IN A NUTSHELL Author's noteDonald Trump's address to the 81st United Nations General Assembly on 22 September 2026 offers a clear expression of a model of international relations centred on national power, military strength, economic competition, energy production and national advantage. This article examines that model from the perspective of Sustainable Health Equity. It considers Trump's treatment of war and peace, Iran, Gaza, Venezuela, Cuba, migration, fossil fuels, climate change, international law and the United Nations itself. It also examines several factual claims in the speech that have been challenged by independent fact-checking. The analysis is placed within a broader body of work developed through the Sustainable Health Equity Movement and published in PEAH, including the concept of Wellbeing in Sustainable Equity (WISE), the estimation of a major global health inequity burden, the projected climate-related mortality of more than 220 million excess deaths during the remainder of the twenty-first century, and the estimated global "dignity gap" of approximately US$7 trillion. The article argues that these are not separate crises. They are expressions of a global order in which economic, military and political power remains concentrated while the costs of deprivation, ecological damage and conflict are distributed very unequally. The article therefore proposes a refoundation of the United Nations around sustainable equity: ensuring that every person can achieve a dignified and healthy life while humanity remains within the ecological limits of the Earth
By Juan Garay *
Former Head of European Union Cooperation in Cuba (2017–2023)
Professor of Health Equity (Cuba, Mexico, Brazil, Spain)
Co-Chair of the Sustainable Health Equity Movement (SHEM)
By the same Author on PEAH: see HERE
From National Power to Sustainable Equity
a critical reading of Donald Trump’s 2026 UN address and a proposal for the refoundation of the United Nations
Introduction
The United Nations was created in 1945 after a world devastated by war. Its Charter sought to establish a system in which sovereign states could cooperate to prevent conflict and promote human rights, development and international peace.
More than eighty years later, the basic architecture of that system remains largely unchanged, while the problems facing humanity have become increasingly global and interconnected.
Climate change, biodiversity loss, pandemics, nuclear weapons, mass displacement, global financial concentration and unequal access to knowledge and essential resources cannot be addressed effectively by states acting only in competition with one another.
Trump’s 2026 address is therefore significant beyond the individual statements it contains. It expresses a particular understanding of how the world should be organised: strong nations protecting their interests through economic, military and technological power.
This raises a larger question:
Can a world facing common existential risks continue to be organised primarily around competition between powerful states?
From the perspective of Sustainable Health Equity, this requires reconsidering what we mean by security, prosperity and development.
Power as the organising principle
Trump repeatedly connects national strength with economic production, military capacity, energy resources and geopolitical influence.
There is nothing new about states defending their interests. The problem arises when national advantage is treated as if it can be pursued independently of the interests of other peoples and of the ecological systems on which all societies depend.
A military can protect territory, but cannot prevent a pandemic.
A larger economy does not necessarily reduce health inequality.
More fossil-fuel production may increase energy supply while increasing climate and pollution risks.
Control of natural resources can strengthen national power while intensifying competition for those resources.
The atmosphere, oceans, biodiversity and many essential resources do not respect national borders.
The security of one population is increasingly connected to the security of all others.
War presented as peace
One of the most striking features of Trump’s speech is the presentation of military action and US power as instruments for achieving peace.
Trump describes several conflicts as having been “settled” and presents American military capacity as a source of deterrence and stability.
But ending active fighting is not necessarily the same as establishing peace.
A ceasefire may stop immediate violence without resolving the causes of conflict, protecting civilian populations, establishing accountability or creating the political and social conditions for lasting peace.
This distinction matters particularly in relation to Gaza and Iran.
Trump presents Iran as a major terrorist threat and warns of extreme military consequences if an agreement is not reached.
A consistent application of international humanitarian law requires the same questions to be asked of every actor: who uses force, against whom, under what legal authority, with what distinction between civilians and combatants, and with what consequences?
International standards lose credibility when the vocabulary of terrorism is applied selectively.
Gaza and the erosion of a moral order
The destruction of Gaza raises a wider question about the credibility of the post-war international order.
