The future of global health in the US

December 3, 2024

In the last couple months, I’ve met with global health faculty and trainees at several U.S. universities – the University of Notre Dame, Brown University, Dartmouth College, Duke University, and the University of North Carolina at Chapel Hill. This experience has given me some new insights into their challenges and aspirations.

Read recent commentary on global health research issues from current and immediate past directors of the Fogarty International Center.

Generally, faculty and students on the campuses I visited are actively engaged in global health research and were eager to learn more about NIH’s support for scientists both in the U.S, and in low- and middle-income countries (LMICs). Many of them had received Fogarty support, which had given them the exposure and experience to deepen their interest and skills to take their careers to the next level. Several faculty were from LMICs and are now based at U.S. universities with ongoing collaborations in their countries of origin.

A few common themes arose. These U.S.-based researchers want more equitable partnership in their LMIC collaborations, moving beyond the era of the U.S.-based researcher developing the research question and securing the funding. They view the current model as putting the LMIC co-investigator in a less-advantaged position in outlining the scientific priorities, managing resources, and serving as first and last (senior) authors on publications. Fortunately, investigators are well-positioned to center co-leadership in their research collaborations. There is increasing recognition for the mutual benefit of global research partnership, with funding from NIH, philanthropic organizations, and LMIC governments, among other sources. And, thanks in part to support from Fogarty over the last several decades, research capacity has been strengthened in LMICs worldwide, with researchers poised to work in full partnership with their U.S. colleagues. There is room for both U.S. and LMIC scientists to generate research questions and lead or co-lead on health studies, with clear governance agreements among them for equitable collaboration.

Another concern has been when early-career U.S. scientists with relatively little training and experience make short visits to LMICs to provide expert guidance in these settings. There is a historic perception that the flow of expertise was unidirectional – from the U.S. to the LMICs. To counter this in recent years, there is increasing recognition and support for what is called reciprocal innovation, with co-creation and bilateral flow of ideas and new interventions between the U.S. and LMICs.

Lastly, there are questions about the definition and the future of global health. For the U.S. researchers, their work in LMICs is considered “global health.” But from the perspective of their LMIC colleagues, the field is simply “health.” There have been many recent calls to “decolonize” and reimagine global health for the 21st century.

There was a marked increase in global health at U.S. universities in the 2000s, driven by factors including the HIV pandemic and the increased availability of resources through the U.S. President’s Emergency Plan for AIDS Relief, media attention to other health crises such as Ebola outbreaks, and the influence of public figures such as Dr. Tony Fauci and the late Dr. Paul Farmer. Some universities began offering an undergraduate global health major, which became the most popular major at some institutions. But there are now some indications that the interest in global health among U.S. trainees has peaked. For some training programs, there are still plenty of highly qualified U.S. applicants but fewer than in previous years. And in some U.S. global health master’s degree programs, many or even most of the applicants and students are now foreign nationals, mainly from LMICs.

While in North Carolina, I was the keynote speaker for the annual meeting of the North Carolina Global Health Alliance. This is a vibrant meeting with hundreds of attendees from the many world-class institutions in the state. Reciprocal innovation was the explicit theme, “exploring how global learnings can be adapted to and from local North Carolina settings.” I met with poster presenters reporting on issues such as violence against children and support for breastfeeding in rural North Carolina. I asked them why they were presenting at a global health conference; they said they were in global health master’s degree programs, but their practicum projects were based in North Carolina. Two of the trainees had come from Africa to study health challenges here in the U.S.— opposite of the usual U.S. trainee going to Africa to study challenges there. They said they were proud of their contributions in North Carolina and the skills they had learned would transfer well back to their home countries.

It was striking to see the emerging contours of a re-envisioned global health, in which a bidirectional flow of faculty and trainees address common health challenges with equitable relationships and mutual respect between U.S. and LMIC researchers and institutions. In this model, U.S. universities will continue their critical role as beacons of scientific inquiry and service to the global community. And Fogarty will continue to support global health research partnerships and capacity strengthening as these new models of collaboration continue to evolve.

Updated December 3, 2024

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