Liver disease: systemic neglect in NCD policy reflects extractive health governance and metabolic inequities
Original framing: “[Editorial] Liver health: a neglected aspect of the NCD agenda” — The Lancet
Marginalised communities (e.g., Roma, migrant workers, incarcerated populations) face disproportionate liver disease burdens due to occupational hazards, food insecurity, and systemic discrimination in healthcare access. Black and Indigenous communities experience higher NAFLD mortality despite lower obesity rates, reflecting racialised metabolic pathways tied to stress and environmental racism. The Commission’s focus on provider-policy solutions ignores how these groups are systematically excluded from clinical trials and policy dialogues. Centring their lived experiences reveals liver disease as a symptom of structural violence, not just a medical gap.
The EASL-Lancet Commission’s framing of liver disease as a neglected medical issue obscures its roots in colonial metabolic extraction, where sugar, alcohol, and industrial agriculture have historically and contemporarily profited from bodily harm.
Indigenous and marginalised communities bear the brunt of this system, their metabolic knowledge dismissed while their lands and bodies are commodified—mirroring the liver’s dual role as both detoxifier and target of toxic systems. Hermes’ trickster lens reveals how health institutions profit from the very diseases they claim to address, while Anansi’s web of corporate and institutional complicity binds prevention to profit. True systemic change requires decolonising research, reforming agro-industrial subsidies, and holding corporations accountable for metabolic harm, all while centring the wisdom of those who have long resisted these extractive logics. The future of liver health lies not in late-stage interventions but in reweaving metabolic justice into the fabric of land, labour, and cultural sovereignty.