The International Court of Justice ordered provisional measures in the South Africa v. Israel case under the Genocide Convention. These measures do not constitute a final judgment on whether genocide has occurred, but they demonstrate the seriousness of the legal allegations and the Court’s concern about the risk of irreparable harm.
The PEAH analysis “Gaza and the End of a Moral Order” argues that Gaza represents more than another regional conflict. It is a test of whether the international system can reconcile its declared principles with its actual behaviour. It describes the growing gap between human-rights language and political action and argues that the crisis exposes the exhaustion of a global order whose legitimacy depends on standards that are not consistently applied.
The question is therefore not whether Hamas’s attacks on civilians should be condemned. They should.
Nor is it whether Israeli civilians have a right to security. They do.
The question is whether the same principles of civilian protection, international law and accountability apply equally to powerful and less powerful actors.
The United States’ longstanding military and political support for Israel therefore forms part of the context that cannot simply be omitted from an assessment of the international order.
The issue is not collective blame. It is universal accountability.
The climate-health burden: an unequal planetary war
The ecological dimension gives this debate an even larger scale.
A 2018 PEAH analysis, “Health and Climate Change: a Third World War with No Guns,” modelled the potential health consequences of continued warming and estimated approximately 216 million excess deaths from temperature increase during the twenty-first century, with the great majority expected in tropical and subtropical populations that have contributed relatively little to cumulative emissions.
Later SHEM work has developed this estimate further, referring to more than 220 million projected excess deaths during the remainder of the twenty-first century, predominantly affecting low-polluting countries, communities and age groups.
These figures are model-based estimates, not observed deaths or certain predictions. Their importance lies in the distribution of the projected burden.
The countries and populations expected to suffer most are not necessarily those responsible for the largest share of historical emissions.
Climate change therefore creates a profound intergenerational and international equity problem.
The PEAH analysis proposed a Universal Ethical Threshold of approximately 1.7 tonnes of CO₂ per person per year in its modelling framework, as an indicative ethical allocation of the remaining carbon space.
Whatever precise threshold is ultimately adopted, the ethical principle is clear: ecological space cannot be treated as an unlimited resource belonging disproportionately to those who reached high consumption first.
Prosperity and the fossil-fuel economy
Trump’s speech repeatedly associates prosperity with energy abundance and increased production.
This reflects a conventional economic model in which prosperity is closely associated with production, consumption, investment and energy use.
But economic activity takes place within a finite ecological system.
The 2025 UNEP Emissions Gap Report estimates that current policies remain consistent with warming of approximately 2.8°C this century, while full implementation of current national climate pledges would still imply approximately 2.3–2.5°C.
The WHO has repeatedly warned that climate change is already affecting health through heat, food insecurity, infectious disease, water insecurity and other pathways.
The central question therefore cannot simply be:
How much can the global economy produce?
It must also be:
How much can humanity produce while maintaining the ecological conditions required for life?
And:
Who receives the benefits and who bears the costs?
Venezuela and resources as the spoils of power
The Venezuela section of Trump’s speech is particularly revealing because natural resources are closely associated with geopolitical victory.
Trump refers to Venezuela’s oil resources and uses the expression “to the victor belong the spoils”.
This language is difficult to reconcile with the idea that natural resources ultimately belong to peoples and future generations rather than to whoever possesses the greatest military or economic power.
There is also a factual problem with his claim that the United States and Venezuela together possess more than 60% of the world’s oil. Independent fact-checking found that their combined share of proven reserves is approximately 22%, not 60%.
The larger issue is whether access to natural resources should be understood as a prize of geopolitical power.
If so, the international system itself creates incentives for competition and conflict over resources.
Cuba: coercion, ideology and the human cost
Trump’s treatment of Cuba is framed largely through the failure of communism.
There are legitimate grounds for criticism of the Cuban political system, including restrictions on political freedoms and political pluralism. But this does not remove the need to examine the consequences of prolonged economic coercion.
The most recent PEAH study, “Cuba Under Economic Siege,” examines the combined effects of the US economic, commercial and financial restrictions, intensified in 2026, particularly through constraints affecting fuel and third-party economic operators. It estimates approximately 14,000 excess deaths in 2024 relative to selected demographic and historical references, while explicitly stressing that these are analytical estimates rather than official counts of avoidable deaths.
