From Evidence to Earth Systems: Reconstructing Health Guidelines as Instruments of Planetary Governance in an Era of Climate Instability

IN A NUTSHELL
Author's Note 
Health systems are increasingly recognized as both victims and drivers of planetary destabilization, yet the architecture of evidence-based medicine remains structurally blind to environmental externalities. This paper advances a novel conceptual and policy framework that integrates planetary health into clinical and public health guideline systems through an expanded Evidence-to-Decision architecture. Drawing on recent global health governance debates, climate–health risk modeling, and emerging methodologies such as lifecycle assessment and carbon-utility analysis, the study reframes guidelines as instruments of macroprudential policy with direct implications for sovereign risk, fiscal stability, and climate resilience.

Positioning One Health as the operational bridge between ecological systems and human health, the paper proposes a multi-scalar governance model linking clinical decision-making to national and global risk architectures. In doing so, it argues that the failure to internalize planetary constraints within guideline development constitutes a systemic mispricing of health interventions, with cascading consequences for equity, sustainability, and economic stability.

The paper concludes by outlining actionable pathways for low- and middle-income countries—particularly in Sub-Saharan Africa—to assume global leadership in climate-informed health governance, positioning guideline reform as a strategic lever for resilience, equity, and geopolitical agency

By Kalolo Chitembo

Crisis Expert/ Emergency Medicine Specialist/ Health Economist/ Global Health Advocate/ Climate and ONE HEALTH Researcher

Zambia

By the same Author on PEAH: HERE

From Evidence to Earth Systems

Reconstructing Health Guidelines as Instruments of Planetary Governance in an Era of Climate Instability

Introduction: The Invisible Fault Line in Global Health Governance

Modern health systems operate on a paradox: they are designed to protect life while contributing materially to ecological degradation. The global healthcare sector accounts for approximately 4.4–5% of greenhouse gas emissions, a footprint that rivals major industrial economies. Yet, the epistemological core of health decision-making—clinical and public health guidelines—remains detached from planetary constraints.

This disconnect represents more than a technical oversight. It is a governance failure embedded within the architecture of evidence itself. Guidelines, often perceived as neutral clinical instruments, function in reality as silent regulators of resource allocation, technology adoption, and population health trajectories. Their omission of environmental externalities systematically biases decision-making toward short-term clinical gains at the expense of long-term system resilience.

In an era defined by climate instability, biodiversity collapse, and emerging zoonotic risks, this omission is no longer tenable. The question is no longer whether planetary health should be integrated into guidelines, but how rapidly governance systems can evolve to reflect this reality.

Theoretical Foundation: From Evidence-Based Medicine to Planetary Evidence Systems

Evidence-based medicine (EBM) has historically privileged clinical efficacy, safety, and cost-effectiveness. While frameworks such as GRADE have expanded to include equity and feasibility, they remain insufficient for capturing non-linear, cross-sectoral risks inherent in planetary systems.

Recent advances in planetary health science, ecological economics, and climate risk modeling challenge the boundaries of conventional evidence hierarchies. These disciplines reveal that health outcomes are inseparable from:

Climate variability and extreme events

Biodiversity integrity

Food and water system stability

Anthropogenic environmental change

The integration of these domains necessitates a transition toward what may be termed Planetary Evidence Systems (PES)—a multidimensional epistemology in which clinical, environmental, and socio-economic data converge within a unified decision architecture.

At the core of this transformation is the recognition that:

Evidence is not merely descriptive—it is constitutive of policy reality.

Methodological Innovation: Extending Guideline Architecture

Expanding the Evidence-to-Decision (EtD) Framework

This paper proposes the introduction of a fourth domain within guideline development:

Clinical effectiveness

Economic efficiency

Equity and feasibility

Planetary impact (new domain)

This additional domain systematically incorporates:

Lifecycle environmental impacts of interventions

Carbon intensity of care pathways

Ecological co-benefits and harms

Long-term system resilience implications

Analytical Tools for Integration

Emerging methodologies enable operationalization:

Lifecycle Assessment (LCA): Quantifies environmental burden across supply chains

Carbon-Utility Analysis: Extends cost-effectiveness analysis to include emissions

Integrated Assessment Models (IAMs): Link health outcomes with climate scenarios

Digital Surveillance Systems: Real-time monitoring of climate-sensitive disease patterns

Collectively, these tools transform guidelines into dynamic, data-responsive governance instruments.

One Health as the Operational Bridge

The One Health paradigm provides the institutional and conceptual infrastructure necessary for integration. By linking human, animal, and environmental health, it transcends sectoral silos and aligns with planetary health principles.

This paper advances a One Health Nexus Governance Model, characterized by:

Cross-ministerial coordination (health, environment, agriculture, finance)

Integration of zoonotic surveillance with climate risk analytics

Alignment with national adaptation plans and climate commitments

Embedding within primary care and community health systems

In this architecture, guidelines become interfaces between science, policy, and ecosystems.

Macroprudential Implications: Health Guidelines as Instruments of Sovereign Stability

A critical innovation of this paper is the elevation of health guidelines into the domain of macroprudential governance.

Failure to integrate planetary health considerations results in:

Increased burden of climate-sensitive diseases

Escalating healthcare costs

Reduced labor productivity

Heightened fiscal pressure on governments

Conversely, climate-informed guidelines act as:

Preventive investments in national resilience

Risk mitigation tools within sovereign balance sheets

Stabilizers of long-term economic growth trajectories

This reframing aligns health policy with the logic of central banking, fiscal policy, and global financial governance, positioning ministries of health as key actors in national risk architecture.

Current Affairs and Global Policy Momentum

Recent developments underscore the urgency of this transformation:

Intensifying climate shocks across Africa, including droughts and flooding, are reshaping disease patterns and health system demands.

Global health governance is undergoing fragmentation, with shifting multilateral commitments and renewed debates on institutional legitimacy.

The World Health Summit agenda increasingly emphasizes climate–health integration, digital transformation, and system resilience.

Major financing institutions (e.g., World Bank, regional development banks) are embedding climate risk into health investment frameworks.

These dynamics create a policy window for structural reform—particularly for emerging economies to shape global norms.

Strategic Positioning for Sub-Saharan Africa

Sub-Saharan Africa, often framed as vulnerable, holds a unique opportunity to act as a norm entrepreneur in planetary health governance.

By integrating planetary considerations into guideline systems, countries such as Zambia can:

Leapfrog legacy systems

Align health policy with climate adaptation financing

Strengthen regional leadership within SADC and the African Union

Attract strategic partnerships with global health and climate institutions

This represents not merely adaptation, but geopolitical repositioning through policy innovation.

