On Jan 15, 1919, amid the beginnings of a revolution in post-World-War I Germany, Rosa Luxemburg, a Polish economist and leader of Germany's radical left, was executed in Berlin by militia acting on behalf of the governing Social Democratic Party. She was 47 years old. Her body, loaded with weights, was flung into a nearby canal. Luxemburg has become a legendary figure, although more admired as a martyr than studied as an intellectual. She was an anti-war activist, campaigned for women's emancipation, and opposed Russia's brutal suppression of freedom and democracy. Luxemburg never wrote directly about health or science. But she was urgently concerned about human suffering and she understood the importance of knowledge as a lever for social change. The centenary of Luxemburg's death is an opportunity to reconsider her legacy for health.

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Rosa Luxemburg's most important work is The Accumulation of Capital (1913). Her objective was to investigate how nations developed. She argued that the sustainability of (capitalist) societies depended on economic growth beyond the borders of the nation-state. Economies needed continuous supplies of natural resources and inexpensive labour. The preferred means by which those commodities were acquired was through imperial expansion. She raged against it: “Capital needs other races to exploit territories where the white man cannot work. It must be able to mobilise world labour power without restriction in order to utilise all productive forces of the globe”; “imperialism is the historical method for prolonging the career of capitalism.” Elsewhere she wrote that, “Today the nation is but a cloak that covers imperialistic desires.” And, “The triumph of imperialism leads to the annihilation of civilisation.” Why are these arguments relevant for health today? The Rosa Luxemburg Stiftung, established in 1990, is a Berlin-based foundation dedicated to using her ideas and values to illuminate contemporary social challenges. In 2018, the foundation published an analysis, written by Amit Sengupta, Chiara Bodini, and Sebastian Franco, which stands as a Luxemburgian manifesto for health. Entitled The Struggle for Health, the paper argues that the organisation of modern society “stands in contradiction to the rights of populations to health and healthcare.” At the heart of this contradiction lie the adverse effects of globalisation—the modern reincarnation of imperialism—including conflict, inequality, and the rise of authoritarian government. The result is a “global health crisis”. Good health depends on the political, economic, and social forces that shape conditions of living—unemployment, insecurity, and precarity. This global crisis has weakened the solidarity that helped to deliver strong systems of social protection after 1945. The rising influence of the World Bank, World Trade Organization, and private foundations has undermined WHO and enfeebled multilateralism. One consequence is a deepening democratic deficit in global health. Debilitated accountability has enabled market mechanisms to become the preferred solution for delivering healthcare. Health has been transformed into a commercial relationship between supplier and buyer. The spread of private insurance, outsourcing, and public-private partnerships, together with the deliberate underfunding of state-sponsored healthcare, have segmented and fragmented national health systems. At a moment when the global health narrative has coalesced around universal health coverage, the possibility of creating and managing comprehensive and integrated health systems is becoming ever more difficult. What should be the response? “Public health needs to be based on the principles of solidarity and separated from relations based on the market.” Health has particular social power. Health is an objective that is “a shared claim, a common flag which unites us in struggle.” “Health is a powerful call to mobilise.”

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In her essay, The Russian Revolution, Luxemburg wrote that, “Freedom is always and exclusively freedom for the one who thinks differently.” She was emphasising that the goodness of a society can be judged only by the extent to which fundamental rights for the most excluded and marginalised are protected. A century after her savage murder, Luxemburg invites us to measure the health of our society by the way in which we address the needs of the most disadvantaged and disenfranchised. By such a standard, we must surely hang our heads in shame. But Luxemburg's words motivate us to recommit to this struggle for health.

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