Abstract
Can the world become even less predictable and more anxiety-inducing? Unfortunately, yes, it seems. Conflicts continue to escalate globally. Early January, the USA decided to ‘run’ Venezuela and is now at war with Iran; Israeli bombs continue to devastate Palestinian lives in Gaza; Ukraine remains under Russian attack; and protracted conflicts in Yemen, Central African nations and Haiti persist, fueled by both external and internal destabilising governance forces. The consequences are catastrophic, further unravelling socioeconomic stability, political cohesion, civic trust and healthcare systems, and, above all, disrupting the lives and health of the people caught in the crossfire.
In 2017, we coauthored an editorial when Trump first took office, threatening to withdraw US financial support from the World Health Organization and undermining multilateralism (1). We argued then for a deeper commitment to authentic Global North–South cooperation, rooted in equitable power, knowledge and resource sharing, and for intersectional thinking to advance social justice, ensuring no one, especially the most structurally marginalized, is left behind. In 2025, the USA followed through on its threats by unveiling its America First Global Health Strategy, marking a decisive shift in its approach to global health governance and funding mechanisms (2).
Meanwhile, a decade after the ambitious adoption of the United Nations Sustainable Development Goals in 2015, which renewed global promises of development and wellbeing for all, we now face a stark reality. Nationalistic, inward-looking governments in various regions of the world have erected walls against equity, diversity and social inclusion, rolling back hard-won progress in women’s reproductive and health rights, the rights of sexual and gender minorities, immigrants, refugees and more. Attacks on academic freedom and universities, particularly those championing equity and social justice, have intensified. Global health is under fire from every angle. The brutal dismantling of the US Agency for International Development (USAID), which officially ceased operations in July 2025 with over 80% of its programmes terminated, the US President’s Emergency Plan for AIDS Relief (PEPFAR) funding cuts that have left hundreds of thousands without life-saving HIV treatment and prevention services, and the reduced commitments by the USA to the Global Fund, have far-reaching effects on critical global health programmes and the people they support (3). These cuts threaten to reverse years of progress, with modelling studies projecting millions of preventable deaths by 2030 (3). The recent changes in global health funding by major donor countries deal a near-fatal blow to the field, risking a resurgence of resistance and a spike in infections of HIV, tuberculosis and malaria, as well as declining maternal and child health (3,4). At the same time, essential health surveillance and prevention programmes are being dismantled, deepening the crisis and undermining our global ability to respond effectively (4). Colleagues are losing their jobs or leaving a field that has grown increasingly toxic and unsustainable, just when their expertise and sustained commitment are needed most.
In such a climate, it might seem reasonable to adapt quietly to this new ‘normal’, lower our voices and otherwise carry on as if nothing were amiss. Yet it is precisely because we refuse to regard this as normal, after all, we are driven by solidarity and a principled defiance, that we, as three racialised Canadian women — two early-career researchers born in sub-Saharan Africa and one senior humanitarian worker navigating academia, born in Canada and based in Québec and Ontario — have chosen to triple down, intellectually, emotionally and physically. We propose three urgent calls to action.
First, against this backdrop of fractured governance, growing unpredictability and worsening inequities in social and health outcomes worldwide, we must ask ourselves, as researchers, global health practitioners and humanitarian workers, but first as citizens, what we can do at our level. We cannot simply stand by and watch the crisis unfold. Instead, we must take steps to mitigate its impact or, at the very least, contribute to a broader intersectoral conversation that drives meaningful action. We contend that it is long past time to revitalize public accountability, since we, as citizens, have allowed our voices to be muted. By public accountability (5), we mean the active participation and engagement of the public, whether from communities, civil society organisations or universities, including us as interdisciplinary and intersectoral health professionals, to uncover evidence-based inequities and injustices and propose alternatives to failing global health leadership, governance and democratic processes. Our role as part of the public must go beyond passive observation and documentation. We must embrace our responsibility as watchdogs, leveraging our capacity to generate and translate knowledge into decisive policy influence (5), even when it is challenging and daunting. This requires forging strategic partnerships with a diverse range of civil society organisations, both like-minded and unlike-minded, across the Global North and South, to amplify our impact, challenge the status quo and drive innovative pathways for transformative change and ways forward (6). When donor countries cut global health funding while sustaining or increasing military budgets, and when proven interventions remain inaccessible to millions of vulnerable and marginalised population groups, mostly in the Global South, not due to a lack of technical capacity, but a lack of political will, we must recognize this for what it is: a profound failure of public accountability. As researchers, global health practitioners and humanitarian workers, our role is also to monitor these decisions, expose their harmful consequences, and ensure they are not buried in bureaucratic silence or lost in publications that cater to careers. Concretely, this means, for example, exposing and amplifying the human costs of funding decisions, translating these findings into accessible public forms, speaking truth to power, co-creating reports with civil society and community partners, and connecting grassroots organisations to decision-makers.