Discussion: The Political Economy of Transformation

Despite its technical feasibility, integration faces barriers:

Institutional inertia within guideline bodies

Limited interdisciplinary capacity

Fragmented data ecosystems

Short-term political incentives

Addressing these challenges requires:

High-level political commitment

Investment in data and analytical infrastructure

Strategic framing linking health to economic and national security priorities

Ultimately, the transition is not only scientific—it is profoundly political.

Conclusion: Rewriting the Rules of Evidence

Health guidelines are among the most powerful yet under-recognized instruments in global governance. In their current form, they encode a narrow conception of value that is misaligned with planetary realities.

Integrating planetary health into guideline systems is therefore not a technical refinement—it is a paradigm shift in how societies define, measure, and govern health itself.

In an era where climate instability is redefining risk, resilience, and sovereignty, the future of global health will be determined not only by innovation in medicine, but by innovation in the architecture of evidence.

The System Isn’t Stalling. It’s Being Rewritten: An Insider View from CPD59 (and Beyond!)

IN A NUTSHELL
Editor's note
Find an op-ed piece here on the recently concluded  59^th Session of the UN Commission on Population and Development, whereby the theme of the Commission was on population, technology and research in the context of sustainable development and a major sticking point in the negotiations (closed without outcome) was tech transfer between the global North and global South. 

As a topic with extremely important implications for people in today’s world arena, I am pleased to share the piece within PEAH network and beyond, while readers are invited to comment on its content and suggestions. 

This debrief article reflects the personal views of the author, based on professional experience, and does not represent the official positions of any government delegation or institution

By Levi Singh
Regional Policy Officer at SRHR Africa Trust

Johannesburg, South Africa

The System Isn’t Stalling. It’s Being Rewritten

An Insider View from CPD59 (and Beyond!)

I have spent enough time in multilateral rooms to recognise the difference between a difficult negotiation and a hollow one. Having now supported twelve sessions of the United Nations Commission on Population and Development, I do not say this lightly.

CPD59 was not difficult in the way these multilateral processes are meant to be. It was something else entirely. The zero draft, the foundation for negotiations, was notably weak when first circulated by the Chair, though it was meaningfully improved through the concerted efforts of Member States. By the time Revision 2 of the draft resolution emerged, it contained elements many of us could accept, or at the very least live with, as is the nature of political compromise. Yet even then, very little of what makes multilateralism function, compromise, explanation, reciprocity, and movement, was genuinely on offer.

That distinction matters.

Because when a system stops negotiating in good faith, it does not simply stall. It begins, quietly and incrementally, to rewrite itself.

From the outside, the breakdown will be framed as familiar. Divergence between North and South. Sensitivities around language. A complex geopolitical context. All true, and all insufficient.

Inside the room, the fault lines were sharper.

Take technology transfer. For many Global South delegations, this is not an abstract principle. It is foundational to any credible pathway toward development. South Africa and others grounded their position in existing global commitments that recognise the diffusion of technology and know-how as central to economic growth and sustainable development. That should not have been controversial. Especially since we have a UN General Assembly consensus-based resolution supporting this, as recently as 2024 (A/RES/79/216).

Yet it was treated as negotiable in a way that exposed a deeper reluctance, particularly from parts of the Global North, to move beyond tightly controlled, voluntary frameworks that preserve asymmetry (and entrench inequality – remember SDG10?!) while continuing to speak the language of partnership.

That is not a mere technical disagreement. It is a political choice.

A similar dynamic played out in debates around “the family”. Attempts to advance a singular, ideologically loaded definition were not simply about wording. They were about which and whose realities are recognized and validated in global policy. For those of us coming from contexts shaped by colonialism, apartheid, the AIDS epidemic, migration, and economic exclusion, the insistence on a narrow, nuclear framing is not only inaccurate but also dismissive of our lived realities.

Multigenerational households. Child-headed households. Extended kinship systems. These are not novel cases. They are the social infrastructure of entire societies. Ignoring that in policy language is not neutral. It is exclusion by intention and design.

But these visible tensions only tell part of the story.

What is less visible, and far more consequential, is the extent to which multilateral negotiation is now being shaped outside multilateral spaces.

There is a growing alignment between what happens in rooms like CPD and what is being pursued through bilateral channels. The shift toward “trade not aid”, the quiet expansion of bilateral health agreements in the wake of eliminated funding through mechanisms like PEPFAR, and the parallel effort to consolidate political blocs around initiatives such as the Geneva Consensus Declaration and PROTEGO, all of this sits in the background of what we are seeing play out in the basement conference rooms in New York.

None of it is formally on the table; however, all of it shapes the table.

It is not unreasonable to assume that positions taken in multilateral negotiations are increasingly linked to incentives and pressures applied elsewhere. Preferential access to critical minerals for the production of semiconductors and microchips (ask your nerdy friends!). Funding streams. Strategic political alignment. In that environment, consensus is not just negotiated. It is conditioned.

That is what transactional multilateralism looks like in practice.

And it explains why spaces like the CPD are becoming harder to navigate. Not because disagreement has increased, but because the terms of engagement have shifted.

The outcome, or lack thereof, reflects that shift. As noted in the Global South Coalition for SRHR and Development Justice statement, this is not simply a missed resolution. It is a drift toward geopolitical positioning over collective well-being.

The consequences are immediate.

When there is no agreed outcome, there is no shared political direction. When there is no direction, national and regional implementation fragments. And when implementation fragments, the burden does not fall on those negotiating texts. It falls on those who depend on what those texts are meant to enable, empower, and support.

Each year, hundreds of thousands of women die from preventable causes related to pregnancy and childbirth. Millions more lack access to contraception, to safe health care, including abortion services, to basic autonomy over their own bodies and lives. These are not statistics that sit on the margins of development; rather, they are indicators of whether development is happening at all.

The CPD, anchored in the International Conference on Population and Development Programme of Action, remains one of the few spaces where these issues are addressed in an integrated way. Undermining that space, whether through inaction or design, has direct implications for delivery in communities.

It also raises serious questions about institutional direction.

Proposals to merge United Nations Population Fund with UN Women are often framed as efficiency gains. From a distance, that may sound reasonable. Up close, it risks collapsing distinct mandates at precisely the moment when technical focus and programmatic clarity are most needed. Efficiency should never come at the cost of effectiveness.

Looking ahead, the sequencing should concern anyone paying attention.

CPD60 will focus on poverty eradication. In another moment, that might have been unifying. In this one, it risks becoming another site of contestation, particularly as conversations turn toward debt relief, financial justice, and the structural conditions that enable and sustain inequality (Hello, Stiglitz!).

Beyond that sits 2027, and what is likely to be the final global review of the United Nations Sustainable Development Goals before 2030. A moment intended as a final course correction in this “decade of action for the SDGs” now risks becoming something more subdued in the shadow of UN80 reforms. We have roughly 66 months left.

