Do you remember how COVID19 literally brought humanity to its knees? Antimicrobial Resistance (AMR) could do worse!
It is making infections harder to treat, increasing the spread, severity and fatality of diseases as a silent pandemic, and reversing decades of gains in improvement in human and animal health. Without a robust response, AMR could reduce global average life expectancy by 1.8 years within a decade, and cause up to 39 million deaths by 2050. Globally, annual treatment costs and productivity losses combined are projected to reach US$855 billion by 2035. Those are huge figures. But within them most of the risks and burdens are borne by low-income countries, especially in Sub Saharan Africa. AMR is increasing in our region at a time when limited and inequitable access to diagnostics, medicines, including antibiotics are currently causing more deaths than AMR, according to the Africa CDC. In Africa, 24-27 deaths in every 100 000 people are directly attributable or associated with AMR. This is about 5 times the rate in North America. Africa bears the highest AMR burden globally, and deaths from AMR surpass deaths from HIV/AIDS, malaria and tuberculosis combined. The AU and partners estimate that without action AMR will affect 4.1 million Africans annually by 2050.
AMR is a consequence of socioeconomic drivers, and engaging communities is essential. Where people are born, live and work affect health equity, and those in poorer conditions have higher health risks and poorer access to health services. Many in informal communities self-medicate with antibiotics when they cannot access quality services or sick leave when they are ill. With the increase in work pressures, people are pushed to settle for quick fixes such as over-the-counter antibiotics, worsening AMR. WHO/UNICEF data indicates that poor access to safe water increases disease risk and complicates prevention, while industries, large scale farms and hospitals pollute waterways with chemicals or a spill of antibiotics.
Climate Change has intensified such direct and indirect drivers of AMR, creating hot, water scarce or flooded environments that allow pathogens and resistance to thrive, increasing exposure to disease and death, while also destroying or disrupting livelihoods, biodiversity infrastructures, food and water systems, and other essential services and resources, further burdening already vulnerable communities and countries.
From 2015, when World Health Organisation (WHO) first produced a Global Action Plan on AMR (GAP AMR), the agenda was driven by concerns of those in the health sector about the growing threat of drug resistance, and the lack of data to understand the full extent of the problem or to effectively monitor its spread. Adopted by the World Health Assembly and supported by a Political Declaration on AMR at the 71st UN General Assembly (resolution A/RES/71/3), GAP set out five strategic objectives to fight AMR that were integrated into National Action Plans. However, these made little reference to gender, climate or other health equity related sources of vulnerability, or how to address them.
While by the end of 2023 over 170 countries had developed National Action Plans (NAP) based on GAP, they generally reflected limited focus on inequities affecting AMR and only 10% of the countries provided specific finances for their implementation. A 2025 WHO AFRO progress report showed that all 47 Member States had drafted NAPs using the One Health Approach, only 40% had established focal points for implementation and 38% were conducting national awareness campaigns. More positively, 85% had laws or regulations on the prescribing and sale of human antimicrobials. At the same time, concern has been growing about an inadequate response to the socioeconomic and commercial determinants of AMR, weakening AMR interventions. The distribution and use of substandard and counterfeit drugs, the unregulated sale of antibiotics without prescriptions, the misuse of antibiotics/antimicrobials in commercial farming to promote animal growth and profits and the release of untreated industrial and pharmaceutical waste into the environment exemplify commercial activities contributing to AMR in the region. This has ignited multistakeholder processes to address this equity gap and its drivers, facilitated by WHO and with participation of diverse countries and communities. Debates and evidence have linked AMR to social justice, to health as a right and to socioeconomic and other inequalities, together with the changes needed to address these issues and the range of disparities that make communities and countries more at risk of AMR.
Reflecting this, the quadripartite GAP on AMR 2026-2036 adopted at 2026 World Health Assembly gives greater focus on multisectoral governance, sustainable financing, and equitable access to conditions, antibiotics/antimicrobial medicines, environmental surveillance and services to address persistent implementation gaps, with specific impact focused targets by 2030. GAP 2026 shows many shifts from its 2015 predecessor. It emphasises strong robust surveillance systems and ‘prevention first’, and promotes community engagement beyond basic awareness. GAP 2026 embraces One Health and greatly emphasizes the environmental dimensions of AMR, such as the presence of antimicrobial residues and resistant microbes in the ecosystem.
