Tag Archives: Human Rights

Performing health equity: A repeat prescription from yesteryear

In a recent paper in the International Journal for Health Equity, Berenson et al. deliver a hopeful vision of a world better able to take advantage of SDH research. Had the article been published in 2015, it would have landed in a world positioned to take full advantage of the prescription. Unfortunately, the very value frame that supports SDH interventions has fractured. They note this in the lightest way possible, citing a paper by Woolf et al. as evidence of “adverse political environments” for SDH. This characterisation completely undersells what Woolf et al. actually observed — a complete ban, a dismantling, of any research on SDH-style categories: equity, race, diversity, and inclusion. Woolf et al. provide what is close to a complete rebuttal of the point Berenson et al. seek to make.

One of the strongest conclusions from the authors is that “SDH researchers must aim to create and cultivate policy windows of opportunity by being active protagonists…” This assumes at least a world with something approaching shared values, not a world in which “social determinants” are not simply contested but openly reviled and its advocates cast as the enemy — where your notion of fairness is an attack on our cultural values, where your racial equality is advocacy for our genetic and cultural replacement. By their own adopted framework (Kingdon), policy windows rely on a conducive political context. That cannot be created by researchers and has not existed for over a decade! The current political context is not simply unconducive, it is actively hostile. If “cultivating policy windows” — something like a horticultural endeavour at the South Pole — were the solution, then climate regulation would have been resolved, and abortion laws would be universal and rights-protecting, but they are in retreat.

Berenson et al. warn against research that risks being too “technocratic and detached from real-world constraints”, that offers “descriptive documentation of inequities” without “confronting the interests and institutions that benefit from the status quo.” They will say, rightly, that they are not naive about politics — that they explicitly concede research alone cannot overcome entrenched power, and devote an entire section to asking whether the problem is politics rather than research conduct. All of that is true. But notice what the concession does in their hands. They file it. Then without any apparent guile or appreciation of irony, they propose a five-point technocratic corrective. What is needed, they say is more methodological pluralism, more multisectoral collaboration, better communication, reformed incentives, stronger “brokering institutions.” These echo the calls made in the health policy and systems research literature for at least the last fifteen years — including in several of the paper’s own citations, e.g., Rasanathan & Diaz 2016.

The paper is at its core an advocacy piece playing to an audience of the like-minded. As with so many pieces from the last twenty months, which have come out of a loose coterie of global health scholars, civil servants, philanthropists, and diplomats, it fundamentally preserves a shared delusion of global order (or its complete irrelevance) and the insights of yesterday’s science conducted under the aegis of that order. They want to preserve the findings as if they are real, but not the shared value system and international human-rights framework on which those findings — and their policy relevance — are contingent. That, finally, is the more interesting question the paper never asks: not why its fifteen-year-old prescriptions haven’t worked, but whether those contingent truths can ever reach beyond the frameworks that made them possible.

Berenson et al. call knowledge and science “a crucial bulwark to combat forces arraigned against solidarity.” But a bulwark is a defensive structure. It only matters if you still hold the ground behind it. And the ground — the shared value system, the international human-rights framework on which every one of their findings depends for its meaning — is precisely what is being overrun, and they do not seek to protect. This is the paper’s absurdity. Until universal values and rights are put back into the intellectual core, prescriptions like this one are not merely ineffective, they are complicit. They sustain the fiction that the problem is technique rather than the loss of the framework that made the technique meaningful. They keep wanting to refill the gas tank after the bandits have stolen the engine.

The crimes of the leader

When is an entire nation guilty of the crimes of its leader?

In the aftermath of World War II, there was considerable discussion about the collective responsibility of the German people for the horrific actions of the Nazis. By the mid-1950s, it was almost impossible to find a German who had ever been pro-Nazi—everyone was against it from the start. Whether it was from shame, fear of association, or cognitive dissonance, they would have you believe there was only ever a handful of Nazis and their supporters in Germany.

