Remove citizenship-based discrimination in global health institutions to truly achieve ‘health for all’

Summary box.

• Global health institutions like the World Health Organization (WHO) and other United Nations agencies should ensure ‘health for all,’ without exclusion based on citizenship, origin or geopolitical power.

• Taiwanese citizens have for decades faced longstanding discriminatory policies barring them from global health positions and opportunities, enforced under pressure from larger geopolitical entities. UN staff from all member states, regardless of whether they agree with these discriminatory policies, have enforced this ban willingly.

• Excluding global health professionals from geopolitically weaker regions limits diverse perspectives, stifles innovation and weakens global health systems, including disease surveillance and cross-country learning.

• Multilateral health institutions should safeguard themselves against the influence of political forces by removing citizenship-based discrimination and ensuring diverse representation worldwide. This has become more urgent with rapid geopolitical changes observed in 2025.

Global health multilateral institutions, such as the World Health Organization (WHO), World Bank and other United Nations (UN) agencies, uphold the principle that every person, irrespective of origin or identity, deserves the highest attainable standard of health. Yet, these organisations operate within a complex international landscape marked by historical and ongoing conflicts between nations. Should geopolitical tensions influence who is allowed to engage with, work in or benefit from these institutions? It would be unacceptable if, for example, the WHO chooses who to represent and welcome based on the political strength of one population at one point in time. Such exclusionary practices not only is antithetical to human rights, it also disregards the unpredictable shifts in power dynamics, as we cannot predict who the future geopolitical superpowers will be (imagine US Democratic Party members, as private citizens, being banned from seeking employment on their own when the Republican Party is in power). Health is a human right, and these institutions promote ‘health for all’; therefore, the answer should be an unequivocal ‘No’. It may therefore come as a surprise to many readers that the global health sector is and has been for decades actively discriminating against a political minority, enforced by international organisations through discriminatory policies, knowingly or otherwise. Citizens of Taiwan, a nation with weak geopolitical power, have been excluded and subjected to discriminatory practices by these multilateral global health institutions for decades. Much has been written about the long-standing official exclusion of the Taiwanese government in international systems.¹,³ Here instead I would like to share the discriminations I have personally encountered as a private citizen working in global health. Using my experience as a case study, I illustrate how the inclusion principle is being violated, and that current discriminatory practices hamper diverse representation and weaken population health worldwide. Amidst escalating geopolitical conflicts and wars worldwide, I urge multilateral institutions to consider how they should (or should not) handle geopolitical dynamics that will only intensify in the coming years, and continuously ensure that the inclusion principle is upheld.

Taiwan has a geopolitical superpower as its counterpart, which has pressured multilateral organisations to enforce discriminatory employment and representation policies against Taiwan and its citizens. I was first rejected due to my citizenship 15 years ago, as I was told that I was ineligible for internships (even as a student at a non-Taiwanese university) and fellowships such as the World Bank’s young professional programme. I am not allowed to apply for any UN consultancy roles, let alone full employment. My job applications were promptly rejected by human resource offices, citing my citizenship as the issue. Now, as an associate professor at a Danish university involved in academic research with these organisations, I have been advised to declare my citizenship upfront (like a conflict of interest), asked to use other citizenships (which I do not have), and disinvited from in-person workshops last minute despite my leadership roles and relevant expertise. Imagine a world in which Russia, after a victory where only a small part of Ukraine remains independent, dictates that Ukrainian citizens cannot seek jobs at the WHO? Or the Israeli government vetoing Palestinian youths from doing an internship at the World Bank? This is the status quo for Taiwanese citizens, and it has been for decades.

A colleague questioned whether this is a ‘domestic issue’ that the global institutions should not engage in. Taiwanese are not allowed to participate as Chinese citizens even if we requested it. Furthermore, if global institutions consider this a domestic affair, should they allow one country to actively block a subgroup of their citizens from participating in global activities as private citizens? If Russia blocks Ukrainian citizens after Russia occupies Ukrainian territory, would we also see this as a ‘domestic issue’ that global health institutions should not interfere in?

Throughout my personal rejections, my academic colleagues are mostly surprised and apologetic, while UN staff show no discomfort in processing these discriminatory decisions. This is likely because these are the rules that have been enforced top-down, and they are likely unaware that they are enforcing a discriminatory policy for a geopolitical superpower that they may personally disagree with in real life. Recalling Solomon Asch’s observations of conformity pressures, “Such is the power of the pressure to conform: it can lead us to say what we know is untrue”.⁴

These discriminatory policies have several implications beyond the violation of the inclusion principle. First, do we want to let geopolitical superpowers decide who is allowed to work at global health institutions? As the UN agency promoting health worldwide, is it acceptable for the WHO to choose who to welcome as members based on the political strength of one population at a given time in history? By letting the status quo to continue, we are also ignoring the unpredictable shifts in global power dynamics, as we cannot foresee who the future geopolitical superpowers will be. Taiwanese citizens are, to my knowledge, the only population that is banned from multilateral global health organisations. However, Taiwan is not the only country with geopolitical rivals of greater political power (eg, Ukraine and several Eastern European countries, Palestine, Northern Cyprus), nor the only minority population of a larger nation or ethnic group (such as conflicts in Ethiopia and Sudan). With ongoing geopolitical conflicts and tensions, we cannot guarantee that the current playbook will not be adopted by another geopolitical superpower. We therefore should eliminate and ban this practice while it is not too late.

Second, representation matters, as it “alters the agenda; what is on the table is as important as who is around the table”.⁵ People from geopolitically weaker countries have unique perspectives and should be heard by UN institutions. One often overlooked consequence of this discriminatory action is the long-term systematic silencing of generations of political minorities. The long-standing discriminatory policies have deterred Taiwanese professionals from pursuing global health careers, and this has wiped out new generations of Taiwanese voices, especially young people, on the international stage. More broadly, this contributes to existing inequalities in global leadership that favours certain geopolitically powerful nationalities over others, thus stifling diversity and innovation in global health.⁶

Third, systematic exclusion of any country has major consequences for population health worldwide, including weaker disease surveillance (especially by excluding a Chinese-language speaking democracy with deeper insights of its neighbour) and limited cross-country learnings.⁷,⁹

Global health is not and will never be immune from the influences of political superpowers. Let’s make global health truly ‘global’ and ‘for all’ by eliminating citizenship—and specifically, the ‘right’ citizenship—as a prerequisite for participation in multilateral global health institutions. The voices allowed at global institutions should not be dictated by the latest geopolitical winners. While we still can, let’s safeguard the field so that citizenship-based discrimination is eliminated.

Data availability statement

There are no data in this work.