This has formally established the role of UNEP in AMR, together with other UN agencies. GAP 2026 has been intentional in focusing on equity, with a monitoring and evaluation framework and quantitative targets. It goes beyond bacterial resistance to include fungal, parasitic, and viral resistance, and wastewater/environmental surveillance/residues in its actions and targets. GAP 2026 has recognised the financial barriers to implementation of plans and included specific guidance on investment and financing mechanisms, governance through multisectoral structures, and on prioritizing investment in diagnostics and vaccines over new era antibiotics.
It would appear that there is increasing recognition that AMR policies and interventions must advance equity. This is reflected in more attention being given to multisectoral governance, financing and accountability, to local manufacturing of and access to diagnostics and vaccines and to ensuring sustained access to quality antibiotics/antimicrobials. Equity is also reflected in greater attention on prevention, with improved surveillance and health impact assessment to bring data on the lived experiences of those unable to access/reach health facilities and strategies to address the structural, socioeconomic and commercial drivers of AMR. It includes understanding of the need for local research and effective, tested interventions to produce tangible results for low-income communities. Associated with this is recognition of the need to give more attention to people-centred approaches that amplify, strengthen and resource local voices and indigenous knowledge, and of the importance of low-income country voice in diplomacy on AMR. At all levels within countries, and in relation to the inequities that exist globally across countries, an equity and solidarity lens in AMR related agreements and strategies is essential for an effective response, understanding that AMR is everyone’s concern, crisis and responsibility, and that as we learned during COVID-19, we are all only as safe as the weakest amongst us.
We welcome your feedback or queries on the issues raised in this oped – please send them to the EQUINET secretariat. You can read more on AMR in the May version of the WHO global action plan on AMR 2026–2036 at https://apps.who.int/gb/ebwha/pdf_files/WHA79/A79_5Add2-en.pdf
Editorial
Turn on a smart phone, drive in a car with electric batteries, watch wind turbines turn in the distance or solar panels on roofs, and you’re interacting with a range of technologies that are using the critical minerals that are replacing fossil fuel energy.
There is no doubt that the current excessive and inequitable consumption of the fossil fuel-reliant goods and services has to end. It is a major driver of climate change and ill health. Fossil fuel-linked air pollution alone is reported by the Global Climate and Health Alliance to be causing over 5.1 million deaths annually.
But in extracting critical minerals to replace fossil fuels, are we replicating the same harmful political economy and choices made by powerful corporations and policymakers? Are we replicating the ‘curse of oil’ in the critical mineral sector, with a disproportionate benefit for wealthy countries and transnationals and with ecological degradation, conflict and displacement in zones of extraction?
Globally, African countries, particularly in East and Southern Africa (ESA), are reported to hold high shares of the global reserves of the ’critical’ or ’strategic’ minerals extracted for low-carbon technologies, that is copper, lithium, nickel, cobalt, graphite, manganese and rare earth elements. They are extracted in a range of ways by transnational corporation operations through to artisanal small-scale mines (ASM). While exports of these minerals are increasing, value-added processing is not. Several ESA countries have banned or taxed the export of the raw minerals, and some are introducing processes to increase the concentrations of the minerals exported. But these measures have been slow to translate into meaningful increases in value-added local processing in the region, given constraints in accessing the capital investments for this. There are some new planned initiatives, such as a cross-border DRC-Zambia plan to manufacture electric batteries for vehicles. But the range of battery storage devices used by many homes in the region for solar power continue to be imported.
A clear marker of the inequity in who benefits from this new version of the ‘gold rush’ in Africa is in their public health consequences. These public health impacts are most felt by mine-workers and by communities living around mines. As was found when a mine tailings-dam collapsed in Zambia spewing toxic chemicals into the Kafue river for over 100km, the exposed areas and communities can extend very far downwind or downstream.
Critical minerals have been linked in various studies and surveys to silicosis, tuberculosis and toxic metal poisoning from copper; lung disease, bronchitis, impotence and psychiatric symptoms from manganese; kidney, liver, heart disease and cancers from lithium and nickel; and to genetic damage and newborn malformations from cobalt. The economic insecurity and hazardous settings of informal and small-scale miners and surrounding communities combine to intensify these risks.
These social, environmental and health impacts take place in remote rural areas, making them invisible to the urban and high-income country users of the technologies they enable, and to some policy actors. The under-reporting of the health impacts in ESA countries externalises the burdens to workers and to adjacent and displaced communities and their children; groups who are already struggling with social and economic insecurity.
The energy transition that climate change is driving can neither can neither be “just” nor “green” if these health and well-being impacts are ignored.
