How colonialism and geopolitics shape health injustices: a deep, critical reflection

This is the final article (article no. 7) in a series about global health injustices. Previous article: Addressing the health landscape in Bangladesh's Rohingya community

Introduction

Welcome to the reflective article of the Global Health Injustices Series. Before I begin, I want to thank Jana Antar again for her contributions to the Lebanon and Syria article, and Dr Nasif Mahmood for his contributions to the Rohingya people in Bangladesh article. Writing and researching about these different countries was an incredible experience. Although I initially planned for this series to go beyond ten articles, focusing on the most enduring and neglected injustices was vital, particularly as the world is becoming more dynamic with geopolitical power shifts. With this in mind, I want to emphasise that each vulnerable population faces unique challenges, but they have challenges shared with others that are not mentioned in this series. I wanted to address these injustices because they are urgent and demonstrate how interconnected global struggles truly are. Through writing this last article, I deepened my understanding of how colonialism, interventionism, and health are interwoven.

How the past impacts present reality (colonialism)

The injustices we see in news headlines, social media, or the ones we directly experience should not be understood as isolated examples (Table 1). Instead, they stem from European colonialism and later foreign interventionism, shaping how regional governments were created. The ongoing Gaza genocide and expanding illegal settlements pushing out Palestinians in the West Bank are due to Israel’s brutal military occupation and apartheid for 70+ years, and its acts, including the Nakba. Sudan had external rulers (notably Egypt and the British Empire) contributing to its civil wars through political destabilisation, among other factors. This similarly happened in Yemen, though it is also important to note that foreign intervention from the United States (US) and Saudi Arabian governments contributed to the country's existing crises.

Lebanon and Syria were divided up and governed by Britain and France after the Ottoman Empire collapsed shortly after World War 1, a significant event leading to political destabilisation and ongoing catastrophes, which also happened to Palestine. In Kashmir, the people’s plight erupted through the British Empire partitioning the Indian subcontinent into multiple nations in 1947 (India, West Pakistan becoming Pakistan and East Pakistan becoming Bangladesh), with Kashmir being a disputed territory between Pakistan and India. As for the Rohingya population and Bangladesh, civil wars during the 20th century and ensuing persecution by the government of Myanmar have contributed to their crises. Therefore, it is clear that all of these events I summarised showcase how their root causes lead to the substantial effects of the current daily injustices.  

Moreover, what connects these substantial injustices and many others worldwide traces back to the consequences of European colonialism; these powers dispossessed indigenous peoples of their lands and resources through violence, subsequently broken treaties, or legal frameworks that did not identify Indigenous land tenure systems. While they did disrupt indigenous governments, some recent injustices prevail because post-colonial elites embraced or exacerbated these exploitative systems. This severed deep cultural, spiritual, and economic ties that indigenous communities had with their land. For example, Canada’s colonial legacy, notably its Indian Residential Schools, involved forcibly removing children from their families, leading to negative outcomes for the Indigenous communities. Moreover, it is vital to acknowledge the impact of settler colonialism on Indigenous communities globally across South America, Africa, Asia and the Aboriginal people of Australia and New Zealand. If we do not critically think and learn about these past events, how will we improve our present reality and build a future for everyone?

Table 1: Summary of the historical and modern perpetrators of injustices affecting the countries/communities explored in the Global Health Injustices Series

Current major health problems

Health is essential in global injustices because it is a mirror and a driver of the disparities among various populations. Accessing quality healthcare is usually affected by factors, such as race and ethnicity, which accentuate deep-rooted inequalities. For example,  communities with lower incomes encounter challenges, ranging from a lack of healthcare infrastructure to environmental hazards, leading to worse health outcomes. Therefore, tackling them is essential for achieving justice, as improved health outcomes can empower marginalised groups.

Aside from warfare being a major determinant of health and injustice, I want to highlight migration as a significant co-occurring determinant. Although research is expanding, the bidirectional relationship between migration and health remains inadequately incorporated into practice and laws. Migration is a complicated and heterogeneous multiphase process (Figure 1). Meanwhile, collecting migration data remains difficult due to polarised political views, unwillingness to finance research on discriminatory laws, varying migration definitions, and limited comparable global data. Unfortunately, political rhetoric and media depictions form incorrect assumptions, stereotypes, and negative views of migrants and refugees, leading to a weakened understanding of the severity and positive aspects of migration. Also, this manifests into hatred and scapegoating of migrants and refugees through their “perceived” impact on countries like employment and healthcare. In reality, accessing employment and healthcare is very difficult for them, leading to negative health outcomes. 

Thinking more broadly, health behaviours are not solely individual choices, but are deeply rooted in and affected by social, cultural, and political environments. For example, when looking at politics and health through a framework (Figure 2), it is clear how politics is influential through labour markets and welfare states, leading to socioeconomic, income and wealth inequalities and poor health. One systematic review found that a generous welfare state is typically associated with positive population health outcomes, with the Nordic model as an example. This suggests that political leaders are vital in affecting agendas, encouraging intersectoral partnerships, and showing political will to promote health equity. Another review supported the benefits of a generous welfare state through maternal and child health outcomes. Therefore, health and politics are intertwined, as addressed in previous articles through specific contexts. Now I will discuss it more broadly. 

