We do not deserve to be called “global health”
Daniel W. Krugman, Marina Schor, Gabriela Cipriano, Beauty Dhlamini, Ghiwa Nasser Eddine, Zoha Salam, James Smith
Since the escalation of what has now been described by a genocide studies expert as “Israel’s genocidal assault on Gaza” [1] on October 7 2023, the field that is commonly known as “global health” or “global public health” has done what it does best in the wake of political crises: shallow hand waving and displays of faux neutrality. While at least 24,285 Palestinians have been murdered since October 7, 2023, 1.9 million people have been forcibly displaced, and hundreds of thousands are systematically starved [2,3], the past three months of this atrocity has reflected field’s responses during past crises [4] as well as its firm commitment to working with and alongside Western imperial powers. The vast majority of institutions and individuals across Global North and South have purposefully refrained from taking clear stances, offering instead shallow calls ignorant of the long history of violence against the Palestinian people. Others have refused to take courageous and principled positions, choosing silence or non-committal engagement in the name of ‘universal human rights’ and sentiments of ‘shared humanity’. Although bare-minimum calls for a ceasefire have slowly increased throughout the crisis, the zeitgeist within the field remains consistent: only going as far as to not upset established powers and funders.
If crisis reveals clarity about true moral grounding and ideals, what does the ongoing violence against the Palestinian people reveal about global health? In this commentary, we argue that the collective response of the global health apparatus to the ongoing murder of Palestinians in the name of land dispossession toward colonization elucidates with visceral clarity that we are not — and never have been — a field of ‘global health’. By contrasting some of the most prominent inadequate, delayed, and milquetoast reactions from across the field with the terms those of us in global health use to describe ourselves, we call for a stronger collective response from the field in order to mount a serious defense of the Palestinian people, rectify our current complacency, and practice a global health field yet to be realized.
Examples of global health’s complacency in this escalation of colonial dispossession are plentiful. While Zionist state officials have called directly for the total displacement and elimination of the Palestinian people, responses from prominent individual and institutional responses have not reflected the urgency and clarity of this moment. [1,5] In line with corporate and Western state news agencies, multilateral bureaucracies such as the World Health Organization, the United Nations, and related agencies have released vague and disingenuous statements in the passive voice, which have refused to acknowledge the genocidal intent and execution of the violence, or to name the Zionist settler state that is committing these atrocities. [6–9]
Three of the most powerful global medical journals — The BMJ, The Lancet, and JAMA — have published editorials dehistoricizing the conflict, playing down ongoing atrocities, and/or blaming Palestinians for their own mass death. Strikingly, the editor of The Lancet demonized Palestinians, several of whom are his colleagues, collaborators, and the very people the journal has worked with to help build a ‘progressive’ image while chastising those protesting against the genocidal assault on Gaza for “not understand[ing] the terrorist culture that is projected by Hamas into almost every aspect of life in Gaza”: an unsubstantiated and dangerous claim at a time when the Israeli state continues to perpetrate attacks against “every aspect of life in Gaza”. [10] In a similar vein, an article in JAMA questioned whether health professionals have the responsibility to speak up on the systematic and widespread killing of people through bombing, intentional starvation, and the spread of disease while heinously pinning the responsibility for these atrocities on Palestinians themselves. [11] While calling for a ceasefire after a month of genocidal aggression, [12] the editor of The BMJ asked us to remember how “the UK, US, Spain, and France, some of the countries most criticised for colonialism, were once colonies themselves” [13]. Dutifully demonstrating the common but hallow notion of “shared humanity” amidst the purposeful decimation of the Palestinian people endemic across the field, this tact is what Tuck and Yang call a “settler move to innocence” of “colonial equivocation” — “ the vague equating of colonialisms that erases the sweeping scope of land as the basis of wealth, power, law in settler nation-states”. [14] These published works continue to perpetuate colonial power and violence by reinforcing epistemic parameters for political engagement on the question of pursuit of justice and liberation for the Palestinian people. The disproportionality of Israel’s power, reach and impact in the global sphere is obscured by ahistorical and decontextualized analyes, the dehumanization of the Palestinian people, and orientalist, xenophobic and Islamophobic tropes.
