Loathe Fascism? Then don't be a health supremacist

Those who are not faithful to principles
become open to evil, to have evil done to them
or to do evil themselves

(Pramoedya Ananta Toer)

Health supremacism is an ideology. Supremacist thinking always starts with an imaginary division of the world into supposedly ‘superior’ and ‘inferior’ people. Health supremacism is the idea that someone who is deemed ‘healthy’ is superior to someone who has some form of impairment to their health; any form of perceived illness or presumed health impairment — on this line of thinking — makes you a categorically ‘inferior’ person. Health supremacism says that those who are healthy have a natural privilege to dominate others in society.

At the heart of health supremacism is a piece of fantasy: that there is such a thing as a ‘naturally healthy’ person who is not and cannot get seriously ill or disabled. This is a fantasy, because it is simply not true. Health is one of the most contingent facts about us human beings. Every one of us is always one infection or accident away from acquiring an illness or disability.

To say that all health is fragile is not to deny that there are structural inequalities in health outcomes: if you cannot afford food, or live in an area with significant air pollution, this is bound to have an impact on your health. Structural inequalities leading to different health outcomes are precisely a reason not to essentialise health status. Yet essentialism about health is precisely what health supremacism demands. It is health supremacy’s backbone fantasy. And health supremacists do whatever they can to actively uphold and perform this fantasy.

The ploy is to imagine health as revealing something deep and essential about a person. Instead of acknowledging that health and illness can technically befall anyone, health supremacism imagines good health to be an inherent, natural trait of some persons (but not others). Self-proclaimed health status starts to become part of individual identity. This conception of health as an essential feature of some (but not others) lays the foundation for a worldview in which a specific group — the self-professed ‘naturally healthy’ ones — is naturally superior to others.

How did health supremacism get a boost during the pandemic?

Just as other supremacist ideologies, health supremacism has a long and gruesome history. During the last two years we have seen health supremacism seize hold of public consciousness in a way it had not done for a while. Health supremacist ideology has now become mainstream, and seems unconsciously embraced even by those who say of themselves that they are opposed to supremacist thinking. This is a dangerous development that needs to be resisted and reversed.

Health supremacism has been boosted by the pandemic. Recall, already from very early in the pandemic, the public conception of COVID-19 has been moulded to enact a division into the allegedly ‘superior’ people and the ‘inferior’ ones. The disease was presented as only a problem for ‘the vulnerable’ — people who were older and might have weaker immune systems, or those with ‘underlying conditions’ or ‘co-morbidities’. COVID-19 is increasingly brushed off as a disease that only damages those who were already (in health supremacist terminology) ‘damaged’; as a condition that only leads to real illness in those who were already, somehow, predisposed to get ill. “If this virus hadn’t got to them,” friends around me started to say, “something else would have.” Or: “I’m not worried, I have a naturally strong constitution”.

I don’t know how this narrative became so popular, even among those who should have known better — people who on other fronts speak out against fascism, discrimination, exclusion, or who claim to fight for social justice and inclusivity. But it did become popular.

In actual fact, the virus SARS-CoV-2 has affected any demographic (though of course not equally). Throughout the pandemic, doctors have continued to stress that everyone is at risk. And yet, many keep repeating the fiction that SARS-CoV-2 as such would be a mild virus; that COVID-19 would be a mild disease which a ‘naturally healthy body’ should easily be able to clear. Yes, a health supremacist might admit that some persons do fall seriously ill from the virus. But those who get really ill must already have been somehow different anyway. The typical essentialist ploy.

The health supremacist narratives have grown stronger with each wave of the pandemic. By now, the public image of society is one almost split in two: the presumed superior, ‘healthy’ individuals on the one hand, those deemed inferior, ‘vulnerable’, on the other. The more prominent such a division and this way of framing the pandemic gets, the less it leaves individuals in society untouched. It puts pressure on everyone to answer the question: To which group do I belong?