The article asks whether the progressive deprivation of essential conditions for life could constitute a “genocide without weapons”, but this is presented as a public-health and ethical question, not as a legal determination of genocide.
The distinction is important.
Cuba has internal political and economic responsibilities for its population’s wellbeing. At the same time, external economic restrictions can have real consequences for access to fuel, medicines, food, water, transport and health services.
A serious analysis needs to consider both.
Migration and the reduction of human beings to security categories
Trump’s treatment of migration reduces a complex global phenomenon largely to questions of borders, illegal entry, crime and sovereignty.
States clearly have the right to regulate entry into their territory.
But migration is also driven by war, poverty, political persecution, economic inequality, family reunification, labour markets and environmental disruption.
A sustainable-equity approach therefore asks not only how borders should be controlled, but why so many people are forced to leave their homes.
If the global system produces radically unequal opportunities for health, security and dignity, migration is partly a symptom of that inequality.
The problem of the numbers
The speech makes extensive use of large numerical claims concerning oil, drugs, migration, investment, military action and wars supposedly ended.
Some have been challenged by independent fact-checking.
For example, PolitiFact found Trump’s claim that US operations had eliminated 97% of drugs entering the United States to be unsupported, because seizure figures cannot establish the total amount entering an illicit market. It also found the oil-reserve claim substantially exaggerated.
The methodological lesson is important.
Numbers in public policy require definitions, denominators, time periods, populations and sources.
Sustainable Health Equity therefore requires not simply more data, but better measurement and greater transparency about what data actually show.
From health inequality to sustainable equity
The health dimension provides a useful way to connect the apparently separate crises of poverty, climate change, war and economic concentration.
The WISE paradigm — Wellbeing in Sustainable Equity — proposes that global development should be assessed by the capacity to achieve the best feasible levels of human wellbeing while remaining within economic and ecological limits.
The starting point is simple: the aspiration for a long and healthy life is universal.
The question is whether the economic and ecological resources needed to achieve this can be distributed fairly.
The WISE analysis estimates a persistent burden of approximately 16 million excess deaths each year associated with global health inequity, while identifying an estimated dignity gap of around US$7 trillion—the additional resources required for countries below the proposed dignity threshold to approach the best feasible levels of health.
This is not simply a call for traditional development aid.
It points towards a much larger redistribution of global resources.
The same analysis proposes a threshold beyond which additional income no longer corresponds to further gains in life expectancy while being associated with increasingly unsustainable ecological consumption. It estimates that a large share of global GDP lies above such an “excess” or “hoarding” threshold.
The implication is uncomfortable but important:
Global justice requires both ending deprivation and reducing excessive accumulation.
The US$7 trillion dignity gap therefore needs to be considered alongside the resources currently accumulated or consumed above levels compatible with sustainable equity.
Restoring the broken human deal
The 2024 PEAH paper “Restoring Broken Human Deal” develops this argument further.
It describes the present system as a broken deal both among human beings and between humanity and nature. It links persistent health inequity, ecological destruction, financial concentration, military power and weak global governance to a common failure of international cooperation.
The paper argues that the problem cannot be solved simply by increasing conventional development assistance.
It calls instead for a new societal paradigm based on empathetic local governance, ecosystem-friendly production and consumption of essential needs, and collaborative innovation directed towards global public goods.
This changes the meaning of redistribution.
It is not simply transferring money from rich to poor.
It means restructuring the global economy so that resources currently absorbed by excessive consumption, speculation, military expenditure and ecological destruction can instead support health, knowledge, essential services and the transition to sustainable production.
The missing denominator: planetary limits
Perhaps the largest omission in Trump’s speech is the absence of a meaningful ecological denominator.
Economic and military power are discussed as if they could continue expanding without reference to the Earth’s capacity to absorb emissions, regenerate ecosystems and provide resources.
The planetary-boundaries framework provides one scientific way of approaching this problem.
Humanity has already crossed several proposed Earth-system boundaries.
This changes the meaning of development.
The question can no longer simply be:
How much more can humanity produce?
