I would like to begin with a disclaimer: I am not an expert, only a student of medicine and public health and for nearly two decades, I have observed human beings in their physical, mental and social dimensions.

That does not make me an authority, only observant. I wanted to sound frustrated when I sat down to write this, but then I wondered—does it matter? Frustration is a luxury; questions are not. I have many, though I am unsure who will answer. As a millennial, I have witnessed transitions our grandparents could scarcely imagine: wars broadcast in real time, disasters that erased cities overnight, a global pandemic that confined humanity indoors, political upheavals and a technological revolution placing the world in our palms. We adapted because we had to, learning new skills, survival languages and ways of coping. Survival became second nature.

Yet somewhere along the way, a deeper unease settled in. The global order, whether one calls it capitalism, neoliberalism or simply the way the world now functions, resembles a furnace. The poor are the primary fuel, cheap coal that burns quickly and leaves little trace. The middle class are slightly better quality wood, sandal or oud perhaps, offering a more refined flame. And the elite sit above it all, cooking their meals on the heat generated by everyone else’s exhaustion. It is an uncomfortable metaphor, but it is difficult to escape once it takes shape in the mind.

What puzzles me most is not merely the inequality. History has never been free of hierarchies. What unsettles me is the obsession with controlling public opinion. Power today does not only seek obedience. It seeks validation. Governments, corporations and influential figures commit grave errors, sometimes even crimes, yet they continue to invest enormous energy in shaping narratives. Why is our opinion so important? If power is secure, why must it constantly manufacture consent?

Elite capture is not confined to one country or one culture. It cuts across race, religion, gender, ethnicity and geography. The language may differ, the faces may change, but the structure feels hauntingly familiar. In Pashto we have a phrase, Ghareeb Tabah De. It means the poor are destined for ruin. It is not poetry. It is resignation distilled into three words.

Across continents, poor families wake before dawn, work beyond exhaustion and sleep with uncertainty. They farm in scorching heat, dig in suffocating mines, assemble products in factories, drive buses, clean offices, serve food, deliver parcels. They are the invisible scaffolding of modern comfort. Without them, there would be no abundance to hoard. Yet they are told that their hardship is personal failure, that their neighbour is their competitor, that resources are scarce because someone just like them is taking too much.

The ten ninety gap illustrates this imbalance with brutal clarity. Ten percent of the population enjoys ninety percent of the resources, while the remaining ninety percent survive on what is left. These resources are not abstract numbers on a spreadsheet. They are land, water, energy, healthcare, education and opportunity. They exist because human beings create them with their labour. And still, the narrative persists that we are divided by identity more than we are united by shared struggle.

In public health, we often speak about the poverty disease cycle. Poverty increases exposure to illness through malnutrition, unsafe living conditions and limited access to care. Illness, in turn, drains savings, reduces earning capacity and pushes families further into poverty. It is a loop that tightens with every generation. When a child grows up in a household burdened by chronic disease, the consequences extend beyond the clinic. They shape education, employment and dignity. And yet we treat poverty as an individual flaw rather than a structural design.

Now, once again, we find ourselves staring at the possibility of regional war. Conflicts erupt, narratives harden and ordinary people brace for consequences they did not choose. One cannot help but wonder whether wars are sometimes convenient distractions, ways to bury scandals, silence dissent or consolidate power. Meanwhile, it is not the elite who stand in ration lines or send their children to the front.

The tragedy is that elites across borders often find ways to cooperate when their interests align. Trade continues. Assets remain protected. Channels of communication stay open. It is the public that is divided, persuaded to mistrust one another along lines of nationality, sect or ideology. Perhaps I am wrong. Perhaps I am overly cynical. But as a student of health and society, I cannot ignore patterns that repeat themselves. Ghareeb Tabah De is not just a phrase. It is a warning. And unless we begin to ask uncomfortable questions together, it may continue to define the fate of far too many.

—The writer is Associate Professor, Health Services Academy, Islamabad.

© Pakistan Observer