How does health supremacism manifest itself?

Health supremacist thinking pervades public consciousness, even though we might not always be aware of it. To be clear, it was already there prior to the pandemic. An obvious example of this is widespread everyday ableism — discrimination in society that favours able-bodied people — and a tendency towards eugenicist policies (more on that later). However, with the pandemic, supremacist thinking seems to have leaped ahead. In countries like the US, the UK, The Netherlands, and Sweden, it seems largely to have become the norm in public health policy and is met with terrifyingly little resistance. If you want to see health supremacism at work in the attitudes towards the pandemic, it can be helpful to distinguish between its overt manifestation, and its covert forms of existence.

Overt health supremacism is hard to overlook, precisely because it is usually loud and prominent. It is self-consciously spectacular and symbolic, and typically teams up visibly with other far-right ideologies. In this light, Emily Gorcenski’s reporting in 2017 on the ‘unite the right’ rally in Charlottesville was prescient: right wing activists increasingly manage to stand together to amplify their messages. In summer 2020 in London’s Trafalgar Square, weather forecaster and anti-vaxxer Piers Corbyn lead a considerable anti-mask protest. The event was intended to draw attention. Sociologist Phil Burton-Cartledge describes how this protest attracted an assortment of rightwing activists, including from the British Union of Fascists, climate change deniers, and adherents of QAnon conspiracy. A similar rally took place in April 2022 in Los Angeles, where activists carried placards alleging that vaccines are dangerous and promoting ‘medical freedom’. Rolling Stone journalist Eric Levai described what he saw there as “a slickly packaged fascist telethon with ominous warnings of what lies ahead”. A year earlier in the same city a group of neo-fascist ‘Proud Boys’ violently tried to ‘unmask’ people in a raucous, public display of supremacist sentiment. These are overt and symbolic performances of health supremacism: they protest and violently counter infection control measures that (in the supremacist view) the supposedly ‘superior’, ‘naturally healthy’ people don’t need, and the supposedly ‘inferior’ ones would not deserve. (It goes without saying that this is a dangerous, sickening doctrine. The only reason I am describing it here is to make it easier to understand and recognise what is happening, so as to be able to counter it.)

Covert health supremacism can be more slippery and take many forms. It can come in the form of institutional discrimination, exclusion, covid minimising, and micro-aggressions. Think of the public health officials who presented as positive and reassuring the observation that those who got seriously ill or died from covid are mostly those with pre-existing health conditions — as if the illness or death of a person would somehow matter less, just because they had diabetes? Or think of voices that say “If you haven’t had covid by now, you don’t have any friends” — presupposing that anyone trying to avoid getting infected with a SARS is a social outcast.

Other examples of covert health supremacism: when an employer forces their employees to come into the office without measures to protect against infection. When a volunteer group is unwilling to facilitate alternative forms of access to its monthly meetings. When a friend circle drops you because your insistence on masks and meeting outdoors is ‘no longer fun’. Or what about the general vibe that the pandemic is over, even though we know that transmission is high, long covid is rife, that vaccine efficacy seriously wanes over time, and that treatment for long covid is currently still unavailable. All of these tacitly, but unmistakably, communicate a clear health supremacist sentiment: ‘If you think you might not be able naturally to withstand covid, perhaps you should not be here at all.’

Maybe the most performative form of everyday health supremacism during the pandemic has been the irrationally strong resistance to mask-wearing in many European countries. This apparent aversion to masks continues to baffle me every day. Masks are a simple and generally effective measure to help protect others and mitigate the spread of an airborne virus. The fact that so many treat the minimal inconvenience of wearing a mask as infinitely more important than the protection it offers to others, when they know that some really require that protection, shows that they regard those who seek such protection against covid as inferior. But it doesn’t stop there. Not wearing a mask is not enough. The mask refusal needs to be actively, visibly performed: people who wear masks need to be called out and humiliated, looks need to be given, eyes need to be rolled. The existence of people who, for whatever reason, take the risk of covid seriously seems intolerable to the mask refuser.