That is not a long time. It is certainly not enough to pretend that multilateral processes alone will deliver outcomes.

And then there is the question we are not yet asking loudly enough. What comes after 2030?

Because the truth is this. The post-2030 development architecture is already being shaped. Not only through formal negotiations, but through the behaviours we are normalising now. If we accept a version of multilateralism that is increasingly transactional, increasingly selective, and increasingly detached from decades-old rights-based commitments, then that is the system we will carry forward.

And it will not be a people-centred one.

At the heart of the current framework sit the principles of people, planet, peace, prosperity, and partnerships. In practice, what is most at risk is not the language, but the intent. Particularly the idea of solidarity.

Without solidarity, partnerships become conditional. Without solidarity, development becomes uneven by design. Without solidarity, inequality is not reduced; it is rationalised as yet another indicator and target.

So, we are left with a choice, and it is a more immediate one than many are willing to admit.

We can continue along this path, preserving the appearance of multilateralism while hollowing out its substance, allowing an international order to consolidate that serves the interests of a few.

Or we can choose to correct course. Deliberately. Urgently. And with a level of honesty that reflects the stakes.

The United Nations still offers the space to do that.

But after twelve CPDs, I am less convinced that space, on its own, is enough.

Because if processes continue to fracture, outcomes will follow.

And when outcomes fail, it is not institutions that absorb the cost.

It is people.

Neoliberal Epidemics, part 2 “Deadly Austerity Past and Future”

IN A NUTSHELL
Editor's note
PEAH is pleased to publish a manuscript here as the secont part of a two-part posting based on the new edition of Ted Schrecker and Clare Bambra's book How Politics Makes Us Sick: https://link.springer.com/book/10.1057/978-1-349-96127-6

By Ted Schrecker

Emeritus Professor of Global Health Policy, Newcastle University

By the same Author previously on PEAH: see HERE

Neoliberal Epidemics, part 2

“Deadly Austerity Past and Future”

I began an earlier post on PEAH by referring to a 2023 New York Times story, “The U.S. Built a European-Style Welfare State. It’s Largely Over,” which described the expansion of social protection during the early stages of the pandemic and the subsequent rollbacks. The US uses multiple official poverty measures. According to the most meaningful of these, the Supplemental Poverty Measure (SPM), as pandemic-related income supports were rolled back, the overall poverty rate rose from 7.8 percent of the population in 2021 to 12.4 percent in 2022, and the child poverty rate more than doubled, from 5.2 percent to 12.4 percent in 2022. This experience showed once again that poverty, deprivation and rising inequality – and therefore their consequences for health inequalities – are the outcomes of policy choices that could have been made differently. As US Senator Elizabeth Warren put it: “What we have today didn’t happen because of gravity. It happened because of a bunch of choices.” Many others have made a similar point.

Long before the pandemic austerity, under that name and others, was a key accelerant of inequality and insecurity. Low- and middle-income countries have long experience of International Monetary Fund-mandated programs of “fiscal consolidation,” which prioritize the reorganization of national economies around export earnings in order to pay foreign creditors, at the expense of domestic priorities such as education and health care.[1] After the recession that followed the financial crisis of 2007-2008, austerity became the economic policy flavour of the year throughout Europe, as structural adjustment “travelled north,” in the words of the leading authority on its global impacts. David Stuckler and Sanjay Basu, who wrote the first book on austerity’s destructive health impacts in the high-income world, correctly described it using the analogy of a large-scale clinical trial carried out on a non-consenting population. Wolfgang Streeck captured the underlying political dynamic by arguing that polities in Europe (and by extension elsewhere) were undergoing a long-term shift towards a “consolidation state” the top priority of which was “to make a state attractive for financial investment by making it clear to the financial markets that the state is in a position to service its debt,” with rapid and volatile increases in the cost of borrowing as the price of failure. In the US, legal scholar Michelle Wilde Anderson painstakingly described an “austerity experiment” leading to “a generation of new minimal cities,” sometimes (as in the case of Detroit) facing actual bankruptcy and consistently “focused on little more than the control of fire and violent crime.” Even crime control sometimes fell by the wayside, as the New York Times reported in a 2015 story about private fundraising to finance processing a backlog of more than 11,000 rape kits that local government in Wayne County (Michigan) could not afford to follow up.

Anti-austerity protest, Montréal, Canada, 2016.  Credit: Exile on Ontario St.  Reproduced under a Creative Commons 2.0 licence

The unexamined presumption here is the Thatcherite one that alternatives to austerity are simply ‘unaffordable’. In the words of Philip Gourevitch, again writing in the aftermath of the financial crisis: “The grip of capital lies in its ability to define the boundaries of acceptable discourse, to cast challenges as extremism.”[2] As with other invocations of limited resources, it is always necessary to ask why resources are scarce for some purposes while seemingly limitless for others, and what actors and institutions define the boundary between scarcity and abundance. Reducing the health-destroying effects of the inequality machine described in my previous post, and in Clare Bambra’s and my book on the subject, requires relentless advocacy for two challenges, in particular.

The first of these is increasing the progressivity of taxation and the fiscal capacity of governments not only by reversing regressive measures like the Trump administration’s tax cuts for the rich, but also by taxing today’s massive accumulations of wealth.[3] Thomas Piketty memorably observed in Capital in the Twenty-First Century that a temporary tax on private capital would have been sufficient to eliminate all outstanding European public debt^[4] – a compelling alternative to the consolidation state. Taxing wealth in a world of hypermobile capital presents formidable problems of cross-border coordination, which is why a blueprint proposed by award-winning economist Gabriel Zucman is of special importance, even as such coordination would face intense (and quite possibly extra-legal) opposition.

A second challenge is revitalizing and expanding the public sector of market economies. This is if anything even more contrary to carefully propagated neoliberal wisdom, yet is essential to loosening the stranglehold of corporate capital identified decades ago by Eduardo Galeano: “Countries tremble at the thought that money will not come or that it will flee. …. If you don’t behave yourselves, say the companies, we’re going to the Philippines or Thailand or Indonesia or China or Mars.”[5] The international race to the bottom in corporate tax rates is just one manifestation of the consequences.

My own country, Canada, provides a useful case study of neoliberal evisceration of the public sector. At the start of the 1980s the federal Crown (that is, the people of Canada) owned, among other enterprises, one of the two national rail transport networks; the national flag air carrier; an integrated oil and gas producer and marketer; two aerospace manufacturing firms; and a world-class vaccine laboratory and manufacturer. By 1996 all had been sold off, along with provincially owned potash and uranium miners and many telecommunications firms. Fast forward to 2026, and the Canadian government plans to host a summit foregrounding opportunities for (mainly foreign) investors that has been described as “a little bit like a large public company holding their investor day.” Capital was playing a long game.

