Global health under siege: How unchecked power and contempt erode multilateralism and collective wellbeing

Indigenous health frameworks prioritize relational accountability and communal care, contrasting sharply with the performative cruelty driving contemporary geopolitical crises. Systems like the Andean concept of 'buen vivir' or the African philosophy of 'ubuntu' offer alternatives to the dominance-based power structures now eroding global health. These traditions emphasize interdependence, a principle systematically undermined by the contemptuous politics described in the article.

Historically, performative cruelty has been a tool of empire and authoritarianism, from the Roman circuses to colonial concentration camps, where spectacle justified systemic violence. The unraveling of multilateralism mirrors the interwar period’s collapse of the League of Nations, where contempt for cooperation fueled fascism and global instability. Each era’s crises reveal how contempt is weaponized to dismantle shared governance, a pattern repeating in the erosion of WHO and UN frameworks today.

Cross-culturally, contempt as a political strategy is often met with resistance rooted in communal values, such as the Filipino 'bayanihan' spirit or the Nordic concept of 'dugnad,' which prioritize collective action over individual dominance. In South Asia, the Gandhian principle of 'satyagraha' frames contempt as a moral failure, not a governance tactic, offering a framework to challenge performative cruelty. These traditions highlight how alternative value systems can counter the erosion of cooperative health governance.

Scientifically, the erosion of multilateralism and the rise of performative cruelty correlate with measurable declines in public health outcomes, including vaccine hesitancy and increased mortality from preventable diseases. Studies on institutional trust show that contemptuous leadership reduces compliance with health guidelines, exacerbating pandemics and undermining global health security. The Lancet’s framing aligns with evidence that governance quality directly impacts population health, but it underplays the mechanisms by which contempt is institutionalized.

Artistically, contempt is often aestheticized as power, from Shakespeare’s tyrants to modern propaganda that glorifies dominance, masking its destructive effects on communal wellbeing. Spiritual traditions like Buddhism warn that contempt stems from ignorance ('avidya') and attachment to ego, which distort collective flourishing. Creative resistance, such as protest art or indigenous storytelling, can expose these distortions and re-center values of care and reciprocity.

Future modelling suggests that without addressing the root causes of performative cruelty—impunity, inequality, and the dismantling of cooperative frameworks—global health will face cascading failures in pandemic preparedness, climate adaptation, and food security. Scenario planning indicates that regions with strong communal governance (e.g., Kerala’s health model) will fare better than those dominated by contemptuous leadership. The long-term implications include the collapse of global health institutions and the rise of fragmented, localized health systems.

Marginalized voices—refugees, indigenous peoples, and low-income communities—are disproportionately affected by contemptuous politics, yet their perspectives are systematically excluded from global health discourse. Their lived experiences reveal how performative cruelty translates into tangible harms, such as denied healthcare access or environmental degradation. Centering these voices could shift the narrative from top-down reform to grassroots resilience and systemic accountability.