When Surveillance Becomes a Social Determinant of Health
Juan Sebastián Pinto’s explosive essay is framed as a story about war, Silicon Valley, and authoritarianism—but for public health, it should read like an emergency briefing. What he describes is the rapid conversion of surveillance, data extraction, and narrative control into tools of population management. That has direct, measurable consequences for health, equity, and democracy.
My final message before I’m on an FBI watchlist: Palantir, Epstein, & The New York Times
Public health has long understood that where people live, work, and move shapes their risk of illness and early death. What Pinto is documenting is something newer: surveillance exposure is becoming a social determinant of health. When communities, especially immigrants, protesters, racialized groups, and the poor, live under persistent drone monitoring, biometric tracking, and algorithmic suspicion, the result is not just civil rights harm. It is chronic stress, avoidance of care, social isolation, and behavioral suppression.
We already see this in ICE-targeted communities. Fear of data-sharing between health systems and immigration enforcement reduces clinic attendance, vaccination uptake, and the accuracy of disease surveillance. When Palantir-like platforms fuse hospital records, school data, social media, and geolocation into “risk scores,” the chilling effect spreads. People stop seeking help. Trust collapses. Outbreaks go undetected.
Pinto’s most important insight for public health is that these systems are not neutral tools. They are built for what the military calls “kill chains” and what social scientists would call coercive control. When they are repurposed for civilian life policing, immigration, welfare, and public safety, they import the same logic: identify, predict, isolate, neutralize.
That logic directly contradicts the foundations of public health. Our field depends on consent, trust, confidentiality, and voluntary cooperation. Surveillance capitalism and security-state AI depend on the opposite: extraction, opacity, intimidation, and asymmetric power.
There is also a second layer here that public health cannot ignore: narrative warfare. Pinto shows how media institutions and tech platforms shape which deaths count, which harms are visible, and which populations are rendered disposable. This matters because policy follows stories. If immigrants are framed as threats, their detention becomes “safety.” If Gaza is framed without civilians, mass killing becomes “precision.” If protesters are framed as terrorists, surveillance becomes “public order.”
Public health is both a formal institution and a movement. As institutions, health departments, universities, and hospitals must now ask: Who has access to our data? Which vendors power our analytics? Are we feeding systems that harm the communities we claim to serve?
As advocates, we must treat algorithmic surveillance the way past generations treated lead paint or tobacco: a structural hazard that demands regulation, resistance, and public education. Because in a world where data becomes a weapon, protecting health means protecting people from being watched, sorted, and targeted in the first place.