The G20 Johannesburg Summit hosted under the South Africa presidency in November last year, reflecting the prior Social Summit, called for a more holistic global framework for equitable benefit-sharing in critical mineral value chains, “integrating economic, social, and environmental dimensions across the value chain – from extraction to processing, manufacturing, disposal and recycling”. Implementing this call requires changes in the trade, investment, tax and global rule systems that block equity, and that have done so from colonialism, to neoliberalism, to the financial and mercantile hyper-capitalism and imperialism that we are seeing today. For any progress in equitable benefit-sharing, people’s health and wellbeing must be central, and health should act as a marker of delivery of such change.
Making health a marker of equitable benefit-sharing means moving away from relying on ad hoc surveys to demonstrate risks and health impacts, as these are generally localised, reactive, and lack legal force to ensure change, except through persuasion or litigation. It implies institutionalising monitoring and responding to health impacts. One option is to implement health impact assessment (HIA) as a more systematic approach integrated in investment plans, in licensing, and during and after mining operations. Beyond preventing harmful exposures inside mines and emissions from mining processes, this includes tackling the waste discharge and toxic contamination of air, water and soil that harm food systems and living conditions, and the social, demographic, nutrition and livelihood risks to communities during and after mining operations. Integrating HIA can more proactively assess such impacts and profile measures to prevent unfair health burdens of critical mineral extraction in the ESA region. Environmental Impact Assessments are being done in all countries in the region, but they do not meet this need. They may protect the environment, but not the people.
For equity, HIA should be done with direct involvement of those affected in reviewing the findings and recommendations, through co-determination and with prior informed consent on key plans. Public reporting of HIAs should enable those affected - workers, ex-workers, pregnant women, children, displaced and other communities, social sectors, public service providers, and many others - to engage in shaping or ensuring the legal, work environment, service and system reforms and duties to protect health.
Not addressing people’s health and conditions in the fossil-fuel sector has led to litigation and conflict and left degraded ecologies and social deficits. Paying attention to people’s health in the extraction and processing of critical minerals is a key lever and a driver of demands for political economy changes and green transition plans that may actually reach and enhance people’s lives. It sends a clear message that a ’just green transition’ is not only about the product, it is about the system and the people.
We welcome your feedback or queries on the issues raised in this oped – please send them to the EQUINET secretariat. You can read more on health impact assessments and health in the mining sector on the EQUINET website at www.equinetafrica.org, and on critical minerals in the African Extractivism and the Green Transition website at https://www.aegt.ca/.
We often read about threats of war, conflict and climate emergencies, and earthquakes, tsunamis, floods, and wildfires seem to be more common. For those living in poverty, these threats add to existing stresses from in adequate housing, food, water and insecure livelihoods. Climate change is making farming more difficult, stripping away a food security as a safety net that came from rural production for those facing employment challenges. People are displaced by climate emergencies and conflict, losing social links and access to services. Structural drivers of deprivation, climate injustices and conflict combine in forms of systematic oppression that make their impacts hard to repair. Not surprisingly, this combination of climate stresses, conflict or deprivation are worsening existing mental ill-health. These stresses when chronic can also lead to forms of anxiety and trauma that include psychosocial and spiritual dimensions, including from situations where people feel powerless to change their circumstances. When climate injustice affects people’s ability to control their lives and mental wellbeing, seeing this only from a clinical lens can discount the range of drivers and forms of mental disorders, silencing those affected by them.
Transformational climate justice as a concept aims at change in drivers of inequity and mental health issues – particularly the unequal burdens of climate change and their roots in power imbalances and social, political, and economic systems. It focuses on generating long-term sustainable change in systems to confront these drivers, while recognising the silent burdens they cause, including for mental health. Transformations that are aimed at more equitable access to basic needs like water, food, and health care are inherent for climate justice.
When policies focus only or primarily on technical and ignore social responses, when they ignore indigenous knowledge systems in climate smart agriculture, or when they do not devolve resources to the community levels to enable more community-led responses, including in shaping plans, they can deepen power imbalances. Beyond changes in material and ecological conditions, transformational climate justice thus aims to build relations and cohesion within communities and in partnerships and collaborative activities with civil society and non-government organisations and public sectors. This can improve access to mental health counselling and services. More deeply, the social dimensions support the sharing of collective values and analysis, and the growth of social power, trust and confidence to produce change in other areas, including in service provision, in decision-making and in government policies and plans.
Transformational adaptation among communities thus focuses on power, collaborative action, and co-production. By integrating these features, they widen responses beyond technical or infrastructure projects to integrate justice and equity.