During a decade of savage austerity in the UK that disproportionately targeted low-income individuals and communities, the editor-in-chief of The Lancet wrote that:

Austerity is the calling card of neoliberalism. Its effects follow an inverse harm law—the impact of increasing amounts of austerity varies inversely with the ability of communities to protect themselves. Austerity is an instrument of malice. …. What is promoted as fiscal discipline is a political choice. A political choice that deepens the already open and bloody wounds of the poor and precarious. …. The task of health professionals is to resist and to oppose the egregious economics of our times.

Nearly a decade on, the task he described is more imperative than ever. Thanks to President Trump’s reckless Middle Eastern adventurism, at this writing global recession is a real possibility; meanwhile, as recent research shows, windfall gains from high oil prices accrue disproportionately to the very top of national income distributions. Even if recession is somehow averted, understandable demands for increased defence spending are likely to lend superficial legitimacy to intensified austerity on other fronts.

Even when not at direct risk of reprisal, health professionals are often uncomfortable engaging critically with macro-scale issues of economic policy and their distributional consequences. Especially in these times, if they fail to do so, then micro-scale or incremental interventions to reduce health inequalities, although implemented with the best intentions, are likely to be about as effective as sticking plasters on a sucking chest wound. Barring a dramatic (dare I say revolutionary?) change in the political environment, it is hard to avoid the conclusion that for many people, in many countries – perhaps for most people, in most countries – the worst is yet to come.

Notes

[1] The definitive reference is A. Kentikelenis & T. Stubbs, A Thousand Cuts: Social Protection in the Age of Austerity (Oxford: Oxford University Press, 2023).

[2] P. Gourevitch, “Choice and Constraint in the Great Recession of 2008,” in M. Finnemore and J. Goldstein (eds.), Back to Basics: State Power in a Contemporary World (Oxford: Oxford University Press, 2013), p. 211.

[3] The indispensable World Inequality Report 2026 (R. Gómez-Carrera et al., Paris: World Inequality Lab, 2025) points out that “fewer than 60,000 multi-millionaires control today three times more wealth than half of humanity combined” (p. 11 and Executive Summary Figures 2 and 3).

[4] T. Piketty, Capital in the Twenty-First Century (Belknap Press of Harvard University Press, 2014), pp. 541-544.

[5] E. Galeano, Upside Down: A Primer for the Looking Glass World, tr. M. Fried (New York: Picador, 1980), p. 175.

News Flash 662: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Flying gurnard (Dactylopterus volitans)

News Flash 662

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MSF Open letter: Linking pathogens and data access to enforceable benefit-sharing commitments in the Pandemic Agreement

From Fragmentation to Architecture: A One Health Bretton Woods Framework for Climate-Resilient Health Systems by Kalolo Chitembo

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From Fragmentation to Architecture: A One Health Bretton Woods Framework for Climate-Resilient Health Systems

IN A NUTSHELL
Author's Note 
Despite unprecedented advances in biomedical science, digital health, and climate risk analytics, global health systems continue to underperform in the face of converging crises. This paradox—where knowledge accumulates but outcomes stagnate—reflects a deeper systemic failure: the absence of integrated governance, aligned incentives, and operational delivery architectures.

This paper proposes a One Health Bretton Woods Framework, a unified conceptual model that integrates human, animal, plant, and ecosystem health within a financing and governance architecture designed for implementation at scale. Drawing on emerging evidence from implementation science, climate resilience financing (including performance-based instruments), and digital health adoption studies, we introduce the concept of Trust-Adjusted Implementation (TAI)—a systems-level determinant explaining why technologies and policies fail to translate into real-world outcomes.

We argue that future resilience will depend not on discovery, but on the institutionalization of incentive-compatible, trust-validated, and performance-linked delivery systems. This framework positions One Health not as a coordination paradigm, but as a governance and financing doctrine, analogous in ambition to the post-war Bretton Woods system

By Kalolo Chitembo

Crisis Expert/ Emergency Medicine Specialist/ Health Economist/ Global Health Advocate/ Climate and ONE HEALTH Researcher

Zambia

By the same Author on PEAH: HERE

From Fragmentation to Architecture

A One Health Bretton Woods Framework for Climate-Resilient Health Systems

Introduction: The Implementation Paradox in Global Health

Global health has entered an era of epistemic saturation. Surveillance systems detect outbreaks in near real-time, climate models predict vector shifts with increasing precision, and digital health technologies promise universal access.

Yet, system failures persist.

Recent analyses across implementation science and global health governance converge on a central diagnosis:

the constraint is no longer knowledge, but delivery.

This failure is most visible at the intersection of:

Climate shocks disrupting food and health systems

Zoonotic spillovers linked to ecological degradation

Underperforming health systems despite increased financing

The prevailing paradigm—fragmented across sectors, institutions, and financing streams—cannot manage these interdependencies.

We argue that the global system is facing a structural equivalent of the pre-1944 economic order:

fragmented, uncoordinated, and incapable of managing systemic risk.

Conceptual Shift: From One Health Coordination to One Health Governance

One Health has traditionally been framed as a coordination mechanism across:

Human health

Animal health

Environmental systems

However, this framing is insufficient.

We propose a shift toward One Health as a governance architecture, defined by:

System Integration

Biological systems (human, animal, plant) are treated as interdependent infrastructure, not sectoral domains.

Institutional Alignment

Global and regional institutions must operate within a shared incentive and accountability framework.

Financing Integration

Climate, health, and agricultural financing must converge into performance-linked investment systems.

The Trust-Adjusted Implementation (TAI) Model

A central contribution of this paper is the formalization of Trust-Adjusted Implementation (TAI).

Model Definition

Delivery = f (Evidence × Incentives × Infrastructure × Trust)

Where:

Evidence = scientific and technical knowledge

Incentives = financial and policy alignment

Infrastructure = physical and digital systems

Trust = behavioral and institutional adoption

Empirical Basis

Recent qualitative and systems-level studies demonstrate that:

Clinicians resist autonomous AI diagnostics but adopt decision-support tools

Algorithmic bias reduces trust and adoption in diverse populations

Infrastructure mismatches (e.g., cloud dependency) undermine system reliability

Administrative burdens (dual data entry) inhibit integration

These findings indicate that trust is not a soft variable—it is a binding system constraint.

Financing the System: From Input-Based to Performance-Based Architectures

Traditional global health financing is characterized by:

Input-based disbursement

Short-term project cycles

Fragmented funding streams

This model is misaligned with system-level resilience.

