🌍✊In the face of cuts to aid and the rollback of rights, how can we act for health equity? Three researchers call for sharing power and transforming solidarity into action. 🧭 Two defined concepts and examples of concrete actions for those who produce or relay health knowledge.
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1️⃣ SUMMARY
The authors describe a context of conflicts, nationalist governments that roll back acquired rights, attacks on academic freedom and cuts to international health aid, notably the dismantling of USAID and cuts to PEPFAR (p. 3). They recall an initial editorial from 2017 and the announcement in 2025 of the America First Global Health Strategy (p. 3). They present themselves as three racialised Canadian women and choose to "double down" (p. 4). They make three calls: revitalise public accountability (p. 4), embody intersectional solidarity (p. 4-5), recognise global health equity as a pragmatic necessity (p. 5). The text primarily targets researchers, global health practitioners and humanitarian workers (p. 4).
2️⃣ WHAT TO REMEMBER
1️⃣ Quantitative findings from cited sources. Documented claims and projections to distinguish. The authors indicate that USAID officially ceased its activities in July 2025, with over 80% of its programmes halted, and that cuts to PEPFAR have deprived hundreds of thousands of people of HIV treatment and prevention services (p. 3). They also mention millions of avoidable deaths possible by 2030. These are projections, not observed deaths. The study cited in reference 3 examines particularly a scenario of complete cessation of American funding, without replacement by other sources: its results must be understood in light of this hypothesis.
2️⃣ Three calls to action, made by the authors. Revitalise public accountability by documenting injustices, monitoring decisions and using knowledge to influence policies (p. 4); embody an intersectional solidarity based on a genuine commitment to eliminate power asymmetries in coalitions and to transform partnerships (p. 4-5); recognise global health equity as a pragmatic necessity, and not as a utopian ideal. This third call particularly relies on the interdependence of health systems, the links between health security and human rights, climate change and the One Health approach, which connects human, animal and environmental health issues (p. 5).
3️⃣ A return to oneself. A critical examination of one’s ally positionality. The authors invite researchers, global health professionals and privileged citizens not only to "study the oppressed", but to examine how they themselves contribute to perpetuating systems of inequity. Writing and publishing on equity is not enough: it is necessary to listen to the affected groups, learn from their experiences and mobilise collectively under their leadership. This approach also involves being accountable to them, as well as to the public (p. 5).
3️⃣ TO ACT
Framework : this editorial provides neither a step-by-step method nor a readily usable toolkit. However, it relies on conceptual frameworks and offers several examples of action. The suggestions below reflect the actions recommended by the authors for researchers, global health practitioners and humanitarian workers, whom they first address as citizens (p. 4-5).
1️⃣ Make the effects of funding decisions visible (case 1 : action requested by the document). Examples given: expose and amplify the human costs of funding decisions, translate these results into forms accessible to the public, co-create reports with civil society and community partners, link field organizations to decision-makers (p. 4).
2️⃣ Act under the leadership of the concerned groups (case 1 : action requested by the document). Listen to groups in a situation of vulnerability and marginalisation and mobilise under their leadership, for example in research, in the development of initiatives, in advocacy or in knowledge mobilisation (p. 5).
3️⃣ Build strategic partnerships (case 1 : action requested by the document). Forge partnerships with diverse civil society organisations, whether close to or distant from its positions, in the North as well as in the South (p. 4). Suggestion Practices in Health : these pathways aim at global health; their transposition to local action in France is not addressed by the document.
4️⃣ 3 PRACTICAL QUESTIONS
1️⃣ What does "public accountability" mean for the authors? The active participation of the public (communities, civil society organisations, universities, including interdisciplinary and intersectoral health professionals) to uncover inequalities and injustices supported by evidence and propose alternatives to failures in leadership, governance and democratic processes in global health (p. 4).
2️⃣ What is a fair partnership according to the text? This is not a benevolent cooperation led from a position of privilege, but a common struggle with the communities most exposed to social and health inequalities (p. 4). This requires time, perseverance and a shared vision (p. 4-5).
3️⃣ What systemic change pathways are mentioned? According to five cited regional reports: decentralise power to the countries and regions, establish sustainable funding beyond volatile aid (regional funds, global transaction mechanisms), broaden priorities beyond pandemics, towards primary health care and global health equity (p. 5, ref. 13).
5️⃣ TO GO FURTHER
1️⃣ Health Practices Blog: “For the promotion of health and democratic expression, let’s support our health agencies!”, 22 April 2025. Relay of the advocacy from the Health Promotion Federation for agencies presented as counter-powers. https://www.pratiquesensante.com/blog/annonces-28/pour-la-promotion-de-la-sante-et-l-expression-democratique-soutenons-nos-agences-de-sante-4712
2️⃣ External resource: WHO, “Responding to the health financing emergency: immediate measures and longer-term shifts”, 3 November 2025 (in English). Policy options for countries facing cuts in external aid, prioritising services used by the poorest. Press release: https://www.who.int/news/item/03-11-2025-who-issues-guidance-to-address-drastic-global-health-financing-cuts (page opened and verified on 22 October 2026). Link to the publication referenced from this press release, not opened: https://www.who.int/publications/i/item/9789240117587
6️⃣ #️⃣ HASHTAGS
#healthpractices #GlobalHealth #HealthEquity #IntersectionalSolidarity #PublicAccountability #Advocacy #SocialDeterminants #InternationalAid
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