In South Africa, for example, just transition discussions have given evidence of contesting power and positions between private sector energy producers, communities, national and global funders and local climate change unions. Climate injustice in South Africa from floods has left people without shelter, support, or dignity. Amongst those affected, commercial sex workers facing deprivation and climate emergencies are pressured to engage in high-risk sexual activities and experience violence, amplifying their trauma and mental ill-health. Addressing the abuse, trauma and deprivation that are drivers of their mental ill-health means that beyond counselling adapted to their circumstances, they need housing infrastructures and food to improve their autonomy, including in reproductive health.
A further example is found in communities in Ethiopia, Tanzania and Kenya, where Ackerl and co-authors reported in 2023 that only 52% of households are food secure. The combination of floods, drought, asset deprivation and a lack of financial and social resources generate this insecurity and associated stress. Transformational adaptation is applied in a mix of intercropping and early planting strategies to reduce risk from unpredictable rains. Ethiopia’s Health National Adaptation Plan II (2024-2028) responds to the needs of pastoral communities experiencing environmental-linked distress by integrating mental health into primary health care, within the wider agro-ecological approaches.
Primary health care (PHC) offers an entry point for addressing the scale of community experiences of mental ill-health in a context of inadequate access to mental health services and professionals, engaging traditional, faith healers, clergy and imams or mission hospitals to provide social support and trauma counselling, and to ensure safe spaces for this, including for displaced communities. PHC offers a space for peer support approaches that function beyond clinical models, but need to be backed by training of primary care health workers to provide appropriate care for mental health issues. PHC services can integrate mental health screening into community-centred approaches that take climate emergencies and impacts into account as a source of vulnerability. The intersectoral approaches in PHC can connect mental health services with services that enable agriculture, or strengthen access to food, water and other forms of social support. These forms of collaboration across organisations, institutions and communities help to address the social disempowerment referred to earlier.
Early health warning systems and public education can provide evidence and information to tackle the stresses from climate injustice and mobile apps can provide information to and hear responses from those affected. Cultural and religious services and people can play the role of support systems for the mental health of communities affected by climate change. Education and outreach programmes and initiatives on climate change and future preparedness provide safe spaces to foster emotional wellbeing and self-expression in youth and school children. Specific interventions, such as therapy linked to farming activities, and drama and music therapies for children impacted by floods, and community-based psychosocial support, as currently implemented in Tanzania, can be integrated into measures for climate preparedness.
As a bottom line for the region, mental ill health from the combination of climate-related stresses interacting with socio-economic inequities calls for a transformational climate justice. This calls for more mental health and climate change policies and for interventions to be implemented in ‘bottom up’ approaches by communities and organisations in collaborative processes in east and Southern Africa. It implies integrating mental health in adaptation and recovery programmes, encouraging in inter-departmental collaborations between various sectors and training a spectrum of health workers, police, and community leaders on mental health and psychosocial support in the context of climate disasters, as for example in the training led by Africa CDC.
Particularly in east and southern Africa, where climate change may be amplifying power imbalances and increasing mental ill health, and where resources and infrastructures are limited, we need to link the transformations needed for climate justice to the range of systems for health. Beyond the integration of mental health into primary health care services, an interaction between PHC approaches and the initiatives in other sectors can build collaborative action to change the combination of conditions that are eroding mental wellbeing.
As we approach the end of 2025 we hope that you have the opportunity to re-energise, reflect, and re-invigorate for the year ahead. In a year that has seen dehumanising genocide, crises and inequality, we know that the most harmful consequence of injustice is when people lose the confidence and understanding that they have the power to produce change. As EQUINET we have learned and been nourished with ideas and a sense of the possible, for our region and globally, by the diversity of people, perspectives, experiences and knowledge in our various exchanges, work and partnerships. Thank you, and we wish you buen vivir, wellbeing and progress in struggles for a more just world in 2026.
In our August newsletter we asked what constitutes a just response when our global political economy is generating deepening deprivation, conflict and inequality, and when powerful actors fuelling and gaining from these conditions appear to be able to act without penalty? You contributed on the realities we are facing and what a just response demands.
From different countries in east and southern Africa you pointed to global issues- conflict, climate extremes, and economic shocks - that are deepening inequality and insecurity. You noted that intensified extraction of minerals and biodiversity and rising debt burdens in the past decade are depleting public funds for health, education and other services, and that households are struggling with food security. Of the 6.6 million Zambian children, 71% are suffering from multiple dimensions of deprivation. Poverty conditions are associated with crime, gender-based violence (where rates in South Africa are among the highest in the world), discrimination and other forms of conflict.
