Letter from the Editors

Smallpox eradication is considered one of public health’s greatest successes. The virus caused countless horrific deaths for millennia, but thanks to global coordination of technological prowess, its last victim died in 1978. Public health has chased this resounding high ever since. But uncomfortably, both the spread and eradication of smallpox were possible because of the tools of the capitalist and colonial structures in which the discipline of public health developed. The birth of the smallpox vaccine is credited to Edward Jenner, who published it in 1799 and built his own scientific reputation upon it. However, this British scientist used centuries of folk wisdom to develop the vaccine that led to the eradication of smallpox. He systematized the observation that cowpox protected against the worst forms of smallpox. He also built on the precepts of variolation already known in the Middle East, India, and China and only later in the West. By 1802, Jenner’s vaccine was already being sent to Mysore, India as an example of the technological superiority of the British empire.

On the opposite side of the world, the disease decimated Indigenous communities across North America. In Canada, the Hudson’s Bay Company used its preexisting trade routes as a means to ensure its suppliers in Indigenous communities were protected against the disease with the vaccine, thereby consolidating the commercial enterprise’s European market share in furs. Into the late 20th century, smallpox eradication programs worldwide used coercive aid agreements that reinforced dependency relationships between core imperial powers and the global periphery. Thus the dynamics of colonialism and capitalism were key components of the most successful public health intervention in history and of many developments since then.

Imperialism’s drive to extract raw materials and human capital has had a profound impact on the health of communities across the world. Both public and private institutions and organizations have played an important role at the heart of imperial power, with interlinkages between imperialist domination and public health being forged and mediated through an array of political and governance processes. The Rockefeller Foundation’s initial activities in infectious disease control were aimed at enhancing the productivity of labor in the US South. More recent projects of major humanitarian organizations such as the United States Agency for International Development (USAID) and PEPFAR have continued to leverage public health as a means toward consolidating global imperial control and the accumulation of capital. The forays of the military and surveillance corporations such as Palantir into public health and healthcare are emblematic of a tendency toward the uncritical embrace of technocratic solutions and the positioning of public health itself as a site of profit extraction. Corporations now insert themselves and their ideological agendas into a previously unprofitable sector, trading subject matter experts for software programmers and AI experts, as seen with Elon Musk’s Department of Government Efficiency (DOGE).

The façade of a paternalistic benevolence and the fallacy of good intentions often provide cover for an imperial/colonial public health, which in spite of its historical successes in disease control and prevention, has come up against contemporary contradictions and challenges to its logics. These heightened contradictions, which range from the decimation of public health institutions in the US to conform to a right-wing political agenda; increased mistrust in scientific evidence and public health interventions; the return of infectious diseases such as measles to North America and Europe; the increase in drug-resistant strains of epidemic diseases; polio’s stubborn resistance to global eradication; the increasing burden of climate- and environment-related illnesses; community-wide poisonings by agro- and petrochemicals worldwide; surging violence and victim-blaming; blatant racism and misogyny; and the rise of ‘wellness’ movements closely tied to right-wing agendas—all suggest a need to re-think how public health is conceived, taught, and practiced.
In this issue, we trace the contemporary points of struggle that challenge aid as a tool of violence and seek to develop an anti-imperialist public health practice. This is highlighted in Mohammadi et al’s contributions on aid as a tool of colonial governance in Palestine. Daniel Krugma;s piece traces the ways in which young Kenyans worked with their communities to develop and practice a version of public health aligned with the quest for justice and freedom. Additionally, James Brittain discusses the direct relationships between strengthening of capital and the decline in mental well being for the working class. Beau Morgan presents insurgent medicine as a response to a carceral healthcare system in Appalachia.

A remaining task is to explore how public health could operate in a post-revolutionary state. Who, or what body, should decide matters of managing and deploying vaccine stockpiles, resolving pharmaceutical shortages like bicillin (the primary treatment for syphilis), or preventing incursions of animal diseases that could decimate food supplies or crossover to humans? How does such a body remain accountable to the people? Public health interventions often necessitate some degree of coercion, and a careful analysis of how that is applied, toward whom, and who it ultimately protects is of utmost importance. A mask mandate that shields immune compromised people from COVID-19 and New York City’s compulsory tuberculosis treatment mandate (which resulted in a disproportionate detention of people experiencing homelessness) are operationally similar interventions, especially if criminalization is the result of noncompliance. This issue attempts to explore these tensions: what does it mean to work for the public’s health in a world order that offers only tools of domination and exploitation? Malhis et al. and Chuckie Calsado lays out how projects and policies purportedly for collective well-being, in contexts as disparate as Palestine and the Philippines, replicate the oppressive dynamics in which they exist.