It must be:
How much can humanity produce and consume while preserving the ecological systems required for life?
And:
How can the remaining ecological space be shared fairly?
These questions form the basis of sustainable equity.
International law and exceptionalism
International institutions are imperfect and should be reformed.
But the alternative cannot be a system in which powerful states accept international rules only when those rules coincide with their interests.
International law depends on universality.
No state should be above accountability because of its military capacity, economic influence or permanent position in an international institution.
The tension is particularly visible in the Security Council, where five states—China, France, Russia, the United Kingdom and the United States—possess permanent seats and veto power.
This was a political arrangement designed in 1945.
It is increasingly difficult to reconcile with the principle of sovereign equality among UN members and with the global nature of contemporary problems.
From United Nations to United Peoples
The UN Charter begins with the words:
“We the peoples…”
Yet the organisation remains primarily structured around sovereign states.
A refounded UN should explore how to give stronger representation to peoples, regions, civil society, future generations and the global commons while retaining states as essential political actors.
The objective would not be world government.
It would be a more democratic system for managing problems that no country can solve alone.
Climate change is one example.
Pandemics are another.
So are nuclear weapons, artificial intelligence, global financial instability, biodiversity loss and access to essential medicines and scientific knowledge.
A proposal for the refoundation of the United Nations
A refounded UN could be built around the following principles.
1. Sustainable equity as a central global objective
Every person should have the conditions necessary for a dignified and healthy life, while humanity remains within planetary boundaries.
2. A global dignity floor
Countries and communities below an agreed dignity threshold should have access to the resources necessary to reach the best feasible levels of health and wellbeing.
The WISE analysis estimates the present global dignity gap at approximately US$7 trillion annually.
3. An excess-resource threshold
Above a level at which additional accumulation no longer contributes significantly to human wellbeing while increasing ecological damage, resources should progressively be redirected towards global public goods.
This is the economic counterpart of the dignity floor.
4. Recognition of global commons
The atmosphere, oceans, biodiversity, major freshwater systems and other essential ecological systems should be treated as shared responsibilities of humanity.
5. Rights of future generations
Future generations should have recognised rights to the ecological conditions necessary for life and health.
6. Universal application of international law
No state should enjoy effective exemption from international law because of its political or military power.
7. Reform of the Security Council
The permanent veto should be substantially reformed, with greater representation and mechanisms allowing the wider UN membership to act when the Council is paralysed.
8. Progressive demilitarisation
Nuclear weapons and other weapons of mass destruction should ultimately be eliminated, while military expenditure is progressively redirected towards human security and global public goods.
9. Health and knowledge as global public goods
Essential medicines, vaccines, scientific knowledge, health technologies and other life-saving resources should not depend primarily on purchasing power.
10. A fair system of human mobility
The causes of forced migration should be addressed alongside the protection of the rights and dignity of migrants and refugees.
11. Ecological transformation
Global economic governance should support rapid transition away from fossil fuels while ensuring that lower-income countries have sufficient resources to achieve dignified development.
12. Democratic global financing
The UN and other global institutions need predictable and sufficiently independent financing rather than excessive dependence on voluntary contributions from powerful states and private interests.
From competition to cooperation
The alternative to a power-centred international order is not the absence of power.
It is the democratisation and redistribution of power.
Nor is it the rejection of economic development.
It is a different understanding of development: improving human health, dignity and capabilities while reducing unnecessary material consumption and protecting the ecological systems on which future generations depend.
This also changes the meaning of security.
Security should include food, health, water, energy, climate, peace and ecological stability—not simply the military capacity of states.
It changes the meaning of prosperity as well.
Prosperity should not be measured only by how much a country produces, consumes or accumulates, but by whether people can live long, healthy and meaningful lives without undermining the ability of others and future generations to do the same.
Conclusion: a call for a new global settlement
Trump’s 2026 UN speech provides a particularly clear expression of one possible future: a world of strong states competing for security, resources, markets, technology and geopolitical influence.
But this is not simply about one president or one country.
The deeper problem is the persistence of an international system in which military power, economic wealth and control of resources determine whose interests prevail.
The evidence and analysis developed through Sustainable Health Equity point towards another possibility.
