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The healthy state? How geopolitics undermines the protection and improvement of health of the people we serve

Publication date: 02.07.2024
Author: John Middleton

As Britons go to the polls this week, there is a common, underlying force which is subverting all our efforts to create a better global, national and local society. That force is preventing progress on tackling climate breakdown (1), it is increasing inequalities in health, allowing life expectancy to deteriorate (2,3), and growing the burden of non-communicable diseases (4). It is filling our waterways with sewage and trashing the environment (5). Health services, education, the courts, the police, local government, and other public services have been allowed to decay. This same force undermines the NHS (6) and seeks to scrap laws that prevent unqualified non-medics from filling gaps in the medical workforce (7).

That force is neoliberalism. Neoliberalism was first proposed by Austrian economists Hayek and Von Mises, as an antidote to the centralized tyranny of Nazi Germany. (8) Neoliberalism is a global economic force driving governments to pursue low tax, reduce regulation, and encourage small state policies; it aids the expansion of uncontrolled globalization and colonialization of health-damaging manufacturing and services by multinational companies. (9,10) Neoliberalism was rejected by many countries after the second world war, as they pursued social welfare policies; but it was inflicted in grand scale on the ‘developing’ world by the International Monetary Fund and World Bank. (11) Neoliberalism accelerated through the 1980s with the policies of Thatcher and Reagan and became mainstream for many western countries. (12) Neoliberalism was given a practical tool, an engine to grow exponentially, in the ‘most influential book you’ve never read’, by Davidson and Rees-Mogg in 1997. ‘The Sovereign Individuals’ are the financial trailblazers who have mastered the new information technologies to avoid taxes and hide their wealth from governments, they have become the oligarchs and the super-rich. (13) Governments are being drained of the wealth they need to fund social welfare and reduce health inequalities. (14,15) As wealth accrues to the super-rich, someone must take the blame for leaving the rest in increasing levels of poverty, destitution and despair. To explain the increasing poverty and harshness of life for the masses, there has been a rebirth and rise of populism. (10) This has accelerated political corruption, (16) created culture wars, (17) distrust of others and increased global political instability. (18) Populism encourages and normalizes tribal behaviors; easy obvious answers are offered for complex societal problems. (19) Migrants and any vulnerable minorities are to blame. Nationalism becomes a driver for desperate ill treatment of other people, nations and cultures. What begins as an exercise in scapegoating, leads on to performative cruelty, whether it is criminalising homelessness and poverty within countries (20), dispatching refugees to Rwanda, (21) or bombing children in Gaza (22). We accept, even support, our governments inflicting pain on people, as long as it is, please, not us. (23)

The information revolution has supported and accelerated all these pernicious trends. (24) It has created its own dark geopolitical force through the explosion of social media, and industrial-scale disinformation undermining individual critical thinking and democratic processes. (25) Health professionals have failed to understand the extent and the aims of disinformation, for example in anti-vaxx campaigns. (26) It is not necessary for disinformation to win an argument, merely create widespread uncertainty and distrust of scientific knowledge. The information revolution has also amplified the extent to which people move in ‘bubbles’ or ‘tribes’, rather than traditional political or societal communities; it is easier to locate other individuals with extreme views or conspiracy theories than it could have been in the past and spread such opinions unchallenged, (19) whilst solidifying the opinion within their respective echo chambers.

Neoliberalism has no respect for professionalism, expertise, or science. Regulation is not necessary. There is a worldview, popular in far right and alternative religious circles that believes progress and equality are poisonous illusions. The market is best placed to determine how services are delivered and how the skills of experts should be used. (7)

Dark money from corporations and sovereign individuals are fuelling the engines of disinformation and the merchants of doubt in think tanks around the world, undermining political campaigns and government policies, and funding political parties supportive of their aims. (1,27-30) These think tanks have even been implicated in drafting legislation (30) Fossil fuel funding has subverted the Australian referendum on constitutional change to include a voice to government for the first peoples of Australia (28). The Atlas Network, active in that campaign, is increasingly influential in the European Union (29) supporting right wing surges in the European Union elections and most recently in France. (1,29). Dark money has also fuelled the powerful information machinery that undermined Brexit, the US 2016 election and other elections worldwide. (31)  The playbook from the tobacco industry, challenging and undermining health evidence has been repeated by fossil fuel, big food, and big alcohol. (27) 2.7 million lives have been lost to these in Europe alone last year. (4)

Austerity policies championed by right wing think tanks, have led to the utter impoverishment of the very poorest and increased the amount of absolute destitution in the UK. There is virtually no wealth to be taken from these people anymore. So, the aggressive ‘warlord capitalists’, (32) are coming now for the wealth of the middle classes-held in their pension funds and property, as we saw with the disastrous Truss-Kwarteng mini budget of 2022. (33) And the middle classes will pay more for their mortgages, however inappropriate interest rate rises are for tackling inflation now. The illusion that the cost of living is high because of Covid and the Ukraine war has been convenient for accelerated corporate greed and profiteering. (34)

Cheerleading for neoliberalism in the UK is the Institute of Economic Affairs. (35,36,) They have backed small state policies since their inception in 1955. They have championed the rebranding of the tobacco industry bolstered by the campaign for respectability of e-cigarettes, and most recently in their lobbying to halt Prime minister Sunak’s last bill, the Tobacco and Vapes Bill 2024 (37) They have benefitted from fossil fuel funding (30) They achieved their highest visibility, and ignominy in their celebration of the Truss-Kwarteng budget. (33) They are amongst the think tanks supporting the agenda of the super-rich, the oligarchs, the multinational corporations putting profit over health, the new borderless empires seeking to enslave us all, and happy to undermine the NHS, professional, and drug company regulation. (7)

In this year of elections across the world, 97 countries go to the polls, covering almost half the world’s population. (38) There have been further advances for nationalism and populism and setbacks for democratic movements. Public health communities should seek to understand the underlying motivations behind these popular votes. But we should also be aware that democratic processes are being undermined and political movements being fuelled by multinational commercial interests, disinformation and money. With the UK election as the imminent example, we are seeing little vision for a better society from the major political contenders. The best appears to be rather a hope to halt years of austerity, declining health and life expectancy for many, and challenge greed and corruption for a few. As Andrija Stampar, father of European public health and founding member of the World Health Organization was given to say, ‘Where there is no vision, the people suffer’. We must demand more vision and hope for the future from our politicians, of whatever their political creed, and wherever they are in the world. The protection of people and planet, and indeed human survival depends on it.

Sebastian Levesque

ASPHER Young Professional and Intern 2022-23.

Professor John Middleton

Past president, ASPHER

Vice president, Global Network for Academic Public Health

This paper is based on an address by Professor Middleton to the ASPHER Deans and Directors’ Retreat in University College Dublin, Ireland, September 1st 2024 and the ASPHER internship of Sebastian Levesque, in 2023. A further paper from the internship will be published in 2024.

With thanks also to Robert Otok and Lore Leighton, ASPHER secretariat.


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