One tends to think of conversations about 'future health' as being about technology yet, of course, it covers almost any decision about the nature and shape of healthcare services. But notions of 'future health' are a luxury that not everyone can enjoy, or at least the horizon is, for some, horrifically proximate. Perhaps, say, when one’s immediate needs involve trying to feed one’s family and trying to avoid being murdered while doing so. The World Health Organization reported in July 2025 that nearly one in five children in Gaza City is acutely malnourished.1 More widely, there are some 1.2 million people, in Gaza City, Sudan, and beyond, who are living in the most severe famine conditions,2 This is, as the authors assert in a Lancet editorial, a ‘moral failure’ that will have inter-generational consequences as the pathological brutality of starvation cascades into irreversible trauma.
What should we do? March on the streets? (Certainly worth considering.) Or perhaps give more to charity? It brings to mind the philosopher Peter Singer’s thought experiment detailed in his 2009 book, The Life You Can Save.3 Singer encourages you to imagine walking alongside a shallow pond where you see a toddler drowning in the shallows. Would anyone hesitate to go in and rescue the child? What if you were wearing expensive new shoes? Almost certainly not, you can probably afford new shoes, and much else besides. Yet the question Singer then puts to us is why we don’t give more money to save children in countries where such items as food, malaria nets, and vaccines are relatively cheap and life-saving.
Ultimately, Singer offers some realistic and practical action and his work has been a large part of the effective altruism movement. Effective altruism espouses a ruthlessly evidence-based approach to prioritising giving and even career choice. It is not quite utilitarianism and there is a compelling argument for many of its principles but it has run into some trouble when it was adopted by neoliberal types, especially Silicon Valley billionaire tech bros, whose moral compasses are not always as exquisitely calibrated as Singer’s. At its worst it has been co-opted as justification for the unequal accumulation of wealth. Which brings us to the thorny topic of philanthropy, though most people won’t even characterise it as thorny, it is so normalised. Yet, why should people who have accumulated the most wealth get to dictate healthcare policy?
Billionaire philanthropy and private foundations are a by-product of extreme wealth inequality. The all-pervasive influence of the Bill Gates Foundation has been well documented across global health policy, journalism, and in the political arena.4 Often, philanthrocapitalism has a technological bent but it remains a ‘black box’ without serious accountability.5 Future health needs primary care and it should be debated and decided by our communities. It will certainly be shaped by technology but we have to remain mindful of who is leading the conversations and how influence is exerted.
Highlights
Our Analysis articles this month lean heavily towards the digital with two short articles on coding, the cornerstone of much quantitative research, and a detailed appraisal of the future role of AI in the NHS. We have an editorial on near-patient testing and two editorials on medical education are relevant to anyone considering the future workforce. Many research articles this month relate to care for children and young people and it is them who will have to live with the consequences of a rapidly warming planet. Nunes and colleagues write on that too — future health topics don’t come any bigger than the climate emergency.
- © British Journal of General Practice 2025
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