The projected burden of climate-related mortality falls disproportionately on populations that have contributed least to historical emissions. Global health inequity continues to generate millions of preventable deaths every year. At the same time, the WISE analysis identifies a substantial global dignity gap alongside enormous concentrations of resources above levels compatible with sustainable equity.
Gaza and Cuba provide two contemporary examples of a broader problem: the distance between the universal principles proclaimed by the international system and the way power is actually exercised. The PEAH analyses of Gaza and Cuba argue, from different perspectives, that the consequences of geopolitical power increasingly reach directly into the conditions of life, health and survival.
The response should therefore be larger than opposition to any single government.
It should be a new global settlement.
A refounded United Nations could place sustainable equity at the centre of international cooperation:
a dignified life for every person; ecological limits for everyone; greater redistribution from excess to deprivation; global public goods; universal accountability under international law; peace instead of permanent military competition; and democratic institutions capable of representing humanity as a whole.
This would give new meaning to the opening words of the UN Charter:
We the peoples.
The challenge is no longer to decide which country should dominate the twenty-first century.
It is to build institutions through which humanity can learn to share the twenty-first century—and protect the living Earth on which all of us depend.
References
- Garay JE, Chiriboga DE, Kelley N, Garay A, Garcia-Carmino E. Health and Climate Change: a Third World War with No Guns. PEAH, 2018. The analysis modelled approximately 216 million excess deaths from temperature increase during the twenty-first century, predominantly in tropical and subtropical populations.
- Garay J. Towards a WISE – Wellbeing in Sustainable Equity – New Paradigm for Humanity. PEAH, 2023. The article develops the WISE paradigm, the dignity threshold, the estimated US$7 trillion global dignity gap and the concept of an excess/hoarding threshold.
- Garay J. Restoring Broken Human Deal. PEAH, 2024. The article develops the analysis of global governance failure, health inequity, ecological destruction, economic concentration and the need for a new societal paradigm.
- Garay J. Gaza and the End of a Moral Order: Energy, Power, and the Emergence of a Post-Hegemonic World—and the Prospect of a New Global Life Expectancy Decline. PEAH, 2026.
- Garay J. Cuba Under Economic Siege: Evidence of the Humanitarian and Health Consequences of United States Coercive Measures and Arguments for an Equity-Based Response. PEAH, 2026.
- United Nations. Charter of the United Nations. San Francisco, 1945.
- United Nations. Universal Declaration of Human Rights. Paris, 1948.
- International Court of Justice. Application of the Convention on the Prevention and Punishment of the Crime of Genocide in the Gaza Strip (South Africa v. Israel). Provisional Measures, 2024.
- United Nations Environment Programme. Emissions Gap Report 2025. UNEP, Nairobi, 2025.
- World Health Organization. Climate Change and Health. WHO, Geneva.
- Richardson K, et al. Earth beyond six of nine planetary boundaries. Science Advances. 2023;9(37):eadh2458.
- United Nations Security Council. Voting System and the Right to Veto.
- United Nations Security Council. Vetoes since 1946.
- PolitiFact. Fact-check: President Donald Trump misleads on Iran war, AI in speech to UN. September 2026.
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* MD, internal medicine, MSc Trop Med, MPH, independent researcher and co-founder of the Sustainable Health Equity Movement (SHEM) and Valyter Ecovillage, a community initiative promoting shared living, care for nature and sustainable development. He has worked for more than three decades in public health, health equity and international cooperation. He served as Coordinator of the European Union Cooperation Programme on Global Health and for Mexico (2013–2017) and Cuba (2017–2023). He is Visiting Professor at the Latin American School of Medicine (ELAM), the Marta Abreu Central University of Las Villas (UCLV) and the Agrarian University of Havana (UNAH) in Cuba; the Autonomous University of Chiapas (UNACH) in Mexico; Fundação Oswaldo Cruz (Fiocruz) in Brazil; the National School of Public Health (ENS) in Spain; and the University of California, Berkeley, USA. His research focuses on Sustainable Health Equity, global health, human development, international cooperation and the governance of knowledge and global public goods for the common good.