The truth hardly needs defending. The great majority of Germans knew what the Nazi Party stood for. The last free election held in pre-war Germany was in November 1932, when the Nazi Party won 33% of the vote. The March 1933 election, when the Nazi Party won 43% of the vote, was held after the Reichstag fire and in the presence of significant political intimidation. Before the last free election, the German people knew Hitler. He was openly anti-Semitic, anti-communist, and anti-democratic. In the 1920s, he compared Jews to germs, stating that diseases cannot be controlled unless you destroy their causes. By 1925, he had argued for the special entitlement of Germans for Lebensraum and the conquest of Slavic lands in Eastern Europe. He attempted a coup and established a paramilitary force.

Almost immediately after he won the March election in 1933, he established the first concentration camp (Dachau) for any social and political undesirables. He was also openly anti-Roma and Sinti, and anti-Catholic.

The tendency towards everything that followed historically was there for all to see. What responsibility did the German people have in 1933 to resist? What about ‘34, ‘35, ‘36, ‘37, … ‘45? In 1945, actual membership of the Nazi party was at its highest, about 10% of the population. When were the German people collectively responsible for their government’s actions?

In many ways, the question is unfair. How can a Bavarian farmer bear the same responsibility as a concentration camp commandant? Those who joined the party, served in the Einsatzgruppen, or otherwise actively participated in Nazi crimes must bear a more direct criminal and moral responsibility. What of the civil servants? What of those who made sure the infamous trains ran on time, delivering millions to their deaths? What is the moral calculus associated with the flow of benefits—direct and indirect—from the persecution of others, such as cheap farm labour from concentration camps, a new home, more job availability, etc.?

The night of 9 November 1938 was Kristallnacht—a pogrom against Jews throughout Germany and Austria. Over 1,400 synagogues were burned, thousands of Jewish businesses were destroyed, Jewish homes were ransacked, and dozens were killed in the streets. The violence was public, visible, and undeniable. Evidence suggests that many Germans—perhaps most—disapproved of the brutality and destruction. But this disapproval remained private and passive. There were no mass protests, no general strikes, no widespread efforts to shelter Jewish neighbours. The gap between private discomfort and public acquiescence reveals something crucial about collective responsibility: moral squeamishness without moral courage is functionally equivalent to complicity. After Kristallnacht, no German could claim ignorance of the regime’s violent intentions. The persecution was no longer bureaucratic or hidden—it happened in city centres with flames visible for miles. If it hadn’t before, Kristallnacht was the moment when passive opposition became morally insufficient, when continued participation in or acceptance of the Nazi system—even by those who privately disapproved—became a choice that enabled everything that followed.

What does resistance look like? Rolling and continuous general strikes, protests, refusal to deliver to, repair, or assist the state apparatus. It is painful; it will result in loss of liberty, loss of property, and, probably, loss of life. Resistance starts with the most, not those with the least. It will fracture families and friendships.

Where Americans have resisted the Trump administration, they have used polite institutional resistance—lawsuits, protests, opinion pieces, and letters to the editor—all of which assume the system can contain someone who fundamentally doesn’t operate within its rules. It’s the equivalent of Germans relying on Weimar constitutional mechanisms to check Hitler after 1933. The Supreme Court has essentially unleashed a criminal President, because by definition, he cannot commit a crime, and he is only enjoined after he has turned a criminal act into a de facto reality. You cannot un-ring the illegal bells he rings.

That’s an outrageous parallel, you say. Donald Trump is no Hitler. And I agree. Donald Trump is a greedy, narcissistic kleptocrat. And in the name of the American people, he has committed international crimes. He has supported genocide. He has ordered the extra-judicial killing of scores of people. He has threatened allies with invasion. He has had people imprisoned without due process. He has had people tortured. He has destroyed the multilateral system. He has put troops on the streets of US cities. He has attempted (it remains to be seen if he succeeds) to subvert the electoral system. He has compelled universities and multi-billion-dollar corporations to bend to his will. He and his family have stolen and extorted billions.

