recent US proposal to restrict visas for individuals with obesity or chronic metabolic conditions has intensified a global debate: is health becoming a tool for exclusion? This policy has been framed as a protective measure for national resources and security, but it also signals the rise of health nationalism—a phenomenon in which health status becomes a criterion for belonging, mobility and value within and across borders.

Health nationalism isn’t monolithic. It takes economic, securitised and ideological forms. Economic protectionism includes measures like drug pricing reforms aimed at cutting national healthcare costs. Securitised health nationalism restricts access based on perceived health risks. Ideological nationalism treats the health of certain populations as a marker of national identity. The US approach blends the first two, creating domestic benefits but raising ethical and global red flags.

To understand why this decision matters, it is essential to look beyond politics to the underlying drivers. The United States faces one of the highest obesity rates in the world, with more than 40 percent of American adults meeting criteria according to the Centre for Disease Control and Prevention. The worldwide prevalence of obesity, according to the World Obesity Federation, more than tripled between 1975 and 2022 and it is now recognised as one of the most important public health problems facing the world today. Obesity is associated with increased healthcare spending, reduced productivity and elevated risks during infectious disease outbreaks. Against this backdrop, a government might argue that stricter visa health requirements prompt global attention to obesity prevention, sending a stronger message than decades of public health campaigns alone. From this perspective, the policy could be seen as a catalyst for international dialogue on chronic disease, though whether such pressure leads to meaningful health improvements is far from guaranteed.

This set of US policy actions reveals a tension. While one proposal restricts mobility based on health status, another initiative aims to lower the prices of glucagon-like peptide-1 (GLP-1) receptor agonists which is a class of medications that improve insulin secretion, slow gastric emptying, reduce appetite and have transformed the management of obesity and Type 2 diabetes. Greater affordability would expand access for millions of Americans, potentially improving population health and workforce productivity while reducing long-term national healthcare costs. This juxtaposition captures the dual nature of modern health nationalism: promoting domestic health benefits while simultaneously using health criteria to limit international participation.

Real health security does not come from drawing boundaries around who is “healthy enough” to enter a nation. It comes from building resilient, equitable and globally engaged systems.

From a public health perspective, turning chronic illness into a basis for exclusion carries risks. Global scientific collaboration, cross-border research networks and culturally diverse health workforces are essential for innovation and pandemic preparedness. Visa restrictions for individuals with obesity could suppress these strengths. Furthermore, historical precedents such as the vaccine nationalism and personal protective equipment export controls during the Covid-19 pandemic demonstrate that inward-looking health strategies can erode global equity, trust and responsiveness.

The ripple effects may extend internationally.

If more countries emulate restrictive policies aimed at excluding individuals based on chronic disease, global health governance frameworks—such as the International Health Regulations and the Global Health Security Agenda—could weaken. While arguments about finite healthcare resources and national priorities are not without merit, a purely protectionist stance risks undermining long-term preparedness for transnational threats.

Other high-income nations, from Canada to Japan to EU states, show another path: protecting health without excluding people. They invest in system strengthening, targeted prevention and inclusion. Evidence shows securitised health nationalism is neither inevitable nor necessary. Mitigating its harms requires transparent policymaking, independent oversight to prevent politicisation, safeguards against medicalised discrimination and investment in public health infrastructure, primary care and prevention, thereby addressing causes rather than symptoms.

Mitigating the harms of health nationalism requires policymaking that is genuinely balanced and grounded in evidence. This includes transparent decision-making that prioritises data over political convenience as well as independent oversight to ensure health criteria are not shaped by ideology or used selectively. It also means putting safeguards in place to prevent discrimination that is disguised as “health risk management,” and investing in the fundamentals of public health, such as strong infrastructure, primary care and prevention. By focusing on root causes rather than restricting people, countries can strengthen health security without compromising equity.

Health nationalism may offer short-term benefits, but it risks long-term damage to equity, global cooperation and collective security. Real health security does not come from drawing boundaries around who is “healthy enough” to enter a nation. It comes from building resilient, equitable and globally engaged systems. As countries confront the growing burden of chronic disease, they must remember that health is not only a national responsibility but also a global public good.

The writer is a medical doctor who writes on global health security, health diplomacy, and the policy dimensions of health. Her work focuses on the intersection of clinical care, public health and international health governance.