Have you ever read a book and then immediately had to tell everyone else about it? Jason  Hickel’s ‘The Divide’ was one of those books for me. Except for this time, it was a little  different. Usually I get this feeling when I’ve read a touching story or fallen for a great  character. This time I learnt how wrong I was about how the world works.  

You’re almost definitely aware how unevenly spread resources are on this planet. You may  even have heard that the richest eight people control the same amount of wealth as the  poorest half of the world combined1 or that the world’s richest 1% have more than twice as  much wealth as 6.9 billion people.2 This kind of inequality has been going on for so long that  most of us have accepted it as some sort of universal law. So, we find ourselves, in 2021,  still trying to close a gap – unsure of why that gap is there in the first place. 

‘The Divide’ tells us about the origin of poverty, something that many of us (including me)  assumed had no start date. 500 years ago Europe was not any better off than the rest of the  globe. Many communities were living longer, healthier lives than Europeans. 

So what changed? 

Refusing to sugar-coat, Hickel describes in detail the years of relentless exploitation,  manipulation and plunder the West thrusted upon the rest of the world. Seeing nothing but  their opportunity to gain, human life was a mere inconvenience. I have to be honest with  you, part two is a difficult read. It describes genocide that reduced a population from 75  million to 3.5 million3 – for gold. It tells of human life stolen from Africa and turned into well  over $97 trillion of forced labour. 

“The real benefit that Europe gained from this period was not just that allowed for the  extraction and direct accumulation of wealth, but rather that it provided ecological windfalls  that allowed Europe to pivot towards industrial production.” 

Being an optimist, I saw a silver lining – we had seen the end of this era of exploitation.  Right? No such luck. While Part Two in the book is concerned with the start of inequality, in  Part Three Hickel goes on to explain how plunder is here, now in the 21st century. 

Before I read ‘The Divide’ I had very little idea what was driving the widening gap between  rich and poor today. Thinking back to my very eurocentric geography education we were  sold a story that developing countries are poor mainly due to flaws in their own government.  But ‘The Divide’ taught me that corruption and similar issues are only a small part of the  problem. 

Rich countries loan money to countries in the global South. This dept forces these counties  to turn to austerity measures in order to repay. “In other words, public assets and social  spending retroactively become collateral in the repayment of foreign loans”. Which keeps  these indebted counties exactly where the loaners want them – unable to develop, and  funding their own development. Which sounds eerily similar to the more obvious forms of  colonialism detailed in Part Two. 

And suddenly, when you realise just how much money is moving from low and middle  income countries to high income countries the concept of aid becomes far more sinister.  Rich countries are taking far more money out of poor countries than they donate in aid. Be it  unfair loans, unfair trade or a lack of democracy; for every $1 of aid that developing  countries receive, they lose $24 in net outflows.4 Aid makes rich countries look like givers,  and poor countries appear dependent on them. 

“Poor countries don’t need our aid, they need us to stop impoverishing them. Until we  tackle the structural drivers of global poverty – the underlying architecture of wealth  extraction and accumulation – development efforts will continue to fail” 

At this point the nature of global inequality is becoming much clearer. As a healthcare  professional I find myself wondering about the impact of global inequality on health  outcomes. The social determinants of health – the conditions in which we are born, work and  age are largely controlled by what each state is able to provide. Every day 10,000 people die  because they lack access to affordable healthcare.1 The difference between the longest life  expectancy and the shortest is over thirty years6

Clearly there is a lot of work to be done. Good clinicians appreciate the importance of  treating the system and not just the symptoms. Just as pain should not be treated blindly  without finding a source of the pain, health inequity cannot be properly addressed without  finding the cause. 

You could argue all things considered the West has a duty to rectify this gap in health  outcomes. Attempts have certainly been made – but overall the pattern of exploitation and  exclusion rings true. Voluntourism – the act of travelling (usually from a high income country  to a low income country) to provide some sort of service is an example of this. It is difficult to  do correctly. At its best it can offer high quality resources in a way that is both sustainable  and beneficial to the communities it tries to help. At its worst it can devastate them. An  example – Renee Bach. An untrained American missionary posing as a healthcare  professional and endangering many Ugandan children’s lives as a result.7 While intentions  are usually noble we cannot keep up the ‘bandaid on a broken leg’ approach. We must take  the harder route of addressing why there is a gap in these services in the first place. The  goal is not to feed the needy but to stop the hunger in the first instance. 