Informal workers make up a large share of producers in our region. In Zimbabwe they are around 80% of the labour force, contributing about 60% of GDP. They work in harsh, often hazardous conditions for minimal fluctuating income, trading health for survival. Many are young people, facing insecure futures and bearing the brunt of climate impacts and economic shocks, with minimal social or institutional protection. Many small-scale miners in our region are extracting lithium and cobalt used in green transition technologies in high income countries, harming their health while generating wealth largely earned outside the region.
This situation represents daily violations of rights to health and its determinants, and a gap in the implementation of laws and policies that protect these rights. Those most affected are largely excluded from the national, international and corporate systems that are planning, accumulating, distributing and using the wealth from resources in the region.
Violence and rights violations reach their extreme when people are caught in military conflict. Not surprisingly this is often in areas of significant resources for wealth extraction. A humanitarian crisis and genocide in Sudan that has been ongoing since 2019 was profiled in October, with report of thousands of people massacred, and over 20 000 fleeing Al-Fashir alone. Of 40 million Sudanese people, over 20 million are reported to be nearing starvation and 10 million forced to leave their homes. Uganda, the largest refugee-hosting country in Africa, shelters over 1.6 million displaced people, despite its systems already being overstretched. In Sudan, cholera, malaria, dengue and malnutrition have escalated. Health services have not escaped violence. The World Health Organization reports that 460 patients and their companions were killed at the Saudi Maternity Hospital in El Fasher in October 2025. Director-General Tedros Ghebreyesus said that prior to this latest attack, WHO had verified 285 attacks on healthcare in Sudan with at least 1204 deaths and over 400 injuries of health workers and patients since the start of the conflict.
In 2018, Sudanese women, youth, workers, and professionals protested en masse against economic hardship and authoritarian rule, with demands for freedom, peace, and justice. Yet interests in Sudan’s significant gold resources by countries and military forces contradict these social demands for equitable revenue distribution. Violence appears to serve, rather than disrupt extraction, with gold, livestock, and agricultural exports continuing, and in some cases increasing, during the conflict, despite the social devastation and rhetorical commitments to peace.
What is the response to these various dimensions of injustice?
One response has been as protest. In Madagascar in September, young Gen Z protesters took to the streets to demand economic opportunities, a leadership that will improve their quality of life, and to participate in the decisions that affect their lives. Disillusioned with the government, protestors rejected government calls for talks, demanding the president’s resignation. The president fled in October, and the military took power, forming a transitional committee with the promise to restore civilian rule. Whether this will produce the change that motivated the protests remains to be seen.
As for young people in Madagascar, the responses to our question in August showed clear aspirations for a more just society: One that invests in secure jobs, livelihoods, communities and services, where people access affordable water, housing, clean energy, infrastructures and services; that prioritises social development over individual wealth accumulation and respects human rights. The call is also for dehumanising violence to end. As WHO noted in relation to the military attacks in Sudan, “All attacks on healthcare must stop immediately and unconditionally,” and health workers and civilians should be protected under international law.
These changes call for communities everywhere to be protected, organised, empowered and heard, in a culture of solidarity and accountable, democratic governance. Recognising people as active agents in inclusive, locally-grounded approaches is seen to be an essential foundation for building a fairer, just future. This demands a clear strategy to rebuild societies from the damage of neoliberalism, debt, structural adjustment, extraction and violence. Without this, protest simply brings new hands on the steering wheel, while the inequity continues.
The responses pointed to the role of regional solidarity, self-determination, strategies and standards in generating more inclusive economies, providing space and accountability for policy innovation. They indicate confidence that we have the assets, capacities and social demand in the region to build a fairer alternative, if we reclaim resources, states, and collective values.
However, whether locally, nationally or regionally, people struggle within global systems that protect existing privilege and wealth, and that encourage leaderships to do the same.
Hence the disappointment that multilateralism and United Nations institutions have failed to enforce international law, or to set a global political economy framework that confronts inequality. Of the 140 targets in the Sustainable Development Goals (SDGs) set in 2015 to be met by 2030, only 12% are said to be on track, 50% to be moderately or severely off track, and 30% have either stagnated or regressed. While some point to a funding barrier, and there is indeed a reported $4 trillion yearly funding deficit to meet the SDG targets, there is a deeper critique. There is no shared vision of the alternative global political economy that can embed such development goals, and an unwillingness to disrupt powerful economic interests. So global financial institutions and private lenders continue to prioritise fiscal wellbeing over social or planetary wellbeing, UN institutions fail to protect vulnerable populations against deprivation, exploitation and even genocide, and powerful actors globally spin narratives that hide the realities on the ground.
