Farewell global health

About a year ago, I started writing an article on the decline of global health. I have now posted it (4000+ words). We could all see the trend of nation-states withdrawing into more populist, authoritarian, and revanchist postures. Divided nations are ill-suited to a global agenda of working together for a common good. A flock of authoritarian governments congratulating each other today is no basis for future global cooperation. Nonetheless, if I wanted to make the case, I needed to be more explicit about the link between a fracturing the global order and global health.

As the 2024 U.S. election approached, this article—a dozen drafts in—became increasingly difficult to write. It was missing a pivotal data point. Now that data point has been colored-in and the post-inflection trajectory is clear.

We should be worried about the future of global health.

Global health is fundamentally about shared, universal values—the human rights-based framework. These values underpin the very concept of the ‘global’ of global health, distinguishing it from the technical, disease-control focus of the old “international health.” Technical solutions, while vital, are merely tools to realise the foundational rights that ensure equity and dignity in health. Without this the normative values-based approach of equity and rights, decisions about who receives care risk being driven by wealth, political alignment, or cultural affinity. It will destroy global health.

The AIDS crisis marked a pivotal shift, marking the beginning of global health. Through advocacy and international cooperation it reframed health as a universal right. Yet this hard-won progress has been in decline for the past 20 years and faces existential threats. A second Trump administration promises deeper erosion of multilateralism, international aid, and rights-based approaches. Health will become a geopolitical bargaining chip in a transactional world of nationalist posturing—its moral foundation stripped away. As authoritarianism rises and equity erodes, global health is on life support: reaffirm universal rights or surrender to a transactional, fragmented future.