Second, building on the points above, we champion and embody intersectional solidarity, which refers to a genuine commitment to eliminating ‘all forms of power asymmetries within a coalition’, forging authentic partnerships, shifting power and reframing how we conceive, design and implement global health initiatives (7). It means actively collaborating with the most vulnerable communities and their representative organisations (7), while critically reflecting on our own positions of power and privilege in these systems (8). Our goal must be to center equity in every action we take in global health. Equitable partnership is not about benevolent cooperation from positions of privilege, but about genuine co-struggle with communities in their plurality, facing the sharpest edges of social and health inequities. As researchers and humanitarian workers in the Global North investigating and addressing global health issues in the Global South, we hold structural advantages, access to funding, platforms and networks, although much less so now with dwindling international commitments to global health research and implementation. Still, these advantages exceed what our colleagues in the Global South often have. While intersectional solidarity may feel overwhelming, it is crucial if we are serious about achieving global health equity. Building strategic coalitions and fostering equitable partnerships, alongside political solidarity, requires time, perseverance and a shared vision. It demands that we engage in coalitions, cultivate trust through consistent action over time and remain committed to the long-term work of transforming systems. This is not a quick fix, but a necessary and ongoing intergenerational process. It further demands that we critically redefine allyship, shifting our focus from merely ‘studying the oppressed’ to examining how we, as researchers, global health professionals and privileged citizens, perpetuate systems of inequity (8). Writing and publishing about ‘equity’ is far from enough. To advance global health equity, we must actively listen to and learn from the voices of population groups in situations of vulnerability and marginalisation, who are the true experts of their own realities. More than that, we must mobilise collectively under their leadership, for example, in research, initiative development, evidence-based policy advocacy, or knowledge mobilisation activities. This perspective may be unpopular among researchers and global health professionals, but unless we turn the lens on ourselves and the power structures (upstream determinants of health) that shape health outcomes downstream, our words will be devoid of consequential and transformative action. True praxis begins with accountability to us, communities with and for whom we are conducting research, and the public.
Third, we must recognise that global health equity matters (9,10); it is not a utopian idealism but a pragmatic necessity (10). COVID-19 taught us that health security and human rights are indivisible, that pathogens respect no borders and that neglecting health systems and equity anywhere threatens health everywhere. Now, with emerging zoonotic diseases and the One Health imperative, with climate change driving new patterns of infectious diseases and structurally affecting the social, socioeconomic and environmental systems globally, global health governance and equity are not moral luxuries but essential survival requirements for all species, beyond humans. Without them, we risk spinning endlessly in the global health hamster wheel, reacting to crises without addressing the underlying root causes of inequities. The framework of social determinants of health reminds us that health inequities are not natural or inevitable; they are produced by policy choices about resource and power distribution, governance structures and whose lives we value, or not (11). Freedom through solidarity is a political act, a return to the simplest etymology of citizenship for researchers and practitioners of global health in their diversity. Bandara et al. urge global health institutions and global health educators to embrace a ‘truly global’ and decolonial approach (12). This requires rejecting the ‘White saviour industrial complex’, a framework that perpetuates charity-based narratives, and critically interrogating power dynamics to address and redress the asymmetries embedded in so-called collaborations and partnerships for equitable global health (12). Global health must move boldly beyond performative gestures and center justice, equity and structural transformation. Amid this crisis, opportunities for systemic change are being identified. Five global regional reports agree on the pressing need to decentralise power to countries and regions, establish sustainable financing beyond volatile aid through regional funds and global transaction mechanisms, and expand priorities beyond pandemics to primary health care and global health equity (13). Operationally, this means we must walk the talk; otherwise, we risk undermining our credibility as equity-focused researchers and global health practitioners.
In conclusion, these are not aspirational ideals for a more stable and equitable future. They are necessary commitments for confronting the fractured present. As authoritarian forces dismantle multilateral cooperation and nationalist agendas erode solidarity, global health researchers and practitioners must deepen our commitment to equity, not retreat from it. Our principled defiance means refusing to normalise catastrophe, rejecting the urge to retreat into safe, fundable projects, and insisting that research in global health serve as an instrument of justice rather than merely a documentation of suffering. The work is challenging, the path uncertain, but the alternative, complicity through inaction, is untenable. We choose to triple down not because we believe individual action will reverse global trends, but because our collective act of resistance and refusal to accept and normalise the status quo might protect the possibility of a more just future. The era of reimagining global health is over. Now is the time to turn vision into action and make change happen.