Issa G. Shivji, the prominent Africa thinker asks: will naming and shaming over these violations shake power into action? Or if power is amoral, how do you confront it? His answer is to keep unmasking a capitalist political economy that trumps morality, values and humanity in its relentless pursuit of profit and insatiable thirst for accumulation. Samir Amin argues for ‘delinking’ and building sufficient political power in the region to construct self-determined development strategies that are not in servitude to global value chains. Some point to China, with its large public sector and high levels of public investment that override private corporate interests in the economy. Others point to successful wellbeing economies. There are options. They demand social debate at all levels, and accountability to public interest.
Neither can we let multilateralism off the hook, given its role in transnational taxes, pricing, financial flows, trade, intellectual property and other global processes affecting the region. While the UN is being weakened and subjugated by market forces and power imbalances, it cannot be lost to drivers of inequity. When established in October 80 years ago, the UN aimed to promote peace, human rights and international co-operation. This mandate is still undelivered. One commentator observed that if the UN was disbanded on a Friday, it would be reinvented by Monday. Protecting what is democratic, such as the one state, one vote in the WHO and the General Assembly, and changing what is not, such as the undemocratic composition of the Security Council or health-harming intellectual property rules are part of that reinvention.
The most harmful consequence of injustice is when people lose the confidence and understanding that they have the power to produce change. However, your responses highlight that inequality, extraction and impunity are not inevitable. There are building blocks, ideas, strategies, alliances and diverse terrains of action that show this.
We welcome your feedback or queries on the issues raised in this oped – please send them to the EQUINET secretariat.
We are daily confronted by images of vulnerable people, including children, starving and dying in situations of preventable conflict. We are weekly confronted with stories of hospitals being attacked and health workers killed in military attacks. We are constantly hearing of floods and extreme weather destroying lives and homes of already precarious communities. We keep hearing about toxic pollution of rivers, harmful emissions and extreme hazards in work that are causing injury and disability. There are international human rights norms and standards that were set to prevent and respond to these realities and new, important standards being set, but they appear to be ignored and inadequate for new challenges, including from transnational corporate control of artificial intelligence. International and national institutions that were supposed to ensure their implementation appear to be disregarded and ineffective, and solidarity resources cut and redirected to military budgets. Powerful actors who are generating these conditions and their consequences appear to be able to act without penalty. If such a global situation is taking hold, the consequences can and are impacting on our national and local realities. What is a just response? There are interesting developments, and podcasts in this newsletter and the editorial from the Global Health Watch share some proposals. Please send us your contributions and experience on this as we explore these realities and their consequences and discuss the responses further in our next issue.
From the “shadow of the COVID-19 pandemic” that set a context for Global Health Watch 6, the Global Health Watch 7 (GHW7) is being released under a different and more ominous shadow, that of Donald Trump’s return to the US presidency. We are in the midst of a massively disruptive transition in which the former US-dominated (neo)liberal world order is being transformed into a form not yet clear. The new Trump administration is driving this change, leaving global health churning in its chaotic wake, affecting all regions including east and southern Africa. Hence the heightened imperative to continue our activist mobilizing for health justice.
GHW7 begins with the ‘big picture’ issues in the global political economy, including chapters on ecofeminisms and ancestral health knowledge systems. Together these three chapters outline a new scenario for a global economy based on planetary health and human wellbeing. A second section delves into the state of play across health systems, opening with an update on the privatization, financialization and corporatization challenges affecting health systems, and provides public health alternatives. It raises the pros and cons of the increased use of artificial intelligence (AI) in health systems, makes proposals for equitable health systems from an intersectional gender perspective, and presents an analysis of ‘abolition medicine’ which draws important connections between the social organization of prisons and health care systems. It includes a commentary on ‘decolonizing’ global health.
However, the GHW7 is not only focused on the health system, It goes ‘beyond health care’ to discuss issues that are critically important for health, beginning with the rise in conflicts globally. It includes a focus on the genocide in Gaza, but the discussion of conflicts is equally important for east and southern Africa given conflicts in Sudan and DRC. It points to the role of capitalism’s ‘military-industrial complex’ in sustaining conflict for purposes of profit and geopolitical power, and provides an analysis of the drivers of migration and displacement, which are the highest ever recorded. There is a focus on some of the core dynamics linking work, employment, and health in the context of neoliberal capitalism. This raises attention to the importance of tax justice and progressive tax reforms at national and global scales, as also advocated from Africa. In discussing the commercial or corporate determinants of health, or those commercial influences in health, it covers the capitalist consumptogenic marketing of unhealthy commodities (tobacco, ultra-processed foods, alcohol) and provides a critique of the consultancy/accountancy transnationals (the ‘Big Four’ firms) that increasingly dominate global health policy making, including for east and southern Africa.