The theme continues in the wider world of research. It is no secret that high income  countries dominate both as authors and editors of global health publications.8 This therefore  controls what gets published, focused on and actioned. With low and middle income  countries under-represented how can these actions be expected to hit the mark? How can  we address the problems at the roots if we do not intimately understand the communities  that are affected by them? 

In the final part of the book Hickel goes on to explain his recommendations on how to make  the global game fairer. Though logical, they are not overly practical for an individual.  However, this part of the book provided hope – which was sorely needed.  

Arguably, the most significant idea for change in this book is the recommendation for de growth (Hickel has also more recently written a book dedicated to this topic – Less Is More).  But how can low and middle income countries develop without growth? It seems world  leaders are desperate for more growth, not caring who pays for it – even if it ends up hurting  us further down the line. Growth often means putting more ecological strain on our planet.  Earth Overshoot Day (the date when humanity’s demand for ecological resources and  services in a given year exceeds what Earth can regenerate in that year) creeps earlier and  earlier in the calendar.9 Hickel suggests starting with a move away from the outdated GDP –  a flawed measure of growth as it ignores social and environmental costs. “When we slice  down our forest for timber, or strip our mountains for coal – GDP goes up.”10 “Degrowth is a  planned, coherent policy to reduce ecological impact, reduce inequality, and improve well being”.11 It pushes for the replacement of GDP with measures of growth that actually reflect  progress, healthier communities and greener economies. In this part of the book we really 

gets to the crux of what drives the flaws in the global system today and how using a more  holistic measure of growth could lead to a more sustainable, equal world. 

The Verdict: Accessible and educational, ‘The Divide’ is a great read for those who  want to tackle global issues and don’t know where to start, but is arguably necessary  education for all. 

Olivia Nwokenna is a clinical pharmacist working in the South West of England. Her interest  in global health was nurtured by her involvement in SFGH while at university. Ultimately she  hopes to use her passion and skills to improve healthcare around the globe. 


1. Hardoon, Deborah (2017) AN ECONOMY FOR THE 99%, Available at: https://policy practice.oxfam.org/resources/an-economy-for-the-99-its-time-to-build-a-human-economy that-benefits-everyone-620170/ (Accessed: October 2021) 

2. Oxfam (2021) 5 shocking facts about extreme global inequality and how to even it up,  Available at: https://www.oxfam.org/en/5-shocking-facts-about-extreme-global-inequality and-how-even-it (Accessed: October 2021) 

3. ‘Population Dynamics in Latin America’, Population Bulletin 58(1), 2003 

4. Global Financial Integrity, Financial Flows and Tax Havens: Combining to Limit the Lives  of Billions of People (Washington, DC: Global Financial Integrity, 2016) 

5. WHO (2021) Social determinants of health, Available at: https://www.who.int/health-topics/ social-determinants-of-health#tab=tab_1 (Accessed: October 2021). 

6. WHO (2020) Life expectancy at birth (years), Available at: https://www.who.int/data/gho/ data/indicators/indicator-details/GHO/life-expectancy-at-birth-(years) (Accessed: October  2021). 

7. Ariel Levy (2020) ‘A Missionary on Trial’, The New Yorker, 6 April, Available at: https:// http://www.newyorker.com/magazine/2020/04/13/a-missionary-on-trial (Accessed October  2021). 

8. Dhananjaya Sharma (2021) ‘A call for reforms in global health publications’, The Lancet  Global Health, 9 (1), pp. e901-e902 [Online]. Available at: https:// 


rc=1&redirect=https%3A%2F%2Fwww.thelancet.com%2Fjournals%2Flanglo%2Farticle% 2FPIIS2214-109X%2821%2900145-5%2Ffulltext (Accessed: October 2021). 

9. Earth Overshoot Day (2021) Earth Overshoot Day, Available at: https:// http://www.overshootday.org (Accessed: October 2021). 

10. BBC News (2017) Viewsnight: Our addiction to economic growth is killing us, Available  at: https://www.bbc.co.uk/news/av/uk-40869867 (Accessed: October 2021). 

11.Jason Hickel (2021) ‘What does degrowth mean? A few points of clarification’,  Globalizations, 18 (7), pp. 1105-1111 [Online]. Available at: https://www.tandfonline.com/ doi/full/10.1080/14747731.2020.1812222 (Accessed: October 2021).

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