The Tragic Irony of Global Health Decolonization
The far left and far right have found an unfortunate common cause: dismantling global health
“We are only going to give foreign aid to those who respect us and, frankly, are our friends,” President Donald Trump told the United Nations General Assembly in 2018. That speech foreshadowed what has now become one of the most consequential shifts in U.S. foreign policy in decades. By 2025, the second Trump administration had enacted a 90% reduction in USAID foreign aid contracts, amounting to $60 billion in cuts to global assistance. As a result, global health funding, humanitarian programs and development partnerships—once pillars of U.S. international engagement—have been systematically defunded or dismantled.
While these actions came from a Republican administration, they mirror the calls made by the “decolonize global health” (DGH) movement, which, during its peak amid the COVID-19 pandemic, advocated for the dismantling of Western-led global health institutions. In some of the biggest medical and public health journals, such as The Lancet and The British Medical Journal, global health thought leaders argued that their field, rooted in colonial legacies and power asymmetries, needed to be defunded, disrupted and radically reimagined. Some even suggested the entire architecture of aid and development should be obliterated to make way for a more just system. At its most radical, the DGH movement rejected reform as insufficient and viewed existing institutions as irredeemable.
This is where the irony emerges. The very outcomes championed by elements of the decolonize movement—withdrawal, defunding, dismantling—are now being realized, not by left-wing critical scholars or Global South governments, but by the populist right. The demands made by the DGH movement at its peak are now being enacted by the political forces it never intended to empower. The left, in its moral urgency, helped legitimize a narrative that is now being weaponized from the opposite ideological end. How could the far left and the far right come to agree on the importance of dismantling global health?
Global health, like its sibling fields of humanitarian assistance and international development, is undoubtedly imperfect. It operates in a profoundly unequal world—one shaped by stark disparities in wealth, health and political power. In this context, global health takes on the formidable task to improve, however incrementally, health outcomes of those most in need of help. Critics of the field, like public health scholar Seye Abimbola in his recent book “The Foreign Gaze,” argue that global health has long obscured the political and historical roots of inequality and prioritized technical solutions over systemic change. These critiques are worth engaging with seriously. But when this dissatisfaction is framed in absolute or ideological terms—positioning the entire system as fatally compromised—the analysis can become untethered from reality.
In a recent article in The Free Press, historian Niall Ferguson describes how Donald Trump’s foreign and economic policy has led to what he calls a “wild decolonization”—an American retreat from internationalism, including its leadership in global health. Rhetorical provocations aside—such as suggesting the annexation of Greenland or Canada—Trump’s approach has been characterized by deliberate disengagement from multilateralism. From trade to aid, the U.S. has withdrawn from many of the institutions it once led. Whether or not one accepts this framing of a collapsing liberal order, the consequences for global health are devastating.
The U.S. has scaled back foreign aid, initiated withdrawal from the World Health Organization and the UN Paris Agreement, weakened USAID and reduced support for National Institutes of Health global research partnerships. The results have been disastrous. The freeze on the “President’s Emergency Plan for AIDS Relief” (PEPFAR), for instance, initially launched in 2003, has disrupted access to antiretroviral treatment for millions of people living with HIV in sub-Saharan Africa. Some projections suggest hundreds of thousands of preventable deaths could follow.
USAID’s diminished capacity has led to gaps in maternal health services, pandemic response and humanitarian relief. Global research collaborations on malaria, tuberculosis and vaccine development also have been curtailed. This is more than a retreat. It is, in many ways, a deliberate dismantling—driven by actors who reject the very premise of the U.S., and by extension Western liberal democracies, as legitimate actors in global solidarity—a position the decolonization movement and the populist right appear to share.
But the philosophical claim at the heart of the DGH movement—that because global health emerged during the colonial era, it must therefore be a colonial project—is more an assertion than an argument. This logic gained traction in academic and institutional spaces. During the pandemic, academic journals, universities and health NGOs responded with a period of institutional self-reflection, examining how organizations based in high-income countries might shift power and decision-making to low-income countries and address the ways they perpetuate unfair structures. Yet, others took this to the extreme and asked whether global health, as a concept and a practice, could be redeemed as a force for good.
This moment brings to mind Moynihan’s Law: “The amount of deviation from the ideal tends to increase as conditions improve.” In other words, the better things get, the more unacceptable the remaining flaws appear. During what was arguably one of the most effective periods in global health history—with major advances in child survival, HIV treatment and vaccine distribution—many institutions turned inward, questioning their own legitimacy. This period of self-questioning coincided with a growing consensus to shift power toward low- and middle-income countries, as reflected in USAID’s localization agenda. Yet the tone of the critique may have obscured the scale of global health’s achievement—and the fragility of the systems behind it, which have always depended on the political will of donors and taxpayers to support people in distant countries with no immediate benefit to themselves.
Today, global health is not only under critique; it is underfunded to the point of collapse. The people most affected are not those writing op-eds or attending academic conferences. They are the patients in under-resourced clinics, mothers walking hours to find closed dispensaries and healthcare workers continuing their jobs without pay. The DGH movement sought transformation. But some of what it demanded—defunding, disengagement—has arrived, albeit from the political right. And the result is not greater equity; it is erosion.
This matters now because there is a blind spot in our collective understanding of where this populist-right push to dismantle global health came from. Without acknowledging the intellectual and institutional conditions on the left that gave it space to grow—or the rhetorical cover it has benefited from—we cannot fully grasp what is happening, let alone mount a coherent response.
The hope now is that multilateral institutions and new coalitions of international actors can step into the breach. That will require a rebalancing of power, but also a renewed commitment to humanitarian and internationalist principles—principles that, even when flawed, are better than disengagement. Calls to dismantle global health systems, however well-intentioned, may only accelerate their destruction.
Pandemics are often followed by periods of social and political realignment. We are in such a period now, and it calls for clarity about the assumptions shaping our actions—across ideologies, disciplines and institutions. The global health sector has long valued its culture of self-critique. That should continue. But so should our recognition of and support for what works, even if progress is partial, incremental or unfinished. A reflexive critique that cannot distinguish between limitation and failure risks undermining the very gains it seeks to protect.
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