There’s a truth many of us in academic global health have been considering for a while but rarely say out loud: Is the era of academic global health—as we’ve practiced it— over? And if it isn’t, should it be?
We’ve built programs, institutes, careers around the promise of “global health.” At places like UCSF (where I am based), we’ve spent the past two decades training clinicians, researchers, and technical experts committed to serving vulnerable communities around the world. And much of that work mattered immensely. Global health - as a scholarly enterprise -has had a transformative impact
But somewhere along the way, that enterprise may have begun to eclipse its mission. Have we stopped asking what global health was for, and focused instead on how to sustain it? Rather than staying rooted in service, solidarity, or systems change, has the field become too preoccupied with itself, with maintaining programs, securing grants, expanding portfolios, and justifying its own existence?
From my vantage, it feels like much of the architecture of global health in the Global North—especially in academic institutions—now exists to sustain the enterprise of global health as much as the science or the communities it was meant to serve.
This isn’t about coloniality or neo-colonial power dynamics, though those critiques are essential and ongoing. It’s about something more banal: the tendency of institutions to perpetuate themselves even when they should transition. It feels like many global health institutions now exist for the sake of existing.
To be clear: global health as a scientific enterprise absolutely warrants scholarship, critical inquiry, and research rigor. The cross-border nature of health inequities demands it. But what we’ve built in many Northern institutions isn’t about that, at least not entirely: in many respects the field has become institutionalized, it has begun to orbit around itself.
What global health should have been about is transition—away from donor dominance, away from Northern gatekeeping, away from inequity and toward equity. Did we get stuck somewhere along the way? Did we spend more time writing grants to keep our teams afloat than rethinking the structures that made us necessary in the first place? Did we make ourselves indispensable—even when we shouldn’t have? Did we submit to our academic masters, who expected us to court wealthy donors in the name of global health— raising money that ultimately reinforced the power, prestige, and payrolls of Northern institutions? And even then, equity gaps have remained.
Now, for better or worse, the tide is turning. Funding for academic global health is shrinking. And the scaffolding that once justified our work (at least in the US)—solidarity, shared struggle, mutual responsibility—feels more fragile than ever. Northern academic institutions can no longer claim moral high ground. So maybe it’s time to retire the language—and the infrastructure—of academic “global health.” And to reimagine our role in something more honest, more grounded, and frankly, more useful: applied public health.
Applied Public Health: A Way Forward
Applied public health should be about getting shit done—using rigorous science, methods, and evidence to tackle the real-world challenges of health and equity, wherever they show up. Whether across the street or across the ocean, it’s about building systems that work, embedding research in practice, and sticking around long enough to ensure those systems can endure.
It would also allow us to turn our gaze inward. Here in the U.S., public health is fraying—inequities are deep, legitimacy is fragile, and our tools, expertise, and moral imagination are urgently needed. Applied public health gives us a framework not just for doing the work—but for doing it better, and where it’s needed most.
Just as importantly, retiring the term “global health” would help us break the false association between where we work and the worth of the work. The point isn’t whether it happens in a low-income country or a neglected U.S. county. It’s how we show up, who sets the agenda, and whether we have the humility to lead when asked—and the wisdom to leave when the job is done.
By shifting from “global health” to “applied public health,” institutions like UCSF could realign with the demands of this moment: extending our reach across both global and domestic contexts, while focusing our academic and technical expertise on the hardest challenges—like how to responsibly transition donor-funded programs to sustainable, country-led platforms. This isn’t about stepping away from international work. It’s about doing it with greater integrity, and making good on the promises we made from the start.
That said, applied public health may not be the final term we land on. Some may prefer something more expansive (planetary health, for example, signals a broader ecological and intergenerational framing). Others may choose language rooted in justice, solidarity, or systems transformation. The point is less about perfect phrasing—and more about reclaiming a sense of purpose.
The Next Chapter?
This could be the next chapter for academic institutions once rooted in global health: becoming centers of applied public health that engage deeply with global and local challenges. At its best, global health was about transition—of power, of knowledge, of ownership. Perhaps the most honest thing we can do now is finish that transition.
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