Performance-Based Financing

Emerging instruments—such as resilience bonds and parametric insurance—demonstrate a shift toward:

Payment for verified outcomes

Risk transfer mechanisms

Integration of ecological and health metrics

Implications for One Health

A One Health Bretton Woods system would:

Link financing to ecosystem integrity, disease prevention, and food system resilience

Integrate climate risk into health system financing

Incentivize cross-sector outcomes rather than siloed outputs

Digital Infrastructure: The Case for Decentralized, Edge-Based Systems

Digital health has been widely promoted but unevenly adopted.

Evidence indicates that successful systems in resource-constrained environments share key characteristics:

Edge computing (offline functionality)

Mobile-first interfaces

Human-centered design

Localized data validation

Implication

Digital infrastructure must be treated as public health infrastructure, analogous to water or energy systems.

Institutional Architecture: Toward a One Health Bretton Woods

We propose a multi-layered governance system:

Global Layer

Norm-setting and coordination

Pandemic preparedness

Climate-health integration

Regional Layer

Sovereignty and pooled capacity

Regional manufacturing and surveillance systems

National Layer

Implementation and service delivery

Institutional capacity building

Cross-Cutting Layer

Data governance

Financing alignment

Trust architecture

Policy Implications for Emerging Economies

For countries in Sub-Saharan Africa, including Zambia, this framework enables:

Health Sovereignty

Reduced dependence on external response systems through local capacity.

Climate Resilience

Integration of agriculture, water systems, and health infrastructure.

Economic Stability

Use of innovative financing instruments to mitigate fiscal shocks.

Digital Leapfrogging

Adoption of decentralized AI and mobile-first systems.

Discussion: From Doctrine to Implementation

The analogy to Bretton Woods is deliberate.

The original Bretton Woods system created:

Institutional stability

Financial coordination

Predictable economic governance

Today’s global health and climate challenges require a similar transformation.

However, unlike Bretton Woods, this system must be:

Decentralized

Digitally enabled

Ecologically grounded

Conclusion

The future of global health will not be determined by new discoveries alone.

It will be determined by whether the international community can construct systems that:

Align incentives

Integrate institutions

Build trust

Deliver outcomes

The failure of global health is not knowledge—it is governance, incentives, and implementation architecture.

A One Health Bretton Woods framework offers a pathway forward.

News Flash 661: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Dusky grouper (Epinephelus marginatus)

News Flash 661

Weekly Snapshot of Public Health Challenges

Register today: In conversation with Tom Fletcher, UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, about the most pressing humanitarian and conflict issues facing the United Nations today, and what role the UK can play. 20 April 2026 Event location: Hybrid — Chatham House and Online

Webinar registration: Youth Co-creation Guide Launch Apr 21, 2026

Webinar registration: Integrated Long-term Care in Europe: Learning from the BUILD, LeTsCare and Laurel Projects: Results and Reflections on Policy and Practice Apr 30, 2026

Interview: Francisco Mendina PhD Candidate Western University, Canada by Daniele Dionisio

Governing Biological Risk in an Era of Climate Instability: Integrating One Health into Macroprudential Policy Architecture by Kalolo Chitembo

From supply to strategy: leveraging central medical stores experiences and information for health system strengthening

Safeguarding Health For People With Intellectual And Developmental Disabilities: Absent Federal Leadership, Others Must Step Up

When the medicine runs out: AMR, antibiotic shortage, and the children being left behind

One Million More People to Get HIV ‘Miracle’ Drug Lenacapavir as US, Global Fund Expand Access

Effect of donor exclusion criteria on blood safety and volume of donations: a systematic review of modelling studies

HRR813. THERE IS NO TYRANNY MORE CRUEL THAN THAT WHICH IS EXERCISED UNDER THE SHADOW OF THE LAW AND IN THE NAME OF JUSTICE. (Montesquieu)

Shifting Global Health R&D Funding: Opportunities in a Changing Landscape

Health Taxes and the IMF: Are Support and Reform Aligned?

Rich countries slash development aid in a short-sighted move with long-term global consequences

Global CSOs welcome launch of Borrowers’ Platform at IMF-World Bank Spring Meetings

Online University Throws a Lifeline to Afghan Women Shut Out of Education

Civil Society Launch a Campaign Against Extractive Industry Exploitation and Land Grabs

Did badly designed aid rules lead to a rise in child marriage?

Restitution of findings in humanitarian research: Guidance note

UNPO Collaborates with Munk School of Global Affairs and Public Policy on Determining the Narrative: The Use of Narratives, (Mis)Information, and Media for Unrepresented Nations and Peoples in the 21st Century

Iran war could plunge 32 million into poverty, says United Nations

Beyond the battlefield: The global ripple effects of the Iran war

Sudan’s Catastrophic Civil War Enters Fourth Year

Millions of people in Sudan surviving on one meal a day as food crisis deepens, NGOs say

From genocide to countless acts of solidarity: Documenting three years of war in Sudan

Donors pledge 1.5 bn euros as Sudan marks three years of war

‘Water Nobel’ winner Madani calls for focus on water crisis at COP31

Indian wastewater rife with drug resistance genes

Delhi Has a New Plan to Fight Its Toxic Air, But Will it Deliver?

Human rights and the rights of Nature are linchpins for truly sustainable development

Why Peatlands Matter: Britain’s Overlooked Carbon Store

Interview: Francisco Mendina PhD Candidate Western University, Canada

IN A NUTSHELL
Editor's note
PEAH had the pleasure to interview Mr Francisco Mendina as a doctoral candidate at Western University in London, Ontario, Canada, who is conducting, under the supervision of Dr. Elysee Nouvet, a research study exploring how humanitarian healthcare professionals conceptualize and practice solidarity in contexts of crisis, conflict, and care. The study has received ethics approval from Western University, and in this capacity Mendina also serves as a staff member of the Global Health Solidarity Project Network as a Wellcome Trust funded research alliance implemented by the University of Ghana and led by Prof. Caesar Atuire at the University of Ghana and the University of Oxford, with six Co-Investigators in Australia, South Africa, Canada, Costa Rica, USA and Austria

By Daniele Dionisio

PEAH – Policies for Equitable Access to Health

INTERVIEW

Francisco Mendina

PhD Candidate Western University

Ontario, Canada

–PEAH: Very pleased to meet you Mr Mendina. Just to introduce yourself, share, please, concise information on your professional background

–Mendina: Hi Daniele, thank you for the warm invitation. I am pleased to meet you as well. I am currently a third-year PhD student in Health Information Science at Western University, where I also serve as a teaching assistant and graduate student fellow with the Global Health Solidarity Network. My research, supervised by Dr. Elysee Nouvet, aims to understand how humanitarian healthcare professionals who have worked in prolonged conflict settings understand and enact the concept of solidarity.

