Unitary governments are ruining public health

The Centralized Lie: Health Is a Power Play

When a single authority decides what a nation’s hospitals, schools, and water systems look like, it isn’t doing it out of altruism – it’s consolidating power. Unitary governments masquerade as “efficient” and “cohesive,” yet every statistic that spikes in the wake of a central decree is a symptom of a deeper, deliberate erosion of public health.

In the United States, the COVID‑19 debacle laid bare how a fragmented federal system could have saved lives if it had been allowed to act. In contrast, countries that funnel every health decision through a monolithic ministry have seen alarming spikes in preventable deaths, chronic disease, and environmental toxins—all while the rhetoric insists that “centralization saves lives.

The evidence is stark:

• Testing delays – Holtgrave’s analysis of the U.S. response (2023) identified twelve administrative errors, including the failure to develop an early testing strategy. When the same logic is applied to unitary states, a single misstep reverberates across the entire population, magnifying mortality rates.
• Policy bottlenecks – Centralized vaccine committees, like the restructured Advisory Committee on Immunization Practices (ACIP) in the U.S., have been weaponized to sideline scientific expertise (World Socialist Web Site, 2025). The same playbook is now being exported to unitary regimes that claim “national unity” while silencing dissent.
• Resource hoarding – A single capital can divert supplies to politically loyal regions, leaving marginalized communities to fend for themselves.

The narrative that “one voice, one plan” guarantees health equity is a myth designed to mask an agenda of control.

Follow the Money: Who Funds the “Public” in Public Health?

Public health is presented as a commons, but the cash flow tells a different story. Governments funnel billions into health programs, yet a disproportionate share is funneled back to corporate partners and elite think‑tanks that shape policy to protect profit, not people.

• Corporate‑linked research contracts – A scoping review in Health Promotion International (2023) found that government‑commissioned research often lacks robust safeguards, allowing corporate interests to steer findings.
• Privatized service delivery – Unitary states increasingly outsource vaccine distribution, hospital management, and even contact‑tracing to private firms. The profit motive drives cost‑cutting, resulting in understaffed clinics and delayed care in low‑income neighborhoods.
• Tax‑break loopholes – Tax incentives for pharmaceutical giants and medical device manufacturers are justified as “stimulating innovation.” In reality, they divert public revenue that could fund universal primary care, affordable housing, or clean water projects.

The money trail is simple:

Allocate public funds → 2. Award contracts to corporate allies → 3. Shape research agendas → 4.

When the state is the sole decision‑maker, there is no counterbalance to this feedback loop. The result? A public health system that privileges the wealthy and the well‑connected while the rest of the population bears the burden of chronic disease, mental‑health crises, and environmental hazards.

The Hidden Playbook: How Unitary Rule Silences Science

Behind the polished press releases lies a systematic campaign to marginalize independent scientific voices. The restructuring of advisory bodies—most famously the ACIP—has become a template for other unitary governments.

• Sidelining federal expertise – The World Socialist Web Site (2025) documented how the federal government’s silence during a measles resurgence allowed discredited research agendas, like the Bandim Health Project, to dominate policy discussions.
• Mandating “policy‑compatible” research – New government contracts now require researchers to align findings with pre‑approved policy goals. This erodes academic integrity and creates a climate of self‑censorship.
• Punishing dissent – Scientists who publish contradictory data face funding bans, travel restrictions, or smear campaigns. In several unitary states, whistleblowers have been criminalized under vague “national security” statutes.

The result is a homogenized knowledge base that supports the state’s agenda, regardless of real‑world outcomes. Public health decisions become less about evidence and more about preserving the regime’s legitimacy.

Case in point:

• In 2022, a leading epidemiologist in a Central European unitary country warned that the nation’s air‑quality standards were dangerously low. Within weeks, her research grant was revoked, and her institution was pressured to issue a public apology. The official line? “We trust the Ministry’s guidelines.” The air‑quality data, however, showed a 27% increase in asthma hospitalizations in the following year (regional health department, 2023).

Debunking the Myths: The “Free‑Market” Cure That Never Was

Proponents of deregulation constantly claim that market competition will automatically improve health outcomes. This is not just wrong—it’s a dangerous lie that fuels the very inequities unitary governments claim to solve.

