PopTalks on Reimagining Global Health for Equity and Resilience
Global health finds itself at a crossroads. Extraordinary challenges persist, but disruption also creates opportunities to reimagine the system. How are we going to build it better?
That was the crux of the PopTalks discussion on September 23, 2025, when two department chairs at prominent public health institutions sat down - our own Dr. Thoai Ngo with Dr. Judd Walson, Chair of the Department of International Health at Johns Hopkins Bloomberg School of Public Health.
Their conversation came at a critical time. Earlier this year, the United States government made a policy choice to step back from its role as a global health leader, dissolving USAID as an independent agency. Roughly 90% of the agency’s programs were terminated, leaving life-saving initiatives around the world in limbo and tens of millions of people at risk.
Meanwhile, on September 18, 2025, the U.S. Department of State released its America First Global Health Strategy. It took the focus away from the bread-and-butter public health work that has improved survival and quality of life worldwide.
“While the strategy emphasized some principles that are quite important––integrated-programs, efficiency, and investment in frontline workers––it deprioritized some critical areas, such as reproductive health, maternal child health, and vaccines,” Dr. Ngo explained.
The funding pullback threatens decades of progress. The U.S. had provided about 42% of all donor government assistance. So far, no other nation has yet to step up to fill the gap.
Looking Back to See Forward
“None of us has magic answers,” said Dr. Walson. “History is an amazing teacher. How did we get here?”
In 1960, maternal mortality, child mortality, and infant mortality were all much higher, while women’s literacy was low. “There was no structure or funding landscape for public health,” explained Dr. Walson. “No Gates Foundation, no USAID. And yet, a small group of dedicated people rolled up their sleeves and started to make a difference. Yes, we’ve hit a stumbling block. But if we come together to meet the challenges, I do think there is hope in this moment.”
Strong political motives spurred foreign assistance. “We, who do this work, lost sight of the political thread that drove the motivation,” explained Dr. Walson. “We assumed everyone should do this because it’s the right thing to do. But political decisions are made for a lot of other reasons - humanitarianism alone is insufficient.”
The America First Global Health Strategy does have some positive principles worth acknowledging:
- Recognizes past U.S. leadership and global health success
- Calls for reducing dependency on foreign aid and investing in frontline workers
- Emphasizes data, accountability, and integration
- Encourages private-sector engagement
“There are some good nuggets there,” Walson reflected, “but the entire agenda is defined by self-interest, nationalism, and privatization.”
Partnership and People First
To move forward and build a better system, stakeholders need to prioritize strong partnerships and solidarity. “There’s a need for people to be part of something bigger than themselves –– like-minded people who see the value in solidarity,” said Dr. Walson, quoting Margaret Mead: “Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it’s the only thing that ever has.”
The promising path, added Ngo, lies with investment in on-the-ground healthcare systems where need is greatest. “We have to shift the money from disease eradication to people, systems, and communities.”
The current process — metrics-obsessed, politically driven, top-down, and vulnerable to sudden policy change — repeats old mistakes. Ngo and Walson agreed we should follow the lead of countries like Ghana, Rwanda, and Vietnam, where decades of investment in access to education, robust health systems, and community support have translated into dramatic gains in survival, life expectancy, and overall population well-being.
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The full, spirited conversation touched on data use, the legacy of imperialism, progress and setbacks in 65 years of global health - and even a little bit of Miles Davis.
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