My path to this work has been shaped by a longstanding interest in community health and humanitarian contexts. During my undergraduate studies at McMaster University — where I completed a Bachelor’s degree in Life Sciences with a minor in Community Engagement — I began volunteering with global health and community health organizations, which sparked my interest in how health systems serve vulnerable and underserved populations. This interest deepened during my Master’s degree in Management of Applied Sciences in Global Health Systems at the University of Western Ontario, where an internship gave me firsthand exposure to the humanitarian healthcare space and affirmed my commitment to working at the intersection of health equity and community engagement.

Prior to beginning my doctoral studies, I worked as a Program Coordinator for HIV/AIDS Support Services at an AIDS Services Organization in York Region, Ontario. In this role, I oversaw project planning, individual case management, and health promotion initiatives, including organizing and leading community education workshops. Across these experiences — from undergraduate volunteering to professional coordination — I developed a deep appreciation for community-centred approaches to health, which continues to inform my doctoral research today.

–PEAH: As maintained in the Global Health Solidarity Project brief ‘…The Challenge Efforts to promote greater health equity for all have been accompanied by an increase in calls for solidarity, especially during crises such as the Covid-19 pandemic. However, at the global level, these appeals to solidarity have produced meagre results. Common conceptions of solidarity in global health are ambitious but ambiguous and under-theorised, making them inadequate and insufficient in providing the clear goals and tools needed to operationalise solidarity…’ In this connection, what are your thoughts in more detail?

–Mendina: The challenge resonates with what motivated my own research. In reviewing the humanitarian healthcare literature, I consistently found solidarity being called to have a more central role — particularly in calls for more horizontal, inclusive, and politically engaged humanitarian responses — yet rarely defined. Authors across disciplines conceptualize the term differently. Humanitarian organizations themselves use the term in varied and sometimes contradictory ways. The result is a concept that is rhetorically powerful but operationally vague.

Additionally, to my knowledge, there are no studies that have sought to understand how those actually working on the front lines of humanitarian healthcare — the people navigating these principles in real time, under real constraints — understand or enact solidarity. That gap is significant and urgent.

This urgency is compounded by the tensions solidarity introduces in practice. Some scholars have argued that solidarity implies political alignment or a challenge to structural injustice, thereby placing it in direct tension with the principle of neutrality — a foundational humanitarian commitment understood as essential to ensuring access to affected populations and the safety of frontline workers. If solidarity is being called upon to have a more central role in humanitarian healthcare, we need to understand what it actually means to those navigating these realities on the ground, and what the practical implications of different understandings might be for access, safety, and operational effectiveness. That is precisely the gap my research seeks to address.

–PEAH: Some in-depth information now concerning the Project objectives

–Mendina: This study aims to generate empirical knowledge about how humanitarian healthcare workers who have worked in prolonged conflict settings understand and enact solidarity.

The study is organized around two interconnected objectives. The first is to understand how frontline humanitarian healthcare workers construct and make sense of solidarity in relation to neutrality — a foundational humanitarian principle, and an increasingly contested one, that commits organizations to refrain from taking sides in conflict. This relationship matters because some scholars have positioned solidarity as in direct tension with neutrality.

The second objective is to examine how understandings of solidarity are enacted in practice: how they intersect with workers’ experiences of accessing populations, navigating questions of personnel safety, and managing the ethical demands of frontline work in complex emergencies.

Together, these objectives are designed to produce the kind of grounded, experience-near knowledge that is currently missing from the literature.

–PEAH: Relevantly, what about the Project approach?

–Mendina: The study takes an interpretive, qualitative approach. Data is collected through semi-structured interviews with humanitarian healthcare workers who have experience in prolonged conflict settings. These interviews are designed as open-ended conversations, allowing participants to speak to their experiences in their own terms rather than being guided toward predetermined definitions of solidarity or neutrality.

Methodologically, the study is grounded in an abductive logic of inquiry, which is well-suited to concepts like solidarity that are vague, contested, and differently understood across contexts. Rather than testing a fixed theory, the approach remains responsive to the tensions, contradictions, and surprises that emerge from participants’ accounts, allowing meaning to develop iteratively through engagement with the data. Analysis is conducted through reflexive thematic analysis, with attention to moral reasoning, ethical complexity, and the situated nature of participants’ experiences.

–PEAH: And as for the expected outcomes?

–Mendina: This study will contribute to a nuanced account of how solidarity in the eyes of Humanitarian Healthcare workers interacts with competing demands such as neutrality, safety, and access, and how it is enacted or contested in practice. Rather than assuming solidarity is inherently transformative, the study asks what it means, produces, and complicates. Findings will inform ethical frameworks, training, and organizational policy while contributing to broader academic conversations on humanitarian reform.

–PEAH: So compounded, your work contributes to ongoing debates around the role of neutrality and solidarity in humanitarian healthcare. Do you have anything to say about this?

–Mendina: Yes, exactly. It is a timely project, and it has been energizing to receive positive comments about the topic and project as a whole. The interviews have been incredibly engaging and I am excited for the next steps of the project and the ongoing conversations about solidarity in the humanitarian healthcare space.

–PEAH: How much progress has made your research so far?

–Mendina: At the time of this interview, we have conducted 14 semi-structured interviews.

–PEAH: And what would you need to better support the Project?

–Mendina: The opportunity this interview provides is itself a meaningful form of support, and I am grateful for it. At this stage, one of the most valuable things for the project is visibility, reaching humanitarian healthcare professionals who may be willing to share their experiences, and broader audiences who care about the future of humanitarian action. If readers of PEAH are working in or connected to the humanitarian healthcare space, I would warmly welcome the conversation.

–PEAH: In the interest of a wider audience, would you be happy to share information on the project research in French or Spanish language as well upon request?

–Mendina: I am happy to share more information and speak about this project with folks who are interested. For those who may want to connect with me on linked in, it is: www.linkedin.com/in/francisco-mendina

–PEAH: Thank you Mr Mendina for your exhaustive answers and very deserving humanitarian commitment

Readers are invited to comment on the content and suggestions of this interview

Governing Biological Risk in an Era of Climate Instability: Integrating One Health into Macroprudential Policy Architecture

IN A NUTSHELL
Author's Note
Climate change, biodiversity loss, and health system fragility are increasingly converging into a unified domain of systemic risk. However, global governance frameworks remain structurally fragmented, treating environmental, epidemiological, and economic risks as discrete phenomena. This misalignment limits the capacity of states to anticipate and absorb compound shocks.

This paper argues that biological risk—defined as the interaction between ecological disruption, pathogen dynamics, and human vulnerability—should be incorporated into macroprudential governance frameworks. Drawing on recent evidence linking climate change to increased mortality, disease transmission, and economic loss, we propose a shift from sectoral policy responses to integrated resilience modelling.