But whether Trump is Hitler is not the question. The question is: when do the American people bear collective responsibility for their leader’s actions? Like the German people in 1933, they knew their leader when they elected him in 2024—and unlike Hitler, they gave him a majority of the votes (not just the Electoral College). When they voted for him, they knew he did not follow the law. They knew he used violence to take what he wanted. They knew he was racist. They knew he pursued his personal interests above any greater good. They knew he was driven by vanity.

Where the German people opposed passively, the American people have resisted institutionally, at a time when institutions do not constrain power. Both groups chose mechanisms of resistance that enabled the regimes they oppose. Both nations bear collective responsibility for their leaders’ actions.

Postscript. Democracies offer their citizens a get-out-of-jail-free card. We elect a new leader, and we are absolved. We held the previous regime accountable and cast them out. Our sins are forgiven. I have always found it a slightly uncomfortable moral maneuver, but I do understand it.

In 2020, Americans could claim they had corrected their mistake. They voted Trump out. Democracy worked. They could also seek comfort in the fact that he failed to win the popular vote. Yes, he won the Electoral College vote, and that is a flaw in our system, but as a people, we rejected him. Then they voted him back in—with full knowledge of what he had done, who he was, and what he would do. The absolution was a lie. The accountability was performance. And the collective responsibility deepens.

Country X has no right to exist!

Feel free to insert any country’s name in the title according to your personal preferences or animosities. My initial instinct was to go for click-bait and title the article, “Israel has no right to exist”. This would be sure to inflame the passions of all the Israelis who condemn as antisemites anyone who asserts Israel’s lack of a right to exist. Then I thought about using “Taiwan”, “The United States of America”—too long—“China”, “Russia”, “France”…. It really doesn’t matter. Countries do not have a “right” to exist.

Countries either do exist or they don’t. Taiwan exists. Israel exists. Palestine lacks the functional sovereignty—control over borders, defence, foreign policy—that defines statehood. Should its people have the right to functional sovereignty? Absolutely.

My father once observed that there is nothing he found more frightening than a sudden proliferation of national flags. I heard the comedienne Sarah Silverman make the same observation. Flags connote nationalism, and nationalism distinguishes itself by being in opposition to a defined “other”—the quintessential thing that distinguishes us from you. It entitles us to have things and deny them to you, and take things from you without regard to your interests.

Nationalists do not look at other countries as having rights. They look at other countries as a wolf eyes a flock of sheep—an opportunity. Of course if the other country is a bear, they may need to be more circumspect, but even a bear can make a great rug.

Nationalism rest on mythic history to instrumentalise the population towards the leader’s ends, not the people’s interests. Now imagine a world in which, as the US seeks in its National Security Strategy 2025, all countries revive their mythic histories. No country will choose the history of the time when they were weakest, a vassal state or worse, completely absorbed. They will pick historical points of grandeur. Mongolia will claim vast swathes of Russia, China, and Central Asia—and rightly so! Turkey will recall it historical right to the Balkans, North Africa, and the Middle East. Who amongst us would not acknowledge Italy’s historical claim on England, France, Spain, Greece, Tunisia, Egypt, Lebanon, and Israel. Neither China nor Russia have need for further over-reach on their territorial claims, but they could. Russia tells the tale of a sovereign need for a Pan-Slavic State that gobbles up Eastern Europe and the Balkans. Egypt should certainly need to have it’s Pharaonic claim to the Levant recognised. Spain will eye its Western hemisphere territories with delight and return to discussions of the Holy Roman Empire. Morocco can start planning it’s revitalisation of Andalusia. Denmark will talk of the glory days when Schleswig-Holstein was not enough—when the North Sea Empire under Cnut the Great included England, Norway, and parts of Sweden. Sweden will promote a modern Baltic State reclaiming its rightful territories in Poland, Estonia, Latvia, and parts of Germany. Will France want to revisit the Louisiana Purchase? I think it should. Ecuador, Bolivia or probably Peru can sound the drums for a revitalised Incan empire. Once Burma has dealt with its pesky insurgency it can turn its eye to former glory: Thailand, Laos, and parts of Cambodia. Indonesia’s Majapahit claim to Malaysia, Singapore, southern Thailand, and the Philippines is entirely justified.