There is a fourth ‘watching’ section in the GHW7 that looks at what is new in global governance for health. It begins with an analysis of the health of the World Health Organization (WHO), noting its declining leadership worsened by the US withdrawal of funding, albeit with the potential uptick of having reached agreement on a new Pandemic Treaty. There is an assessment of the strengths and weaknesses of the Pandemic Treaty (referred to as a Pandemic Accord), particularly in terms of the still-to-be-negotiated annexes that will deal with improved access to pandemic tools for the Global South and global financing for pandemic prevention, preparedness, and response. Some of these funding issues are explored in greater detail in a subsequent chapter that focuses on future pandemic financing models.
With the current situation demanding the activist mobilisation for health justice noted earlier.
The final chapters in GHW7 document health activism at different scales, celebrating acts of resistance (some successful, others not) and describing new activist modalities for healthful change. Its closing chapter draws from the 5th People’s Health Assembly held in Mar del Plata, Argentina, in April 2024, and its declaration calling on activists worldwide to continue advancing the struggle for liberation and against capitalism.
The GHW7 is affirmative for its content and focus, However, it is also innovative for its content coming from writing groups and contributions representing the geographic breadth of People’s Health Movement (PHM).It is a co-production of PHM, ALAMES, EQUINET, Health Poverty Action, Medact, Medico International, Sama, Third World Network, and Viva Salud.In striving to have this edition be an exercise in ‘movement building’ and not simply an analytical synopsis of global health issues, writing groups were encouraged to use their chapters as opportunities to discuss and engage across these geographies, allowing activists to learn with each other. As with previous editions, scores of activists worldwide contributed to its production.
It is published by a solidarity publisher (Daraja Press) rather than a conventional academic or trade book publisher. Each chapter could thus be downloaded and distributed free of charge as soon as it was completed. With all chapters now completed, we will soon produce all as a single book, downloadable for free as a PDF or available for purchase as a printed book. It is available in both English and Spanish, partly with contribution from Latin American PHM activists in convening the 2024 5th People’s Health Assembly in Argentina. It is thus a resource for the many areas and forms of health equity activism in east and southern Africa.
Please send any feedback on and contribution to editorials to admin@equinetafrica.org. You can read more about PHM and freely access the Global Health Watch 7 chapters on the PHM website https://phmovement.org/global-health-watch, where all previous editions can also be found, and on the publisher’s website https://darajapress.com/publication/mobilizing-for-health-justice-en.
“Land is more than a resource in east and southern Africa. For millions of people it is their home, their culture, and their livelihood. So when we talk of the droughts, floods and unpredictable growing seasons caused by climate change it is not just an ‘inconvenient truth’ – it is a catastrophe for all those who live and depend on the land. When these communities are also losing land to multinational corporations annexing land for industrial mono-cropping, they deprive people of livelihoods, wellbeing and generations of wisdom, making people more vulnerable to challenges like climate change”.
This discussion at the sixth EQUINET webinar on climate and health equity in east and southern Africa pointed out how deep the action needs to be to uproot climate- related inequities that undermine health.
This, and the previous five webinars heard from community, national and regional/international speakers how the roots of climate change intertwine with other drivers of inequities in health, and what that means for action at all these levels. High levels of economic and social inequality in the east and southern Africa region – and globally- undermine the right to health for many, including for the many young people who make up the majority of the region’s population.
Looking across rights, laws, health systems, extractive sectors, agroecology, urban food, trade and tax systems, the webinars presented evidence of how climate change and emergencies are clearly having wide-ranging health impacts, with extreme weather disrupting environments, food and water access, expanding disease vectors and increasing injury, mental distress, communicable disease and mortality. The direct health impacts are profound in a region where a large share of the population is reliant on climate-sensitive sectors like agriculture and natural resource-dependent livelihoods and are particularly affected by water scarcity. Climate impacts have raised demand for health care, but have also damaged health infrastructures, adding to existing barriers to access. While acute disasters attract the most attention, many of these direct health impacts emerge from longstanding deficits, especially for already vulnerable communities.
Across all the webinars, climate impacts were reported to not only intersect with existing inequalities in the region, but to also widen them. Whether discussing female reproductive rights, household food security, employment and incomes and other factors affecting health, webinar speakers and participants gave examples of how climate change is exacerbating existing health disparities, widening gender inequalities and depriving already disadvantaged people of the resources for health. The numbers affected are huge: there was constant reference to poor households, women, children, young people, rural and coastal and flood-prone communities and urban informal settlement residents or workers, and others already disadvantaged in the current political economy.
