Advancing global health in an unprecedented (and unpredictable) era

When BMJ Global Health launched 9 years ago, it positioned itself as a forum to address a fundamental, paternalistic information asymmetry in global health. To quote Dr. Seye Abimbola’s launch editorial:

With its focus on ‘achieving equity in health for all people worldwide’, global health is inherently and unavoidably paternalistic…the people in control of resources to address global health challenges often do not have adequate information to design and implement effective interventions in contexts far removed from their own realities. Likewise, the disadvantaged people who typically constitute the target of global health interventions also often do not have adequate information to help themselves.¹

BMJ Global Health set out to be “an open and inclusive forum that brings together and addresses the broad community of global health stakeholders.”¹

9 years later, bridging the information asymmetry remains as vital and as pressing as it was at the birth of this journal. At the same time, the landscape of global health has evolved dramatically, creating massive new challenges that demand our attention. Most notably, the COVID-19 pandemic highlighted the deep interconnectedness of health systems and the abject failure of isolationism.

And yet, I write this editorial on the day after the USA has sworn in a new president who has withdrawn the country from the Paris Climate Accord² and the WHO.³ I write as his executive orders⁴ have made access to medicines more difficult in the richest country in the world—deepening its health inequities—and as his administration has shut down all scientific review at the National Institutes of Health.⁵

I also write as ongoing conflicts in Palestine, Sudan, Democratic Republic of the Congo, and Ukraine claim more lives than have even been able to be counted, and as the world struggles to come to terms with the fact that one of these conflicts has been declared as possibly or plausibly genocidal by multiple international organisations.6,8

It is impossible to predict what will have happened between the writing and the publication of this editorial.

Amid this rapidly changing and deeply uncertain global health landscape, BMJ Global Health must remain committed to the quest for equity on which it was founded. And we must expand our understanding of where these problems exist and how they manifest.

To begin with, the notion that global health is about health that happens ‘over there’ must end. To quote the late Farmer’s 2011 commencement address to the Harvard Kennedy School, ‘The word ‘global’ should not deceive us: Boston is on the globe, too and some people in the USA suffer from deficiencies in infrastructure and personnel not all that different from what I saw in rural Haiti in 1983.’⁹

To that end, this journal will be committed to addressing barriers to healthcare access among marginalised populations, wherever they are—whether this manifests as barriers to accessing care for trans children in Ireland,¹⁰ inequitable access to cancer care for rural Canadians,¹¹ or the effect of insecticidal bednets on malaria in Burundi.¹²

The journal will also prioritise articles that examine health systems, health financing and other macro changes. Financial risk protection is as crucial in Guinea¹³ as it is in the USA.¹⁴ Despite decades of investment, global health systems have yet to solve issues of fragmentation, inefficiency and inequitable access. And as the COVID-19 pandemic highlighted, these gaps threaten our global security.

Health system fragmentation is also evident in the conditions that these systems prioritise. The traditional ‘global health’ focus on infectious disease, nutritional support, primary care and maternal/child health has had the unintended consequence of deprioritising corridors of healthcare that many of us—who live in the Global North—take for granted. For example, nearly 70% of the world’s population lacks access to safe, timely and affordable surgical and anaesthetic care systems¹⁵—systems that are necessary to address 30% of the world’s disease burden.¹⁶

The journal must also confront the ways that technological advancement, particularly artificial intelligence (AI), intersects with existing health disparities. While the promise of AI is great, the substrate on which it has been built is deeply inequitable. AI systems trained on non-diverse datasets risk embedding existing health inequities, opening an entirely new dimension in the ‘information problem’ our journal originally sought to address. Given that current AI systems are literally incapable of generating images of a Black African doctor caring for a white child,¹⁷ we must acknowledge, address and combat its potential to perpetuate systemic racism.

Finally, climate change has emerged as perhaps the most pressing global health challenge of our time. Its effects disproportionately fall on vulnerable populations, serving both to exacerbate existing threats and, simultaneously, create new ones. Global health’s focus on ‘health over there’ must also reckon with its role in furthering this crisis.

To sum up: as we enter the next chapter in BMJ Global Health, the journal will continue to adhere to its ethos of being an open and inclusive forum while actively seeking original research, commentary and analysis that address these evolving challenges. I am deeply grateful to be able to work with a committed Editorial Board to publish rigorous research across all methodologies, and to making that research freely accessible to researchers and practitioners everywhere, and particularly in the Global Majority.

I invite our readers, authors, reviewers and editors to join us in this mission. Bring the quandaries, the complexities and the solutions. Together, we can work towards solutions that recognise the truly global nature of health challenges while ensuring that our pursuit of equity reaches every corner of the globe, from New York to Nairobi, from Lucknow to London.

Mark G. Shrime, MD, MPH, PhD, FACS

Editor-in-Chief, BMJ Global Health

New York City

21 January 2025

Data availability statement

No data are available.