Borders are bad for health

It only takes a pandemic to see how countries can use healthcare to reignite flagging nationalism. COVID 19 spawned a new kind of nationalism: vaccine nationalism, the prioritization of the domestic needs of a country over an outlay to others. 

Even the policies of countries such as Australia and New Zealand, where nationalism is enforced by geography, did not prevent the arrival or spread of the virus. The smug lack of preparedness that accompanied the isolation only served to delay mortality and morbidity and lead to divisions and internal unrest.

We need global health warriors not politicians with a side-line in health.

Not surprising as nationalism has long been associated with poor mental health outcomes such as anxiety disorder, aggressiveness, anger, and depression. It is a population divider just as toxic as race and ethnicity: all of which have been largely associated with adverse health outcomes.

In the end, it is always health care workers who have to try to patch together the pieces of lives destroyed by health inequity, conflict and nationalism – most often without additional resources. It is a Herculean task. Now that the post-pandemic era has spawned global shortages of health care workers, further prioritisation of already-rationed health resources is inevitable.  Most of it already occurs under the radar, so as not to incite unrest. However, the shortages are so acute, global and dire that camouflaging them is no longer possible. 

Traditionally, medical migration occurs from lower-middle income countries to high-income countries.Nationalistic conflicts exacerbate the problem in the home country.  For example, 40% of Lebanese physicians in one study migrated to the United States. In the adoptive country, health worker migration may provide more than just a service role. Health care is international, and its multiculturalism can be used to counter the ill effects of toxic nationalism. 

It is time for health care organisations to be proactive in the pursuit of health and, implicit in that, peace. Known destructive variables to people’s health, such as toxic nationalism, should not be permitted to determine our health priorities. Unfortunately, until health care policies are determined by health care workers and not politicians with a side interest in health, not much can change.  But we can dream. Just imagine what could happen if every health care and public health organization around the world united to speak out against nationalist conflicts and to deprioritising health-care services to those directing the deployment of troops to fight. Now that would be a true Health Care Without Borders.  

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