The systems and tools for delivering public health interventions like vaccination programs are so well-codified that public health as a practice has become synonymous with public health as an institution. But the field is more than state-operated agencies with health-related missions distributing (often) paternalistic aid. It comprises epidemiologists, human and animal healthcare providers, environmental scientists, program managers, policy analysts, educators, researchers, community health workers, and students. Public health workers operate within local and state departments, ministries of health, intergovernmental organizations, non-profits, academic institutions, healthcare facilities, and on the streets of our communities. Public health outcomes are determined by the labor of countless sectors, including sanitation, water treatment, farm, and food services. Though interrelated, public health is often erroneously conflated with healthcare, which is the delivery of individualized care to a single patient, or health policy, which regulates both public health and healthcare systems. In fact, public health is often at odds with healthcare and health policy. In a recent example, after Tennessee lawmakers enacted a ban on gender-affirming care for trans youth in 2025; Vanderbilt University Medical Center quietly sundowned the only center for gender-affirming surgeries in the U.S. South. Patients were notified via a message sent through their electronic medical records system (as detailed by Beau Morgan in this issue). In this issue, Joseph Graves Jr. discusses his recent book Why Black People Die Sooner, including the effects of structural racism and reduced access to specialized medicine. Underfunding of Historically Black Colleges and Universities, Minority Serving Institutions, and Tribal Colleges has also been a barrier to developing robust educational programs to dismantle racial misconceptions in medicine.

Even in more enlightened times, the public health workforce poses challenges for organizing. Like other scientists, public health workers typically identify with the professional managerial class rather than the working class. Public sector workers often lack labor protections afforded to other workers. Fear of retaliation is high, and the workforce is dispersed across multiple settings. In addition, many aspects of public health practice, such as disease surveillance, data analysis, and response strategies, are an easy target for Artificial Intelligence (AI) replacement. While technology can benefit precision medicine, it cannot replace human judgment and experience. Robotics and AI are increasingly positioned as solutions to crises produced by austerity, labor shortages, and systemic devaluation of care work without transforming the underlying social relations.

Neoliberal administrations have made clear that most aspects of a well-functioning public health system are of little use to monopoly capital (its primary beneficiary), except perhaps where it intersects with matters of so-called national security. In fact, people who have access to healthy and affordable food, secure housing, stable income, and a hazard-free environment are less likely to get sick and less likely to need pharmaceuticals or costly hospital visits. Oppressed peoples with precarious access to these basic needs are rendered more vulnerable by defunded agencies not allowed to publish data on health disparities or deliver life-saving services. Jameta Barlow discusses the hollowing out of public health systems under racial capitalism in the US, and potential solutions to remedy such crises.

SftP was formed out of struggle with this very contradiction: the violence enacted through well-meaning scientific work and technological advancement under capitalism. With this issue of the journal, we ask readers to consider how the people’s health can not only be protected, but nurtured, by public health strategies liberated from the constraints of capitalist, imperialist, and neo-fascist systems. Though public health education acknowledges the concepts of social determinants of health, health disparities, and unintended harm, curricula often remain in a neoliberal framework. This reinforces a widespread belief that public health is a categorically and inherently “good” field, capable of solving violence under current conditions rather than being complicit in those conditions. The tools available to public health workers tend to be blunt, tainted by the violent extraction that determines contemporary societies.

We ask you to imagine something different. At their core, all liberatory struggles are public health struggles seeking universal well-being. As an applied practice necessary for liberation, how can public health workers and the communities with whom they collaborate help build those movements? How do we break from the baggage of racism, paternalism, and imperialism to build institutions that people trust? How do we retake and rebuild the redistributive force of the state? These questions cannot be answered in isolation from the greater class struggle. Looking beyond preserving the status quo against regressive attacks, we invite our readers to envision a public health practice, including the scientific labor used to advance it, that is liberatory and free from the tools of oppression.

—Volume 27, no. 3 Editorial Collective