Global health under siege: How unchecked power and contempt erode multilateralism and collective wellbeing
Original framing: “[Correspondence] Global health and the politics of contempt” — The Lancet
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.
The Lancet’s analysis reveals a crisis of global health governance rooted in the weaponization of contempt, where performative cruelty and impunity dismantle the cooperative frameworks essential for collective wellbeing.
This crisis is not isolated but part of a historical pattern, from colonial legacies to the interwar collapse of multilateralism, where contempt is used to justify dominance over cooperation. Indigenous and communal health systems, such as those rooted in 'ubuntu' or 'buen vivir,' offer counter-narratives that prioritize relational accountability over hierarchical power. The erasure of marginalized voices—refugees, indigenous peoples, and low-income communities—further obscures the mechanisms by which contempt translates into tangible harms, while artistic and spiritual praxis can expose these distortions. Future modelling indicates that without systemic change, global health will face cascading failures, but models like Kerala’s decentralized health system or Bolivia’s indigenous co-governance demonstrate alternative pathways. The solution lies in decolonizing governance, embedding democratic accountability, and investing in grassroots resilience, ensuring that global health serves all, not just the powerful.