We introduce the Integrated Sovereign Resilience Index (ISRI), a composite indicator designed to quantify national capacity to withstand biologically mediated shocks. The ISRI integrates five domains: climate exposure, epidemiological risk, health system surge capacity, biodiversity integrity, and food system stability. We situate this index within a broader One Health Nexus Governance framework, which embeds biological variables into fiscal policy, sovereign risk assessment, and development financing.

We further outline policy mechanisms for operationalization, including climate–health stress testing, prevention-aligned financing, and the integration of One Health principles into treasury-level decision-making.

We conclude that resilience must be reframed as a core economic variable rather than a sectoral outcome. States that internalize biological risk into governance systems will be better positioned to maintain stability under accelerating climate pressures.

This work contributes to ongoing research on climate change, zoonotic disease dynamics, and One Health governance in sub-Saharan Africa, with a focus on policy integration and economic resilience

By Kalolo Chitembo

Crisis Expert/ Emergency Medicine Specialist/ Health Economist/ Global Health Advocate/ Climate and ONE HEALTH Researcher

Zambia

Governing Biological Risk in an Era of Climate Instability

Integrating One Health into Macroprudential Policy Architecture

Introduction

The accelerating convergence of climate change, ecological degradation, and population health risks represents a fundamental challenge to contemporary governance systems. While each domain has been extensively studied, their interactions remain insufficiently integrated into policy and economic decision-making frameworks.

Climate change is projected to contribute to millions of additional deaths and substantial economic losses over the coming decades, driven by heat exposure, food insecurity, and the expansion of infectious diseases. Concurrently, biodiversity loss is increasing the probability of zoonotic spillover, while health systems—particularly in low- and middle-income countries—remain under-resourced to manage large-scale shocks.

Despite these trends, institutional responses remain fragmented. Ministries of finance, health, and environment operate within distinct analytical frameworks, limiting the capacity to model and manage compound risks. This fragmentation constitutes a structural vulnerability.

The One Health approach, which recognizes the interconnectedness of human, animal, and environmental health, offers a conceptual foundation for integration. However, its implementation has largely been confined to technical coordination rather than systemic governance reform.

This paper advances the argument that biological risk must be incorporated into macroprudential policy architecture. We propose a measurable framework—the Integrated Sovereign Resilience Index (ISRI)—and outline institutional pathways for embedding One Health principles into economic governance.

The Convergence of Biological and Economic Risk

The relationship between environmental change and health outcomes is increasingly well established. Rising temperatures are associated with increased mortality, reduced labour productivity, and heightened strain on health systems. Climate variability is altering the geographic distribution of vector-borne diseases such as malaria and dengue, exposing new populations to infection.

At the same time, land-use change and biodiversity loss are intensifying human–animal interactions, increasing the likelihood of zoonotic spillover events. These processes are not independent; they interact to produce cascading risks that affect both population health and economic stability.

Economic analyses suggest that climate-related disruptions could significantly reduce global output over the coming decades. Importantly, these impacts are not limited to physical infrastructure or agricultural productivity. Health-related effects—including increased disease burden and reduced workforce participation—constitute a major component of economic loss.

However, these risks are not systematically incorporated into sovereign risk assessments or macroeconomic models. Financial systems typically evaluate exposure to climate risk through physical and transition pathways but rarely account for epidemiological dynamics or health system capacity. This omission limits the accuracy of risk pricing and investment decision-making.

From One Health to Macroprudential Governance

The One Health framework provides a critical conceptual basis for integration but requires expansion into governance and financial systems. We define macroprudential biological governance as the incorporation of ecological and health variables into national economic policy and risk management structures.

This shift entails three key transformations:

Analytical integration: linking climate, health, and ecological data within unified modelling frameworks

Institutional alignment: embedding One Health principles across ministries, particularly finance and planning

Financial internalization: incorporating biological risk into budgeting, debt management, and investment decisions

Such integration would enable governments to anticipate compound risks and allocate resources more effectively.

The Integrated Sovereign Resilience Index (ISRI)

Conceptual Framework

The ISRI is designed to quantify a country’s resilience to biologically mediated shocks by integrating exposure and capacity variables across five domains:

Climate Exposure (CE)

Indicators include temperature extremes, precipitation variability, and frequency of extreme weather events.

Epidemiological Risk (ER)

Captures disease burden, vector distribution shifts, zoonotic spillover potential, and surveillance system coverage.

Health System Surge Capacity (HSSC)

Includes healthcare workforce density, infrastructure availability (e.g., ICU beds), and emergency response capability.

Biodiversity Integrity (BI)

Measures ecosystem stability, habitat loss, and human–wildlife interface intensity.

Food System Stability (FSS)

Assesses agricultural resilience, supply chain robustness, and nutritional security.

Functional Form

The ISRI can be expressed as:

ISRI = (CE × ER) / (HSSC + BI + FSS)

Where:

Higher values indicate greater systemic vulnerability

Lower values reflect stronger resilience capacity

Operational Utility

The ISRI enables:

Cross-country comparison of resilience capacity

Integration into sovereign credit risk analysis

Targeting of development financing

Monitoring of policy effectiveness over time

Policy Integration Pathways

Climate–Health Stress Testing

Governments should incorporate epidemiological and health system variables into macroeconomic stress-testing frameworks. This includes modelling scenarios involving simultaneous climate shocks and disease outbreaks.

Prevention-Oriented Financing

Public finance systems should shift from reactive expenditure to preventive investment. This includes funding for surveillance systems, primary healthcare, and ecosystem protection.

Risk Transfer Mechanisms

Parametric insurance and other risk financing tools can provide rapid liquidity in response to climate-related shocks. Expanding these mechanisms to include health triggers would enhance systemic resilience.

Institutional Reform

Embedding One Health units within finance ministries would facilitate cross-sectoral coordination and ensure that biological risks are considered in fiscal decision-making.

Multilateral Alignment

International financial institutions and development partners should incorporate resilience metrics such as ISRI into lending frameworks and policy conditionalities.

Implications for Low- and Middle-Income Countries

Low- and middle-income countries face disproportionate exposure to climate and biological risks while having limited adaptive capacity. Integrating resilience into economic governance offers an opportunity to align development pathways with long-term stability.

In regions such as sub-Saharan Africa, investments in health systems, climate adaptation, and biodiversity conservation can generate co-benefits across multiple sectors. However, achieving this integration requires access to financing, technical capacity, and institutional reform.

Conclusion

Biological risk is no longer a peripheral concern; it is central to economic stability and governance. The convergence of climate change, ecological disruption, and health system vulnerability necessitates a shift from fragmented policy responses to integrated resilience frameworks.

