I feel like I start all my comments this way, but "Spot on, Mike"
I take a longer view and realize that there is a wax and wane to development and health in particular. There will be openings in the future and we must take a sober look at what was right and wrong in the HIV era. Let's be honest, so much of the infrastructure was built on and depended on HIV and would have to be rightsized anyway. It is happening in a lurch as opposed to a step down.
You asked whether academic global health became indispensable. It is probably more that academia *thought* they were indispensable. There is hubris, entitlement and an echo chamber that counters a lot of the good work. Add to that the natural bureaucratic tendency to judge success by the size of the budget and need to feed the infrastructure. Sound familiar?
From the vantage point of Uganda Sub-Saharan Africa, I can say with confidence that the global health enterprise as traditionally conceived has reached an inflection point.
Down here, we're navigating a quiet but profound shift. The government has laid out a Primary Health Care Integration Roadmap that’s attempting to realign the entire delivery architecture, moving us from the vertical, donor-driven models toward more coherent, people-centred, and system-integrated care. As you know, this is happening against a backdrop of declining donor aid, political uncertainty around global health assistance, and the urgent need to translate health investments into locally meaningful outcomes.
What’s striking is how much of this transition is happening outside the orbit of academic global health. There’s often a mismatch between what is funded and studied and what systems on the ground actually need. Applied public health would mean research embedded in service delivery, data use rooted in local governance, leadership training conducted in-country, and implementation science focused on practical, durable change, not publications or pipeline prestige.
We don’t need to end collaboration; we need to reshape its architecture. That means listening more than prescribing and showing up with a bit more humility
I could not agree more with this post. I thought I was the only one who had been thinking this for quite some time, so thank you for articulating it so well. A gaping hole I see in academic global health aimed at improving the health of the poorest, is agriculture. US academic institutions silo agriculture and health and breed superiority within health sectors to view agriculture as secondary to a person’s health. But it seems incredibly short-sighted to separate the one thing that the majority of the poorest depend on for their livelihood, food security, nutrition, and in some cases, identity, from how to improve health in a sustainable way. And maybe that’s it. Perhaps academia needs to keep the thing separate and hidden that promises sustainable improvements that in the long-term don’t require donor funding.
You ask important questions about the function of Global Health, concerning, in particular, concentration on funding to maintain and renew research projects rather then focusing on how best to serve communities in immediate and ongoing need of adequate healthcare around the globe. It makes sense to reexamine what “global health” means for the 21st century.
Thank you, Mike, for this courageous and honest reflection. I think, like many public institutions, global health programs have been re-engineered to prioritize branding, visibility, and institutional survival over real-world impact. Branding, once a tool for communication, has become a substitute for purpose—shaping identity, justifying existence, and often eclipsing the communities we claim to serve. This shift mirrors a wider erosion of democratic and educational institutions, where value is increasingly defined by market logic rather than public good. I strongly support your call to move toward applied public health—grounded in humility, integrity, and contextual relevance. This transition must not only reorient our methods, but also challenge the very systems that have commodified care, professionalized empathy, and fractured solidarity. Most importantly, it must restore the moral urgency and civic responsibility that once animated this field—not as a brand, but as a commitment.
Mike, thanks for raising this. Some parts are provocative, but a lot of it rings true—especially now, as global health is going through a real shift. This is a chance to rethink how we do things and make the system work better.
One thing I’d add: academic institutions also need to change how they partner with institutions in the global South. Too often, those relationships aren’t equal. We need to aim for partnerships that are fair, respectful, and truly collaborative. And let’s be clear—those of us in the global North have a lot to learn from our partners. That kind of shift would strengthen institutions on both sides and open the door to smarter, more grounded ways of building capacity and driving impact.
I feel like I start all my comments this way, but "Spot on, Mike"
I take a longer view and realize that there is a wax and wane to development and health in particular. There will be openings in the future and we must take a sober look at what was right and wrong in the HIV era. Let's be honest, so much of the infrastructure was built on and depended on HIV and would have to be rightsized anyway. It is happening in a lurch as opposed to a step down.
You asked whether academic global health became indispensable. It is probably more that academia *thought* they were indispensable. There is hubris, entitlement and an echo chamber that counters a lot of the good work. Add to that the natural bureaucratic tendency to judge success by the size of the budget and need to feed the infrastructure. Sound familiar?
Great piece Mike
From the vantage point of Uganda Sub-Saharan Africa, I can say with confidence that the global health enterprise as traditionally conceived has reached an inflection point.
Down here, we're navigating a quiet but profound shift. The government has laid out a Primary Health Care Integration Roadmap that’s attempting to realign the entire delivery architecture, moving us from the vertical, donor-driven models toward more coherent, people-centred, and system-integrated care. As you know, this is happening against a backdrop of declining donor aid, political uncertainty around global health assistance, and the urgent need to translate health investments into locally meaningful outcomes.
What’s striking is how much of this transition is happening outside the orbit of academic global health. There’s often a mismatch between what is funded and studied and what systems on the ground actually need. Applied public health would mean research embedded in service delivery, data use rooted in local governance, leadership training conducted in-country, and implementation science focused on practical, durable change, not publications or pipeline prestige.
We don’t need to end collaboration; we need to reshape its architecture. That means listening more than prescribing and showing up with a bit more humility
I could not agree more with this post. I thought I was the only one who had been thinking this for quite some time, so thank you for articulating it so well. A gaping hole I see in academic global health aimed at improving the health of the poorest, is agriculture. US academic institutions silo agriculture and health and breed superiority within health sectors to view agriculture as secondary to a person’s health. But it seems incredibly short-sighted to separate the one thing that the majority of the poorest depend on for their livelihood, food security, nutrition, and in some cases, identity, from how to improve health in a sustainable way. And maybe that’s it. Perhaps academia needs to keep the thing separate and hidden that promises sustainable improvements that in the long-term don’t require donor funding.
You ask important questions about the function of Global Health, concerning, in particular, concentration on funding to maintain and renew research projects rather then focusing on how best to serve communities in immediate and ongoing need of adequate healthcare around the globe. It makes sense to reexamine what “global health” means for the 21st century.
Thank you, Mike, for this courageous and honest reflection. I think, like many public institutions, global health programs have been re-engineered to prioritize branding, visibility, and institutional survival over real-world impact. Branding, once a tool for communication, has become a substitute for purpose—shaping identity, justifying existence, and often eclipsing the communities we claim to serve. This shift mirrors a wider erosion of democratic and educational institutions, where value is increasingly defined by market logic rather than public good. I strongly support your call to move toward applied public health—grounded in humility, integrity, and contextual relevance. This transition must not only reorient our methods, but also challenge the very systems that have commodified care, professionalized empathy, and fractured solidarity. Most importantly, it must restore the moral urgency and civic responsibility that once animated this field—not as a brand, but as a commitment.
I couldn't agree more. Applied Global Health is an excellent framework in which we can move forward during these challenging times.
Mike, thanks for raising this. Some parts are provocative, but a lot of it rings true—especially now, as global health is going through a real shift. This is a chance to rethink how we do things and make the system work better.
One thing I’d add: academic institutions also need to change how they partner with institutions in the global South. Too often, those relationships aren’t equal. We need to aim for partnerships that are fair, respectful, and truly collaborative. And let’s be clear—those of us in the global North have a lot to learn from our partners. That kind of shift would strengthen institutions on both sides and open the door to smarter, more grounded ways of building capacity and driving impact.
Jirair - absolutely! I couldn't agree more...