Current major geopolitical problems

Geopolitical dynamics are crucial to shaping the lives of vulnerable populations by influencing their access to security, resources, and fundamental human rights; this is impacted by governments, policies, geographies,  and the relationships and interests between countries. In countries or regions plagued by continuous conflict or authoritarian governments, these communities often find themselves at greater risk of challenges like displacement, violence, and systemic discrimination. Moreover, the complicated relationship between global and local power systems results in specific communities being neglected, as more powerful geopolitical interests repeatedly overshadow their needs. To truly support these communities, it is vital to consider how foreign interventionism from countries like the US and the UK impacts the Palestinians, Sudanese, Lebanese, Syrian, Yemeni, Kashmiri, and the Rohingya populations. 

Foreign interventionism, which typically occurs through militarism, is characterised as the international and social relations of training for and executing organised political violence; this is a pervasive feature of geopolitics, rising into civilian domains by shaping countries and regions. Then, humanitarianism is typically seen as an unbiased moral discourse centred on universal humanity and aid. Yet, it is historically linked to militarism, particularly in Western countries and has deepened in recent decades. Humanitarian standards, like International Humanitarian Law (IHL), are supposed to limit wars’ consequences, but IHL may implicitly tolerate particular levels of ‘collateral damage’ as allowable. IHL is embedded in a hierarchy that determines who can be saved and who cannot, possibly causing inequalities and unstable power relations tied to imperial dynamics. Hence, I see Western humanitarianism as deeply entangled with militarism because of how it can serve to justify and expand political violence across diverse countries and regions, as seen in modern news headlines. More importantly, this dynamic drives a vicious cycle of violence, where armed conflicts cause vulnerability by destroying infrastructure, destabilising nations and other negative consequences, like climate change and rising extremism, leading to civil wars and genocide. 

Moving forward

To truly move forward, adopting a multifaceted approach (e.g. decolonising global health) to addressing all the injustices and health disparities is vital; this can work, but I think that should involve giving all the most vulnerable communities their autonomy, liberation and fundamental human rights. There is the notion of peace plans coming from Western governments like the US, yet that cannot start without putting those directly experiencing war, genocide, displacement, ethnic cleansing and other atrocities as the central voice in those conversations. Moreover, we should highlight those most accountable for making amends. For example, they should allow a right to return and a payment of extensive reparations to the displaced Palestinians, Sudanese, Lebanese, Syrian, Yemeni, Kashmiri, and the Rohingya populations to their homelands, among numerous others. The big question is whether these suggestions will become tangible realities. Although reparations and the right to return may seem distant from contemporary political realities, they are moral imperatives for real justice to occur.

Continuously raising awareness and rallying support for affected communities so they can tackle their needs and challenges is important. There is also advocacy, which is vital in showcasing the issues they encounter, which can pave the way for significant policy changes. Moreover, the participation of local and international non-governmental organisations (NGOs), like Amnesty International, is crucial for enforcing ongoing solutions, as they better grasp the vulnerable communities’ needs. When these efforts are done collaboratively, fostering a more supportive environment for those needing it most is vital. Unfortunately, NGOs cannot replace genuine international political will because their impact will always be limited without structural change. Importantly, recognising how interconnected everyone is as a global community is crucial. Engaging in different cultures and experiences should foster empathy and build a collective strength to face challenges, notably climate change and warfare driven by the weapons industry. Uniting and sharing knowledge can encourage real change and all countries actually following international law, which requires powerful countries to be held responsible in ways that have been avoided so far; this should involve acknowledging that the vulnerable communities have a right to resist and defend themselves against their oppressors. 

Conclusion

The global health injustices seen today have historical roots in European colonialism, which has stripped indigenous global communities of their homelands and disrupted their cultural connections. Furthermore, they are influenced by many factors. Moreover, health behaviours are influenced by the broader social, cultural, and political landscapes. Geopolitical dynamics impact vulnerable populations by undermining their security, access to resources, and fundamental human rights; foreign interventionism via militarism makes them worse. Humanitarianism with militarism can reinforce cycles of violence by legitimising unequal power dynamics despite its good intentions. To effectively tackle the global health injustices, uplifting vulnerable communities by prioritising their human rights is vital. The perpetrators should pay reparations and grant the right of return to the most impacted. As individuals, we must raise awareness and push for policy changes. Local and international organisations are pivotal in understanding and addressing community needs. With everything said, I enjoyed writing this series because it showed me how connected all these injustices are and how we can act, listen and reflect together. Ultimately, we must focus on all the countries and communities highlighted in this series, as well as others currently facing injustices like the Uyghurs in China and Afghanistan. We must open our eyes, hearts, souls, and minds to nurture global connections and share knowledge for impactful change.

Written by Sam Jarada

Related articles: How does physical health affect mental health? / Beyond medicine: health through different stances / Regulation and policy of stem cell research

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