Is health supremacism a form of fascism?

Health supremacism is at root a fascist doctrine. Strictly speaking, fascism is a specific historical movement. It began in the early part of the 20th century in Italy, and later on got fused into Nazism in Germany. It was the movement that led all the way to the Holocaust, a mass slaughter exactly in line with the way fascism views the world: violently intolerant of anyone deemed to be ‘inferior’. After the Second World War, various neo-fascist movements have tried to revive (or, more accurately, keep alive) these ideologies. The increasingly visible rightwing militia movements in the United States are a good example, as well as the British National Party in the United Kingdom, and Voorpost and the Forum for Democracy in The Netherlands (the latter movement currently has seats in the Dutch parliament).

The ideological core of fascism, however, can be articulated a-historically. Fascist movements centre around the belief that one group in society has a natural right to dominate the rest. This ‘superior’ group, in the fascist’s view, should be kept ‘pure’ and free from genetic corruption or bodily pollution, lest the privileged group becomes weakened. Methods of exclusion, in-egalitarianism, eugenics, and violence are entirely justified to promote the flourishing of the purportedly privileged group. To be fair, things are more complicated than this, but with this characterisation in hand we can see that most, if not all, supremacist ideologies at least have this fascistic core: they all advocate a view of society in which one group has natural entitlement to dominate the rest. So regardless of their historical trajectory, any supremacist movement is ideologically fascistic.

The fascistic core of health supremacism is the idea that those who are healthy are somehow ‘better’ people, and that society may and must protect their interests and flourishing (rather than the interests and flourishing of members of society at large). Keep in mind that this is a false essentialising claim: those who happen to be, or who perceive themselves as, healthy are imagined to be inherently, intrinsically, and perhaps even genetically better. This essentialist way of thinking about traits has — any psychologist will tell you — a facile and childish attraction on our minds. (Note also that there is no saying that individuals who espouse health supremacist beliefs actually are themselves healthy. It is the appearance and performance of being healthy and strong that counts on this worldview — any particular health supremacist may themselves very well have all kinds of unknown or unacknowledged underlying health complications.)

In this respect, health supremacist ideology exploits the same cognitive loophole as the perhaps more familiar guises of supremacist thinking: white supremacism and male supremacism. Like these other forms of supremacist thinking, health supremacism projects a fantasy of natural strength and dominance of a specific type of person, in an attempt to secure and perpetuate that type of person’s power. Where white supremacism projects a fantasy of the strong white body, and male supremacism a fantasy of the biological superiority of the male, health supremacism projects a fantasy of the superiority of the naturally healthy body. As a necessary corollary, it imagines anyone who is ill or disabled as inferior. In the health supremacist view, social entitlement and privilege should converge on those who are deemed healthy. Anyone who does not classify as such has a lower entitlement to exist — ideally, ill or disabled people should not exist at all. Disability rights activists have for decades been warning for these views. To my mind, these views seem fascistic plain and simple.

How does health supremacism differ from ableism and eugenics?

Health supremacism is closely linked to a phenomenon called ‘ableism’. Ableism is a form of discrimination and a system of stereotypes that treats the ‘able body’ as a norm in society. As K. Cassidy characterises it, “ableism is the prejudiced treatment of people with disabilities under the presumption that they are inferior”. As a consequence, ableist behaviour or policy obstructs and frustrates the wellbeing of those who have some form of disability. Ableist language presupposes that people with a disability would somehow be worth less, or ignores their specific form of agency. Cassidy and many other authors have written about how the response to the COVID-19 pandemic has been strongly ableist and has promoted further ableist attitudes.

