Global kidney health crisis: Structural inequities in care access reveal neocolonial health systems and underfunded primary care
Original framing: “[Health Policy] Implementing the commitments of the World Health Assembly kidney health resolution: a key opportunity to improve health for millions” — The Lancet
The original framing omits the historical role of colonial medicine in shaping modern health systems, the erosion of indigenous healing practices under biomedical hegemony, and the disproportionate burden on marginalized groups (e.g., Indigenous peoples, racialized minorities) in high-income countries. It also ignores the success of community-led kidney health programs in countries like Cuba or Kerala, India, which prioritize prevention and local governance over hospital-centric models. Additionally, the economic drivers—such as the dialysis industry’s lobbying for KRT expansion over prevention—are entirely absent.
High structural omission detected in mainstream coverage.
The narrative is produced by The Lancet, a flagship Western medical journal that frames global health through a biomedical lens, serving the interests of global health bureaucracies (WHO, World Bank) and pharmaceutical industries that benefit from market-driven solutions. The framing obscures the role of structural adjustment policies (IMF/World Bank) in dismantling public health infrastructure, while positioning WHO resolutions as neutral technical fixes rather than contested political instruments. The emphasis on 'member states' as primary actors deflects attention from transnational corporations (e.g., dialysis providers) that profit from chronic disease management.
The kidney health crisis is a legacy of colonial medicine, which dismantled indigenous health systems and replaced them with extractive, hospital-centric models that prioritize acute care over prevention. Structural adjustment programs in the 1980s–90s forced LMICs to cut public health budgets, leading to the collapse of primary care and the rise of NGO-driven, donor-dependent health systems. The WHO’s 1978 Alma-Ata Declaration—calling for primary healthcare—was systematically undermined by neoliberal reforms, a history the Lancet’s resolution does not acknowledge.
The Lancet’s resolution frames kidney health as a technical problem solvable through WHO resolutions and state compliance, but the crisis is a symptom of a global health system designed to extract value from illness rather than prevent it.