I am not a political analyst, but I read (and read with concern) everything that experts in global health and humanitarian action around the world anticipate with Trump's return to the White House. Obviously, one cannot predict the future, but what is certain is that the forecasts are not good. If you look at the election promises he has made and the evidence of what happened in his previous term, it would be best to prepare for the impact, which would shake both global health and humanitarian action in health.
A shake-up of global health governance and health systems
The new president-elect has on numerous occasions expressed his rejection of the current model of global health governance (and the role of the World Health Organization). In fact, it seems that it would not be too surprising if the possibility of the United States' exit from the WHO, or strong pressure to try to bring about reform on its own terms, were to be put on the table. On the other hand, it could also happen that other governments (such as China) enter to occupy to a greater or lesser extent the space left vacant.
Many experts also see risks to some of the international global health agreements already in place and in the pipeline. This includes the pandemic agreement, which could be blocked for good now, after difficult prior negotiations. Moreover, some voices within the United States, WHO and several African countries are now urging the Intergovernmental Negotiating Body to conclude the agreement in December, without postponing it until the (already extended) date of May 2025.
The impact on governance could not only be global, but also have an impact on the national health systems of many countries. The promotion of the entry and greater participation of private actors in the governance of these systems, could favor privatizations, the introduction of commercial interests in public health agendas and universal health coverage, and end up destroying the (limited) progress made in recent years.
Reduction in funding for humanitarian health action
The impact on global health is not only expected to be linked to governance, but also to funding. Declining U.S. contributions to numerous global health funds and initiatives would put much strain on the remaining donor countries, which may not have the financial capacity (or the political will) to compensate.
Humanitarian action, and in particular humanitarian action in health, will probably not escape this reduction in funding from what is currently the largest donor. None of this would be entirely new. Already in the previous Republican term, the administration proposed significant reductions to international humanitarian aid in countries such as Yemen, Nigeria or Syria. A further blow to humanitarian funding (especially in crises like Ukraine or Gaza) could be devastating. It would all be different, of course, if the global humanitarian funding model were not at the mercy of voluntary contributions from donor countries, of course. But we have the humanitarian system we have.
It is not just a question of a reduction in aid, but also of greater politicization of that which remains. If this materializes, a further alignment of funding for emergency and humanitarian crisis response with ideological interests would also be a severe blow to the already battered humanitarian principles. This, however, could mean advances in the policy of localization, channeling more funds through local actors, although not so much to increase their power and capacity, but to undermine that of international actors such as UN agencies. In any case, it could be a positive side effect for local organizations that have not yet seen the promised humanitarian reform materialize.
A blow to advances in sexual and reproductive health and rights
The cuts to global health, development cooperation and humanitarian action in the previous term were not homogeneous, nor are they expected to be now. In fact, there was a clear ideological intention behind the most substantial cuts, which were for UNFPA, UNAIDS, the WHO and UNRWA. There are even those who put a figure on the possible cut for UNFPA ($160 million, more than double the $70 million it lost in Trump's previous term). Even major U.S. initiatives such as PEPFAR (for the fight against HIV/AIDS) could be in jeopardy again.
Now, although in other sectors (such as food safety) there seems to be greater optimism, the worst is expected for organizations that defend and promote sexual and reproductive rights, access to contraceptives, prevention and management of sexually transmitted infections and HIV/AIDS, or safe abortion. Evidently, the return of the Global Gag Rule is expected, that regulation that since 1987 disappears with Democratic administrations and reappears with Republican ones, which prohibits that health funds can be allocated to international organizations that provide services, referrals or information related to abortion (even with independent funding and in countries where it is perfectly legal to do so). The impact of this rule is also well known. Far from reducing promiscuity or the number of abortions, making access to contraception and safe abortion more difficult only increases unwanted pregnancies (and even more so among the most vulnerable women) and unsafe and high-risk abortions for women.
Climate and climate change on the back burner
The fight against climate change and for environmental health may also suffer a severe setback. In recent years, sensitivity to adverse weather events has increased as a result of the numerous catastrophes and natural disasters linked to anthropogenic climate change. Despite this, a denialist government could block funding for climate action and justice and curbing global warming, with catastrophic consequences, which are looking ever closer in time.
Blog
The blog entries in Salud Everywhere expand its content on humanitarian aid and cooperation, health in humanitarian crises and career advice with news, opinion and analysis.
External links
- Sullivan, 2024. What a Trump presidency means for global health.
- Worley, 2024. Trump factor raises the stakes at UN climate summit.
- Loy, 2024. What could Trump 2.0 mean for humanitarian response?
- Lynch, 2024. Will Trump gut UN family planning funds ... again?
- Ravelo, 2024. Devex CheckUp: How Trump's next term will alter global health funding.
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