The Integrated Sovereign Resilience Index provides a practical tool for operationalizing this shift, enabling governments and financial institutions to quantify and manage systemic risk more effectively.

Embedding One Health principles into macroprudential governance represents not only a scientific and policy imperative but also a strategic necessity in an era of accelerating climate instability.

The Progressive Power of Data and Algorithms, and Their Effect on Human Life Loss Due to Geopolitical Tensions, Military Spending, and Global Injustice

IN A NUTSHELL
Author's Note 
The increasing integration of algorithmic infrastructures in defense and financial systems is transforming global power dynamics. Platforms such as Palantir Technologies and BlackRock’s Aladdin concentrate data analysis, predictive modeling, and decision-making capabilities at a planetary scale. This process generates asymmetrical advantages that amplify structural inequalities. The Sustainable Health Equity Movement (SHEM) estimates that over 16 million deaths annually are attributable to unjust inequities.

This article examines how the expansion of algorithmic power, combined with everyday citizen participation in data generation and financial flows, contributes to power concentration and the loss of human life. Community autonomy strategies are proposed as mitigation mechanisms, and potential futures are considered, including scenarios with bionic “humanks” capable of emitting and receiving information oriented toward power and control dynamics

By Juan Garay

Co-Chair of the Sustainable Health Equity Movement (SHEM)

Professor/Researcher of Health Equity, Ethics and Metrics (Spain, Mexico, Cuba, Brazil)

Founder of Valyter Ecovillage (valyter.es)

By the same Author on PEAH:see HERE

The Progressive Power of Data and Algorithms, and Their Effect on Human Life Loss Due to Geopolitical Tensions, Military Spending, and Global Injustice

From Passive Consumers Contributing to Lethal Inequity Dynamics to Sovereign, Resilient Communities Gradually Detached from the Global Toxic Nexus

Introduction

Global power no longer relies solely on physical resources or military capacities, but increasingly on the ability to collect, process, and anticipate information through algorithmic systems. The transition from industrial economies to data-driven economies has created a new form of power concentration: predictive power.

This change is evident in specific platforms. In defense and security, Palantir Technologies integrates massive datasets to produce real-time operational analyses. Its evolution into systems such as Palantir AIP (Artificial Intelligence Platform) demonstrates the gradual replacement of human judgment with algorithmic decision-making in critical contexts, where computational speed diminishes the role of the “human-in-the-loop.”

In finance, platforms like BlackRock’s Aladdin —along with Vanguard and State Street— analyze and model between 20 and 25 trillion dollars in assets. These infrastructures not only manage investments but also influence global capital flows and economic and social priorities.

PwC’s Sizing the Prize report estimates that artificial intelligence could generate up to $15.7 trillion in global economic value, highlighting the growing gap between those who control data and analytical capabilities and the rest of society.

Conceptual Framework

A systemic perspective integrates three dimensions:

Algorithmic infrastructures in defense and finance as sources of predictive power.

Global health inequities, based on SHEM, WHO, and Global Burden of Disease estimates.

Indirect citizen participation, through data generation and economic flows.

AI is analyzed not as an isolated tool but as a component of complex power accumulation systems capable of shaping decisions, perceptions, and human lives.

Results and Analysis

Concentration of Analytical Power

Current platforms operate at unprecedented scales. In defense, they integrate satellite, drone, and sensor data. In finance, they model global scenarios and guide multi-trillion-dollar investments, generating asymmetrical predictive advantages.

Geopolitical and Military Implications

AI has become a strategic element in global competition, driving a technology race that increases military spending (SIPRI, 2024) and diverts resources from social sectors to control and defense infrastructures.

Impact on Inequities and Human Life Loss

Over 16 million deaths annually are attributable to structural inequalities (SHEM, WHO 2023, World Bank 2023). AI amplifies these inequities if its orientation is not aligned with the common good (PEAH, 2025).

Citizen Participation in the System

The use of mobile devices, social networks, digital payments, and global consumption generates data flows that feed algorithmic systems. Individual savings, channeled through banks and investment funds, also indirectly contribute to concentrated power.

Feedback Cycle of Power

Data and capital concentration

Development of advanced algorithmic capabilities

Increased geopolitical and financial control

Reinforcement of structural inequities

This cycle directly impacts global health by influencing resource allocation and social determinants of life.

Discussion

AI has the potential to improve knowledge and efficiency in health, but when it operates within concentrated power systems, it amplifies inequalities.

Historically, the relationship between people and power has evolved:

Empires and feudal systems: coercive contributions (slavery, tribute, conscription).

Progressive democracy: formal political relations from the Renaissance to universal suffrage.

Industrial Revolution and the 20th century: economic contribution through labor, goods consumption, and services.

21st century: massive and often unconscious digital contribution feeding global algorithmic systems.

Power has transitioned from religious, military, and political to industrial and commercial, and finally to algorithmic and data-based, increasingly shaping human freedom and conditioning the common good. Traditional educational and political structures lose influence relative to these systems, and future generations may interact with even more sophisticated control systems, including bionic “humanks” capable of emitting and receiving information oriented toward power dynamics.

Conclusion

Algorithmic infrastructures in defense and finance redefine global power and the relationship between society and data. Citizens contribute directly and indirectly—often unconsciously—to power concentration and human life loss.

History shows that public contribution has evolved from coercive to political, then economic, and now digital, consolidating power capable of shaping perceptions, behaviors, and global priorities. The result is a reduction in human freedom and the potential to generate the common good.

Community-based alternatives grounded in autonomy, resilience, and the local provision of basic needs—such as low-consumption, high-harmony eco-villages—can serve as counterbalances. The challenge lies in redirecting technological systems toward equity, freedom, and collective well-being.

References

World Health Organization. Global Report on Health Equity and Research & Development. 2023.

World Bank. Tracking Universal Health Coverage: 2023 Global Monitoring Report. 2023.

PEAH – Policies for Equitable Access to Health. Artificial Intelligence and Global Health Inequities. 2025. https://www.peah.it/2025/09/15065/

PwC. Sizing the Prize: What’s the real value of AI for your business and how can you capitalise?

BlackRock. Annual reports and Aladdin platform documentation.

Fichtner, J., Heemskerk, E., & Garcia-Bernardo, J. (2017). Hidden Power of the Big Three?

Karp, A., & Zamiska, N. (2023). The Technological Republic.

Marmot, M. et al. (2020). Health Equity in England.

Piketty, T. (2014). Capital in the Twenty-First Century.

SIPRI (2024). Global Military Expenditure Database.

WHO (2008, 2025). Social Determinants of Health.

Global Burden of Disease Study (IHME).

Sustainable Health Equity Movement (SHEM), internal analyses.

News Flash 660: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings