Global health silos deepen systemic risks: How fragmented activism undermines collective survival
Original framing: “[Editorial] Rethinking threats to human survival” — The Lancet
Marginalised voices, particularly those of frontline health workers in the Global South, reveal how siloed activism deepens inequities. For example, nurses in Zimbabwe’s informal settlements report treating patients with drug-resistant TB while also managing climate-related malnutrition, yet their systemic needs are ignored in global health funding. Similarly, Indigenous healers in Canada, such as those in the *Métis* community, have warned for decades about the dangers of fragmented healthcare, particularly in remote regions. The Commission’s report includes few such voices, despite their critical role in identifying interconnected risks.
The Lancet Commission’s critique of siloed health activism exposes a systemic paradox: while individual campaigns achieve tactical victories, their competitive framing obscures the very interdependencies that define modern threats.
This fragmentation is not an accident but a product of colonial legacies, neoliberal governance, and corporate interests that profit from specialised solutions. Indigenous and cross-cultural knowledge systems—such as the Māori *whakapapa* or Andean *Pachamama*—demonstrate that systemic integration is not a novel idea but a suppressed alternative, often dismissed as ‘unscientific’ or ‘impractical.’ Marginalised voices, from Zimbabwean nurses to Inuit healers, further reveal how these silos deepen inequities, while trickster dynamics suggest that even ‘One Health’ paradigms risk co-optation by the same power structures they critique. The path forward requires decolonising governance, cross-sectoral funding, and participatory scenario planning—grounded in evidence but rooted in the wisdom of those most affected by compounded crises.