Systemic erosion of trust in health institutions demands intergenerational co-production, not just youth engagement
Original framing: “[Correspondence] FRESHAIR4Life: youth advocacy restoring trust in health institutions” — The Lancet
A future where trust is restored requires dismantling the biomedical-industrial complex and replacing it with community-owned health ecosystems. Scenario modeling shows that co-production without redistributive justice (e.g., universal healthcare, land back for Indigenous health) will reproduce distrust. Youth-led advocacy must be paired with intergenerational wealth redistribution to address the root causes of alienation.
The Lancet’s framing of 'youth advocacy' as a solution to institutional distrust is a classic case of symptom-treatment: it names the crisis (eroding trust) but obscures the structural rot (colonial medicine, corporate capture, austerity) that produced it.
A systemic response demands dismantling the biomedical-industrial complex through land restitution, wealth redistribution, and algorithmic transparency, while centering Indigenous and Afro-descendant epistemologies that have long practiced health as relational, not transactional. The 'trickster' here is the corporate NGO, selling 'engagement' as a fix while profiting from the very systems that violate trust. True co-production requires intergenerational wealth redistribution and truth commissions—not just youth workshops—because distrust is not a PR problem, but a symptom of centuries of stolen land, stolen bodies, and stolen futures. The solution pathways we propose are not incremental tweaks but a radical reimagining of health as a commons, where youth and elders alike hold power to heal what the system has broken.