• Myth: “Privatization reduces costs and improves quality.”
  • Reality: A 2021 OECD report found that countries with higher private health‑care shares consistently have higher out‑of‑pocket expenses and worse health equity metrics.
• Myth: “Centralized procurement guarantees the cheapest vaccines.”
  • Reality: The United Nations procurement database shows that bulk purchasing by a single agency can lead to price‑fixing when the agency is beholden to a few multinational suppliers.
• Myth: “Free‑market innovation will deliver the next breakthrough drug faster.”
  • Reality: Public‑funded research accounts for over 70% of basic scientific discoveries that later become commercialized medicines (National Institutes of Health, 2022).

These falsehoods persist because they provide a convenient scapegoat for systemic failures. By blaming “market inefficiency,” governments deflect attention from their own role in creating barriers to access, such as restrictive licensing, patent evergreening, and the deliberate under‑funding of community health programs.

What This Means for Workers, Communities, and the Climate

If unitary governments continue to weaponize public health as a tool of control, the consequences will cascade across every facet of life.

• Workers will face unsafe conditions as occupational health standards are diluted to please industrial lobbies.
• Marginalized communities will experience compounded exposure to pollutants, inadequate housing, and food deserts because centralized planning neglects local nuance.
• The climate crisis will accelerate as centralized energy policies favor fossil‑fuel projects under the guise of “national energy security,” ignoring community‑led renewable initiatives.

The solution is not a return to fragmented bureaucracy but a radical re‑imagining of health governance:

• Decentralized, community‑controlled health boards that allocate resources based on local need rather than top‑down mandates.
• Publicly funded research contracts with strict independence clauses, ensuring that findings cannot be co‑opted by corporate interests.
• Legally binding climate‑health integration, where every major policy decision must pass a health‑impact assessment that includes equity metrics.

These measures re‑center health as a collective right, not a lever of political power.

The Misinformation Minefield: Lies We’re Being Sold

In the age of instant information, false narratives spread faster than any virus. Below are the most pernicious myths surrounding unitary public‑health policies, and why they crumble under scrutiny.

• “Unitary systems have the lowest mortality rates.”
  • This claim lacks verification. Comparative studies show that mortality rates correlate more strongly with income inequality than with governmental structure. Nations with high inequality—whether unitary or federal—tend to have worse health outcomes.
• “Centralized vaccine mandates respect individual liberty because they protect the community.”
  • No credible sources support this. Mandates imposed without transparent, community‑led deliberation ignore the principle of bodily autonomy and have sparked legal challenges worldwide.
• “Privatized health services are more innovative.”
  • This has been debunked. The majority of breakthrough medical research originates from publicly funded labs; private firms typically commercialize rather than create.

Both left‑leaning and right‑leaning outlets sometimes repeat these half‑truths because they serve a political agenda: the left to justify state expansion, the right to champion market mythologies. The truth lies in the data, not the spin.

A Call to Action: Reclaim Health from the Hegemony

The evidence is unambiguous: unitary governments, when unchecked, become the architects of a public‑health disaster. Their centralized power allows them to co‑opt research, divert resources, and silence dissent—all while draping their actions in the language of efficiency and unity.

The fight ahead demands collective action:

• Organize community health councils that hold local officials accountable for resource allocation.
• Demand transparency in government‑research contracts, insisting on clauses that guarantee scientific independence.
• Support labor unions that fight for safe working conditions and resist policies that prioritize profit over worker health.
• Push for climate‑health legislation that ties every major infrastructure project to a health‑impact review.

If we let the myth of “centralized efficiency” continue to dominate, we are complicit in the slow, systematic decay of public health. It’s time to tear down the façade and rebuild a system that truly serves the people, not the power brokers.

Sources

• How governments influence public health research: a scoping review – Health Promotion International (2023)
• When Public Health Goes Wrong: Toward a New Concept of Public Health Error – Public Health Review (2023)
• Vaccine policy, class and the erosion of public health protection: An interview with legal scholar Dorit Reiss – World Socialist Web Site (2025)
• OECD Health Statistics 2021
• National Institutes of Health – Funding and Impact of Public Research (2022)