I would like to remind you all that when my ancestors stepped out of Africa, wherever their descendants placed their feet is mine to claim. And maybe this should be a new Pan-African myth of global capture.

Each of these claims rooted in a novelist’s fantasy of historical pride permits leaders to instrumentalise the young as warriors and breeders. And the foolish among us will swell our chests with the false pride of false histories.

For this story shall the good man teach his son;
And a national day shall ne’er go by,
From this day to the ending of the world,
Our claim shall be remembered.

If you walk past a United Nations building you will see flags of every nation fluttering. The message is not of history but future shared endeavour.

The sole purpose of a country is to advance the welfare of the people circumscribed by its borders—citizens and non-citizens. When leaders start to instrumentalise the population—treat them asmeans to the leader’s personal ends and ambition—they fail.

Countries come and go. The people are constant: tilling, toiling, and typing. If they choose to come together in unity within a geographic area, that is their right. They may expand that boundary with the consent of those around, and contract it on a similar basis. It cannot be a whimsical destabilising thing that would instrumentalise the lives of others. It needs thoughtful deliberation that takes into account the rights and duties of all. The purpose is welfare—full stop. Not glory. Not destiny. Not at the expense of others.

With apologies to William Shakespeare for butchering the lines from Henry V, Act IV, Scene 3

The Holocaust Indulgence

In the Middle Ages, the Catholic Church sold indulgences—forgiveness of sin in exchange for money. The most famous indulgence-seller was Johann Tetzel, a Dominican friar who promoted them with the catchy jingle: “As soon as the gold in the casket rings, the rescued soul to heaven springs”. And for the right price, Tetzel hinted, you could purchase forgiveness in advance—a moral insurance policy against judgement for tomorrow’s transgressions.

Tetzel’s theological snake oil was the ultimate fuel for the Protestant Reformation.

Today, we are all witnesses to a modern version of the indulgence, the Holocaust indulgence. No longer is money used to purchase forgiveness for future sin. Instead, the Holocaust indulgence trades on the deaths of six million Jews murdered by Germany between 1941 and 1945.

It is a moral license for genocide. Where Holocaust remembrance was once a shield against atrocity, a reminder of the constant need for vigilance against dehumanising hatred, it is now wielded as a sword to enable atrocities.

Not all Israelis are Jews; about a quarter of Israelis are not. And not all Jews are Israelis; just over half of the world’s Jews are not Israeli. Yet, Israel has worked carefully and decisively to conflate the two. It encourages the conversational mistake of saying Jews when what is meant is Israel or Israelis when what is meant is Jews. It is the keystone to the false claim that any attempt to hold Israel to account for its behaviour is a form of antisemitism, the false claim that to label Israel a racist state, an apartheid state, a colonial state, or a genocidal state is equivalent to calling for a pogrom against Jews. It is not.

European collective guilt for the centuries of antisemitism that culminated in the death of six million Jews is the grant of the Holocaust indulgence. They have allowed the State of Israel to trade on the death of six million people, many of whom would not have identified themselves as Jews until Germany did, many of whom would have abhorred the idea of genocide in their name.

Israel wields the Holocaust indulgence as a prophylactic absolution—a moral insurance policy that permits future transgressions in the name of “never again”. European governments grant it as a way of atonement for centuries of antisemitism. We have two different relationships to guilt, flowing in opposite temporal directions, yet both transactions use the same currency—the death of six million—to absolve modern atrocities.

The result is a closed, corrupted moral system where accountability becomes impossible. Israel can invoke the Holocaust to justify its actions, while Europe remembers its (justified) guilt to excuse its inaction or indirect support. Between them, they have created the perfect indulgence—one that absolves both past and future sin, leaving the present moment suspended in a moral vacuum where atrocity is not just permitted but sanctified.

Like Tetzel’s theological snake oil, the Holocaust indulgence has corrupted the very memory it claims to honour, transforming remembrance from a call to justice into a license for injustice.