above, Fire from Below': Health, Justice and the Persistence of the Sacred

Theoria 55 (116):67-96 (2008)
Abstract
The essay refers to a concern for social justice in the origins of public health, borne in part by religious commitments, and to more recent expressions of a similar concern in debates about health equity. Equity, moreover, is affected by discursive power relations (dominant/hegemonic versus local/suppressed), which are discussed in relation to current research in the African Religious Health Assets Programme on the interaction of particular 'healthworlds' (a conceptual innovation) that shape the choices and behaviour of health-seekers. Two background theoretical positions guide the argument: Amartya Sen's claim that development is linked to freedom (including religious freedom); and, building on Sen's and Martha Nussbaum's human capabilities theory, an asset-based community approach to the building or reconstruction of public health systems. On this basis, it is argued that health systems and health interventions are just to the extent that they mediate between the necessary leadership or polity from 'above' ( techné ) and the experience and wisdom ( métis ) of those who are 'below', taking into account the asymmetries of power that this equation represents. Because difference and diversity are so often expressed in what we might reasonably call 'religious' terms, I specifically emphasize the continuing persistence of religion and, hence, the importance of accounting for its pertinence in social theory generally, and in relation to discourses of health and justice in the African context specifically. Acknowledging the ambiguities of religion, I nevertheless argue that an appreciative alignment between public health systems and religious or faith-based initiatives in health promotion, prevention and care is crucial to sustainable and just health systems in Africa.
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