While there was concern that we often lose sight in climate change and policy forums on the lived experience of these local realities, speakers and participants also raised their global drivers. Commercialised agribusiness and food systems clear forests and land and degrade environments. Transnational corporations (TNCs) are extracting and exporting non-renewable minerals, in activities that are leading to water and air pollution, land subsidence, degraded environments and increasing water scarcity. A skewed global trade system compounds these impacts, as trade protectionism and patents held by high-income countries and TNCs limit the technology and resource transfers needed to manage climate change and its impacts. A global tax and financing system and weak public sector tax capacities enables significant transnational financial outflows, including to tax havens, diminishing the public resources for more inclusive, climate adapted economies, social protection or health systems. In the face of these global drivers, poorly met climate financing promises of only 12% of Africa’s estimated annual financing need of US$300 billion to prevent and mitigate climate impacts, largely provided as unpredictable aid or debt inducing loans, made it clear that global diplomacy processes are neither adequate nor equitable to address these drivers nor mitigate their consequences.
Our final webinar on March 20th on climate-related migration and health equity in the region closes the first round of our discussions and moves our focus more directly to responses to improve health equity, whether at local, national, or regional level, or in engaging globally. We welcome further evidence, views and collaboration in this next phase!
The previous webinars have pointed to options for action. Many build on existing actions to promote health equity, such as: ensuring health literacy and an informed public able to claim their rights, use laws and demand that states meet duties to implement laws and hold those harming health accountable; integrating local voice in planning integrated economies and public services that meet food, energy, waste management and water needs of the whole population; promoting health and environment impact assessments, and inclusive inter-sectoral processes to ensure longer-term planning and public control over TNCs extracting mineral and biodiversity resources to internalise health costs; investing in and ensuring equity in primary health care oriented health systems; and strengthening unified African voice and positions in global engagement.
At the same time, the way climate exacerbates existing drivers of health inequity was seen to demand additional responses, embedded within these measures for health equity, including: integrating climate literacy and specific rights and legal protections related to climate impacts across all sectors;. improving monitoring, collection and use of disaggregated evidence on climate impacts and responses; promoting exchange of promising practice; integrating health and climate considerations in democratic planning, using circular economy models that benefit local incomes and wellbeing; improving TNC tax contributions to generate climate-proofed activities, jobs, services and infrastructures; developing early warning systems and promoting climate-resilient health care practices and infrastructures; and demanding predictable and equitably distributed global tax-based climate financing in place of loans that worsen already high debt burdens.
As high income countries intensify their fossil fuel explorations and global conflicts absorb resources in military activities rather than the transformations needed to protect the planet, the global context appears to be intensifying risk. Consistently across the webinar discussions participants have observed that inclusion of the voices of affected, vulnerable communities and young people into climate planning and negotiations is essential to ground a more robust, people-driven and locally responsive approach within the region. This is seen as essential to strengthen the just demand from the region for changes in the global political economy that are critical in the face of climate change, not only for health equity, but for human survival.
We welcome your feedback or queries on the issues raised in this oped – please send them to the EQUINET secretariat. You can watch the different climate webinars and read the breaks and reports on the EQUINET website.
The expansion and embedding of Artificial Intelligence (AI) in many processes that positively and negatively affect wellbeing will clearly impact on health equity. There are interesting papers on this in this issue that flag some of the issues for this. In this time of challenging political economy changes and influential digital entrepreneurs, actors and platforms we invite and welcome published papers and reports and editorial submissions to the newsletter (email: admin@equinetafrica.org) that help to strengthen informed analysis and debate on AI and health equity from a regional lens. We look forward to hearing from you!
Did we make progress towards equity in 2024? Global inequities in power, wealth and human security persisted. War, occupation and abuse of human rights became the most common feature of daily news. Climate emergencies seemed to intensify. Women, children and already vulnerable and excluded people bore the brunt of these trends, and of the deficit between articulated commitments, conventions and constitutions, and the realities of daily life.
Yet 2024 has also seen inspiring and creative forms of solidarity and innovation, and a flourishing of new ideas and practices. At different levels, sustained resistance to accepting a normalisation of injustice has confronted despondency. We have shared, celebrated and learned from successes at local, national, regional and global level where they have happened.
Moving towards inequity or justice in 2025 is entirely within human choice. So in this abbreviated newsletter as 2025 starts we express thanks for the work done in 2024 and wish all advancing equity and wellbeing in 2025 the strength, confidence and opportunity to raise and realise a fair demand for safe, healthy lives, and freedom from hunger and violence.