Finally, beyond a few notable exceptions in which health workers and global health advocates have called for an end to the conflict by addressing its settler colonial foundations [15,16] the loudest response has been a piercing, undeniable silence. As densely populated residential areas in Gaza continue to be carpet bombed, food and water is intentionally withheld to provoke death, the dispossession of land and state-abetted murder accelerates in the West Bank, communicable diseases spread across camps and shelters crowded with those fleeing the violence, and doctors and nurses operate without the most basic equipment, [17] global health institutions, organizations, and their leaders insist on pseudo-neutrality. Even when some in the field called for an end to the violence, and the interrogation of its root causes, [15] the authors and the handling editor were inundated with complaints and calls for resignation and disciplinary action. When prominent figures in global health rallied around the editor, the majority spoke only of academic freedom rather than Palestine and the wider content of the editorial. In all, while Palestinian healthcare providers, researchers, organizers and unions have called for action, demanding an immediate ceasefire, urgently needed humanitarian assistance, an arms embargo against Israel, [18] and support in lifting the occupation, [19] practitioners, researchers, and advocates who operate under the name ‘global health’ have largely been left to protest and voice calls on their own without institutional support and under the threat of harassment, doxxing, and loss of employment.
Our response to protracted occupation, dispossession, and violence once again spotlight the paradoxical and unattainable nature of the ideals that underpin global health as pursued within the framework of a capitalist and colonial world order. In the absence of radical, systemic change, calling ourselves global health was, is, and will continue to be a lie. We are imperial agents, self-constructed as morally pure who, while claiming to be working toward a healthier world and the ‘decolonization’ of our field, instead aid and abet the expansion of capitalism, Western epistemic superiority, and the US-led imperial geopolitical order. This is not a new claim, nor is it revolutionary as a position in a field that exists merely due to Western hegemonic global ordering, white supremacy, and colonial afterlife. Critical scholarship on global health from scholars in and beyond the field over the past two decades has dutifully demonstrated how the field is inherently and deeply grounded in coloniality [20] and white supremacy, [21] ruled by American and European philanthropic [22] and financial interests, [23] committed to liberal ideas of humanity, [24] and spreading this ideological regime as “truth” around the world. [25] In short, ours is a paradoxical field: we seek to create “global health” but only through the approved and narrow means of an intrinsically violent system rooted in neoliberal hegemony, dictated by the same rulers of that system, and often gleefully in concert with that system all while that system continues the march towards annihilation of colonized peoples and the environment.
The lack of response and reluctance to engage from global health institutions, leaders, and the broader field is not a surprise to us. Franz Fanon has taught us: “The unpreparedness of the educated classes, the lack of practical links between them and the mass of the people, their laziness, and, let it be said, their cowardice at the decisive moment of the struggle will give rise to tragic mishaps” [26] . Without sound theoretical basis beyond progressive liberalism, which is ethically and politically bankrupt while beholden to the ultra-wealthy donors and Western governments that fund us, those who claim to represent and advance “global health” around the world willfully, happily, and subconsciously betray their stated ideals as a matter of habit. These reactions by a field that is committed to “health” reflect, in the words of philosopher Achille Mbembe, “the calculus of life [that] passes through the death of the Other; or that sovereignty consists of the will and the capacity to kill in order to live” [27]. That is, established order and ‘neutrality’ reflect the ways in which order is favored over the lives of people constructed as “Other’’. In order for our field to remain in good standing with the order that gives our ‘righteous’ work legitimacy, those who resist this order suddenly fall beyond our purview as the “all” humans we “universally advocate” for. Our cowardice is then covered up by pushing these claims of “universal humanity”, aversion to violence in any form, and a refusal to engage seriously with the ways in which resistance to injustice and oppression manifest globally. We thus ignore pleas from those who we claim we want to “center” or “give voice to”, dismissing their proposed solutions to the problems we propagate in the name of global health’s “noble” purpose. Tied up in our own self-interest and networks of power, we have fallen in line and exposed in stark relief how we are not and have never been about “global health” as a universal politcal project that benefits everyone. Rather, we are fundamentally and willingly committed to creating a healthier world through the vision of “all the world can be healthy inside this imperialist system, under our rules, and through our means”.
