The final days of global health
By guest contributor Daniel D. Reidpath, PhD
Global health is fundamentally grounded in universal values and the human rights framework. The rights and values distinguish global health from the technical, disease-control focus of mid-20th Century “international health”. While vital, technical solutions are simply tools to reify the foundational rights that ensure equity and dignity in health.
Global health rose out of the human rights efforts to address stigma, discrimination, and access to health care associated with the HIV/AIDS pandemic. In the late 1980s and early 1990s, we saw that without the normative values-based approach of equity and rights, decisions about who received care were driven by wealth, politics, and social status. Societies marginalised and shunned people living with HIV/AIDS because of moralising about the routes of disease transmission.
Some people might find my argument about the central role of rights in global health jarring. Talk to experts or read a journal in global health, and you will hear about technical fixes—effectiveness, cost-effectiveness, health systems, and evidence-based policy. They will tell stories of countries with a GDP per capita below about $15,000, using shorthand over broad categories to describe them, like “Global South” or “LMIC”.
They will also miss the essential point of global health precisely because of the focus on the technical. Yes, global health uses technical fixes. However, it is the propositions about our shared, universal values that transform the technical fix of international health into global health. Health for all—leaving no one behind.
The human rights framework recognises that we each enjoy certain fundamental rights because of no more remarkable qualification than being human. Globally, we have agreed on rights to life, liberty, security, autonomy, privacy, and freedom of thought and expression. Yet all these rights (and more) are rendered hollow without the health necessary to exercise them. And by its obverse, maintaining healthy lives that are denied the means to be enjoyed and have meaning are also betrayed.
We can observe the devastating consequences when we abandon or ignore human rights. In Gaza, the Israel Defense Forces have killed tens of thousands of civilians (mostly women and children) and displaced hundreds of thousands more in a brutal war marked by widespread violations of humanitarian law—while protected from consequences by various Western governments.
Legislators and courts in the U.S., driven by the political ascendancy of conservative Christian groups, have denied millions of women access to abortion care—resulting in higher maternal and infant mortality rates. The U.S. has promoted this idea at the UN General Assembly, declaring a “sovereign right of every nation to make its own laws protecting life”. They have essentialised women as reproductive machinery and argued that once pregnant, a woman is primarily a means to others’ ends.
While weaknesses in global health appear particularly salient today, the reality is that global health has been in decline for 20 years. The decline can be charted over three intersecting waves, each wave further undermining the foundational rights-based principles. It started with post-9/11 U.S. exceptionalism. Following the 9/11 attacks in 2001, the U.S. claimed a unique privilege of circumstance to ignore the very rights it had advocated for and helped establish. These included extrajudicial killings, torture, and detention without charge.
Using the U.S. playbook, other nations followed suit. They would identify a group as a threat to the state and use that as an excuse to crack down on civil and political rights or seize territory. The evidence is irrelevant. Any international criticism of a country’s human rights record can be swatted away as hypocritical.
The second wave built on this precedent through cultural counter-narratives. Rather than merely claiming exceptional circumstances, nations developed arguments against the very idea of universal human rights itself. The counter-narratives drew on notions of “traditional values”, “unique cultural heritage”, or religious doctrine to argue that universal rights were an ideological fiction of neo-colonial powers. China’s current vision of the “universally exceptional” is its apogee—every nation’s unique history and culture makes its values distinct and non-comparable to others. The argument has a patina of pluralism, but it becomes a mechanism by which states dismiss universal rights entirely.
Attacks on multilateral institutions and treaties marked the third wave. During Trump’s first term as president, the U.S. withdrew from or threatened UNESCO, the UN Human Rights Council, WTO, and WHO. It withdrew funding from UNFPA and UNRWA. Beyond agencies, it abandoned treaty arrangements, including the Paris Climate Accord and threatened NATO.
The weaponisation of health aid followed, exemplified by the expansion of the anti-abortion “global gag rule”, which affected hundreds of millions of dollars in funding and forced organisations to choose between U.S. financial support or abandoning critical health rights. Health becomes a tool of political leverage, with aid increasingly tied to ideological compliance.
The presidency of Joe Biden had rewound some of the worst excesses of Trump’s presidency. But Trump is back in January 2025. He has already told us his agenda, and it is one of U.S. primacy (“America First”) with no interest in a multilateral system or any normative constraint on his exercise of power. The signal to other nationalist, authoritarian regimes is clear. Everything is a zero-sum game, with winners and losers, and the strength of a leader is marked by never being a loser.
In a fragmented, transactional world, coordinated action becomes impossible. The pandemic treaty stuttered (it may yet be signed by the US, but not ratified), and critical initiatives face existential threats. HIV/AIDS, which once served as the launchpad for global health, illustrates the stakes. The President’s Emergency Plan For AIDS Relief (PEPFAR) is the most significant commitment by any country to manage a single disease—about $6 Billion annually. Under an America First policy, the aid could be reduced, vanish, or be made contingent on significant concessions from recipient countries. With any reduction, decades of progress on HIV/AIDS could unravel rapidly.
The consequences extend far beyond single programs. Sexual and reproductive health and rights face renewed assault, maternal and infant mortality will rise, and health systems in the poorest countries will weaken further. If other wealthy nations attempt to fill the gaps left by U.S. reductions, they are unlikely to fully compensate for the funding shortfall.
Most critically, health will cease to be a universal right. The idea that people are “born free and equal in dignity and rights” will become a high school debate topic. People will become transactional commodities, valued only by their utility to the state. A woman’s worth will be reduced to her reproductive capacity. An Indigenous person’s worth will depend on their conformity to dominant cultural norms. A disabled person may be deemed valueless. A Christian, Muslim, or Jew may be labelled a threat.
The challenge ahead is monumental. Defenders of global health must rally around its core principles. There are shared, universal values, and they support health and wellbeing. These principles create the reality that health is an end in itself and a means to other ends an individual may pursue. Defending global health will require a reinvigorated commitment to multilateralism, a rejection of transactionalism, and a recognition that technical solutions are meaningless without a normative framework grounded in equity and rights.
The stakes could not be higher. If we lose the ‘global’ in “global health”, we lose not just a field of practice but the very idea that health is a shared human endeavour. And when that idea dies, what follows will be very dark.
About the author:
Daniel D. Reidpath, PhD is the Director of the Institute for Global Health and Development at Queen Margaret University in Scotland. Daniel has been working in global and public health for over 25 years across a wide range of areas including maternal and child health, disease surveillance, disease-related stigma and discrimination, equity, and health systems.
Before joining IGHD he was the Senior Director for Health System and Population Studies Division at icddr,b in Bangladesh, and before that he was the Professor of Population Health at Monash University Malaysia, and the Director of the South East Asia Community Observatory (SEACO), a health and demographic surveillance system in rural Malaysia.
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