You can think of ableism as a specific manifestation of health supremacist thinking. Health supremacism elevates an ideal of the naturally healthy body resistant to illness and disability. As a consequence, the picture of society it draws up is ableist from the outset, because those with a disability will inevitably fail to live up to this imagined health supremacist ideal. But health supremacism is broader than ableism, because it will also deem ‘inferior’ anyone who has fallen ill and has difficulty recovering, in addition to people with chronic or hereditary conditions that would not commonly be understood as a disability by those who have them. Also ‘inferior’, incidentally, will be counted anyone who does not subscribe to the health supremacist ideology.

The fantasy of health supremacism sounds eerily similar to the project of eugenics. Eugenics is a social programme trying to promote certain heritable characteristics in a population, typically by selective breeding, or by forcibly sterilising or murdering specific demographics. It is clear that behind eugenics is a supremacist thought, because the project is driven by the idea that people with some heritable characteristics are better than people without them. But it is good to see that health supremacism and eugenics are distinct. The former is an ideology, the latter a breeding project. And although eugenic ambitions are a paradigmatic manifestation of health supremacism, they are certainly not the only manifestation. As mentioned above, health supremacism manifests itself in a range of social attitudes, including ableism and other forms of privileging based on health. If we assumed that all there was to health supremacism was a specific breeding programme, we would risk losing sight of a variety of other harmful supremacist manifestations.

What can we do about health supremacism?

Fascism is a violent, always destructive, and often lethal political doctrine which can and must be countered. Health supremacism is a fascist ideology, and so it can and must be resisted. Its rise will harm us all. But countering this form of fascism is easier said than done. Because health supremacist thinking has permeated so much of everyday life and public consciousness, the fight against it will for many involve changing the way they do things and changing the expectations that they have. But it’s high time to face this reality.

In his book How to Stop Fascism, the journalist Paul Mason argues that to combat fascism, we need to begin by raising awareness of its ideology and its myths. Describe how those facist myths operate. Pierce through them. Fascistic movements, Mason writes, are driven by the belief that “a group that is supposed to be subordinate to them might be on the verge of achieving freedom and equality” (p. 17). This is part of the fascist mythology, and it is ultimately this fear of the other that fuels their violence. Let’s translate this back to health supremacism. For health supremacists, on the verge of achieving freedom and equality is the collective of those whose bodies, health status and behaviour do not conform or submit to the supremacist ideal of the ‘naturally healthy body’, but who get to live anyway (and live well) if the right measures, (health) facilities, and support are put in place throughout society, in the workplace, in neighbourhood groups, and in friendships. The fear of allegedly ‘inferior’ people — anyone who does not conform to the fantasy of the ‘naturally healthy’ body — living well and even flourishing, fuels health supremacist violence.

Fascism needs to be curbed wherever it rears its head. Just as we should be radically intolerant of white supremacist or male supremacist ideology, anti-fascists should bundle their energies to stand up against health supremacist thinking and outbursts.

Are you opposed to fascist, supremacist thinking? I hope you are. But then just check if, over the past few months, perhaps under pressure from online media or acquaintances or family, you may have made comments or shown behaviour that has health supremacist leanings. First of all, acknowledge the extent to which you have already been surrounded by health supremacist ideas. Given that these ideas are pretty much everywhere nowadays, almost everybody has.

Then, can you identify how you might currently be performing these ideas? Tacitly advertising them? Do you shrug when someone is not able to access the meeting you organised due to a health condition? Have you stopped contacting a friend after they have become chronically ill? Stopped being on their side because of it? Do you dismiss requests for making adjustments to society to accommodate people who are ill or have a disability? Would you pressure a colleague to meet up in a shared air space, even though they said they’d prefer not to? Do you go barefaced even when people around you mask up?

Stop doing those things. Stop it, even if it’s uncomfortable. When you see others around you perform in this way, point out to them what they are doing. Act to change these behavioural patterns. We must expose covert forms of health supremacism as the fascist murmurs that they are.

To adapt a phrase of Gorcenski’s, health supremacy doesn’t want your attention. It wants your inaction. Don’t give it what it wants.