We are not global health. We do not deserve to call ourselves by that name. The ones who benefit most through our work and our rhetoric are us: those in the field whose work maintains its core composition crisis after crisis, thereby propping up broader imperial power and material maldistribution. With our apathetic, neutral and vehemently depoliticised stance, we can comfortably conduct our randomized control trials, behavioral interventions, and epidemiological surveillance among systematically oppressed peoples, including the Palestinian people, and advance our careers without having to stand for a liberatory political position or oppose the systems that execute and enable genocide. As Edward Said wrote: “Every single empire in its official discourse has said that it is not like all the others, that its circumstances are special, that it has a mission to enlighten, civilize, bring order and democracy, and that it uses force only as a last resort. And, sadder still, there always is a chorus of willing intellectuals to say calming words about benign or altruistic empires, as if one shouldn’t trust the evidence of one’s eyes watching the destruction and the misery and death brought by the latest mission civilization” [28]. For as long as global health is defined by such vacuous intellectualism and blind moralism, a more apt name for our global field should be “imperial health” or “hegemonic health”.
However, our current collective shortcomings do not mean we cannot live up to this name. The foundations of decolonial approaches to public health practice established by notable individuals in the Global South such as Frantz Fanon, Che Guevara, and José Rizal teach us that liberatory and healthy futures for the entire world are enacted and imagined through struggle against imperialist systems. As activists around the world are currently declaring, “We are not freeing Palestine. Palestine frees us all.” By fully embracing solidarity with the people of Palestine as global health practice, we may take instruction from our Palestinian siblings in such a way that we emerge from this moment with new means to practice “global health” that seeks to create a healthier world with both established scientific tools and principled political action to match. In short, the politicized, liberatory global health that has been imagined and called for by advocates of a decolonized global health may come in to closer view [29,30].
There are people in global health who continue to defy the status quo, individually and through non-institutional forms of collective action. Weapons manufacturing plants have been blockaded. Health blocs have been organized at protests worldwide. Colleagues have exposed their institutions for investing in companies complicit in violence, and for targeting staff and students for their solidarity with Palestine. These efforts offer a window into an alternative vision for global health that has been long present beneath the imperial surface, but that has been widely subordinated and obscured. The challenge now is to collectivize and expand these efforts from isolated, individual incidents and pockets of collective action that break from the field’s state of complacency in favor of theoretically grounded, value-driven unified action. Through this we create space to imagine and practice a discipline that deserves to be called “global health.”
We end by acknowledging that we are included in all that we are describing, as not only are we all structurally embedded in this system, but also this commentary comes late given the thousands of lives lost. In addition to our other efforts, we offer this commentary as a means of both pushing global health actors into action and charting a new future for the field amidst so much failure, hypocrisy, and cognitive dissonance. By internalizing that current practice falls far short of what we claim by calling ourselves global health, by acknowledging that our writings and calls for “decolonization” are shallow and have coopted liberatory theory, and by admitting that our silence and liberal centrist stance on Israeli atrocities against the Palestinians abets this massacre, we take a step towards an otherwise pursuit of global health. We believe this work begins with offering tangible support to Palestinian organizations — both local and in the diaspora — acknowledging and acting on their calls to action, and drawing inspiration from the growing number of people — mostly young, racalized Black, Indigenous and People of Color — who have the moral clarity to follow these calls.
Positionality Statement
We are graduate students, researchers, and healthcare professionals located in Lebanon, Peru, the United States of America, Canada, and the United Kingdom. We benefit from belonging to elite academic institutions and hold other such affiliations. We do not see ourselves as exempt from our critique; we are a product of, and constituent elements of, the structures and processes of global health, and its neocolonial and hegemonic manifestations. This compels us to speak out and expose the coloniality of global health in pursuit of meaningful change. Where relevant, we acknowledge the Indigenous Nations on the land where we reside. We also acknowledge those who came before us establishing a basis for global health criticism and change upon which we build in the hope of creating a stronger and more equitable future for all.
Competing Interests and Funding
The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest. This study did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
Data Sharing
Not applicable.
Patient Consent
Due to the nature of this commentary, no patients or public were involved in the conceptualisation or conduct of the study and thus no consent was obtained.
Ethical Approval
Due to the nature of this piece, no patients or public were involved in the conceptualisation or conduct of the study, and thus no ethics approval was needed or obtained.
Contributor Statement
DK conceived the presented idea with support of all other authors and drafted the initial manuscript. Critical feedback, editing, and additional writing was then contributed by ZS, JS, MS, BD, GC, and GN. All authors discussed and contributed to the contents of the manuscript and contributed intellectually equally.
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