GH Book Club # 1: Beyond the Enshittoscene

A Summer Book Club Exploring Reimagining Global Health

Hey everyone!

Thanks for reading and for joining us for this slightly unconventional ‘summer’¹ book club. Every two weeks (for the next 2 and a half months) we’ll release a new chapter from our book, along with a companion podcast hosted by our friend, global health provocateur, and occasional troublemaker, Ben Plumley. Here is episode #1:

A brief disclaimer before we begin: this is not the world’s best-written book. Eric and I are academics at heart, which means parts of it are probably too nerdy, there are definitely not enough stories, and almost every chapter could have benefited from one more round of editing. At several points you’ll also find evidence that we became overly attached to our own ideas and failed to delete enough words. But imperfect as it may be, we think the conversation matters. The central question of the book is simple: how should global health reinvent itself in the post-Trump era—and, more broadly, in a world where many of the assumptions that defined the last thirty years no longer hold?

We argue that the old model is running out of road. Reimagining global health will require changes in governance, financing, and even how we think about knowledge itself. It will require a field that takes climate change seriously, embraces technology thoughtfully rather than uncritically, and places communities and clients—not donors—closer to the center of decision-making. Along the way, we throw more than a few ideas against the wall to see what sticks.

But before proposing solutions, we begin with a sobering observation: unless something changes, global health risks drifting toward what Cory Doctorow memorably calls “enshittification.” Yes, enshittification is currently my favorite word, as evidence by this op-ed in Devex and this commentary in the Lancet! It’s also, unfortunately, a fairly accurate description of where parts of the field seem to be headed: a focus on efficiency, diminishing impact, and (potentially) a progressive inability to adapt to a rapidly changing world.

In addition to the podcast, we have also included each chapter in both audio and PDF formats for those who prefer to listen, read, or argue with us in real time. The audio file of prologue is available here:

[Full disclosure its a voice clone of me, not my actual voice!]

And here is the PDF file [open access expires on Sept 5th, 2026]

We would love for you to share the podcast or this Substack series with others who might want to join the conversation. We certainly don’t have all the answers, but we suspect it’s time to start asking different questions.

1. Before anyone accuses us of reproducing Northern Hemisphere tropes, we acknowledge that it is not summer everywhere. For readers south of the equator, this is officially the Winter Book Club. Consider this our first attempt at reimagining global health: starting with the radical idea that seasons are not universal.