High-Income Countries Retreat from Global Health

Introduction

In favor of focusing on domestic economic recovery, migration control, and new geopolitical strategy, high-income countries are overlooking global health in their reprioritized foreign aid plans (Nain, 2025). This retreat from investing in global health displays a departure from historically fundamental moral and legal obligations to global health and human rights. From the Universal Declaration of Human Rights (UDHR) to the International Covenant on Economic, Social and Cultural Rights (ICESCR), the right to health has been codified as a shared responsibility. However, recent policy changes suggest a breakdown in multilateral obligations. The blog seeks to explore the ideological and structural consequences of this retreat, asking what does it mean when global health is no longer treated as a collective imperative, but as a negotiable interest?

Historical Context

More than mere technical interventions, global health has a history of moral and legal obligations rooted in human rights. The right to health, as enshrined in Article 25 of the UDHR, affirms that “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family” (United Nations, 1948). This was further codified in Article 12 of the ICESCR through the obligation of state actors to act toward “the prevention, treatment and control of epidemic, endemic, occupational and other diseases,” as well as the “creation of conditions which would assure to all medical service and medical attention in the event of sickness” (United Nations, 1966; Office of the United Nations High Commissioner for Human Rights & World Health Organization, 2008). Scholars and practitioners over the past two decades have asserted global health to be rights-based and participatory (Meier & Gostin, 2018; Gostin & Meier, 2020). Additionally, Mulumba et al. (2025) argue that enforceable commitments from high-income countries are essential to the global realization of the right to health. Despite these observations, recent trends suggest a troubling retreat from these shared responsibilities.

Policy Shifts

A series of global health funding cuts, including a 67% reduction from the United States in 2025, has disrupted various health programs including those surrounding HIV, tuberculosis, and maternal health across dozens of countries (Krugman, 2025). Similarly, the United Kingdom instituted an aid reduction of 0.5% to 0.3% of gross national income by 2027, most severely impacting sexual and reproductive health rights (SRHR) (Parker & Garcia, 2021). Through the Mattei Plan, Italy restructured its aid to prioritize migration control and energy diplomacy, which reduced bilateral health programming by 26% (Donor Tracker, 2025). Canada, despite earlier commitments to scale SRHR investments, paused new global health funding in 2024, claiming to instead be prioritizing domestic equity (Global Affairs Canada, 2024). Australia deprioritized health programs through a $500 million cut from its Indo-Pacific aid portfolio in favor of strategic infrastructure and defense partnerships (Stanhope, 2024).

Citing “shifting national priorities,” the Netherlands withdrew support from SRHR, LGBTQIA+, and harm reduction programs (Meier & Gostin, 2018). Norway reduced its aid by 5% in 2024, drastically impacting emergency relief and support for low- to middle-income countries (Norad, 2025). Revising its Development Cooperation Charter to align foreign aid with national security, Japan launched Official Security Assistance (OSA) and shifted focus from multilateral health to defense and tech diplomacy (International Institute for Strategic Studies, 2024).

Germany and France have reallocated development funds toward trade competitiveness, migration control, and domestic security (Parker & Garcia, 2021). Germany, despite remaining a top donor to the World Health Organization (WHO), has adopted a transactional posture that has subordinated health to economic and geopolitical interests (Bayerlein, 2025; Bundesministerium für Gesundheit, 2025). Similarly, France launched a new Global Health Strategy and co-hosted the WHO’s Investment Round but cut global health aid by 33% amid domestic budget strain (Organisation for Economic Co-operation and Development, 2024; World Health Organization, 2025a; Krugman, 2025).

Spain and South Korea complicate this trend through selective engagement rather than full high-income country retreat. South Korea reaffirmed its leadership through strategic dialogue with the WHO, and Spain launched a new Global Health Strategy in 2025 (World Health Organization, 2024a; World Health Organization, 2024b; Donor Tracker, 2024). Despite these efforts, both countries have simultaneously recalibrated foreign policy toward economic security and technology diplomacy (Lee, 2024; Ministry of Foreign Affairs of Spain, 2025).

These are more than fiscal shifts in a world of economies. They reflect a deeper ideological repositioning. Many governments increasingly justify aid reductions through a “domestic-first” standpoint that frames global health as competing priority with national economic recovery, rather than as a complementary one (Center for Development, 2025). Others prioritize defense, trade, and migration over health equity as a geopolitical strategy. This logic is echoed across the philanthropic sector, where the Gates Foundation’s 25-year sunset plan embodies a transition from broad global health engagement to a finite, legacy-oriented agenda (Gates Foundation, 2025; Shefcik, 2025). This recalibration, framed as a pivot toward “achievable” goals, reflects the broader trend of donor fatigue and feasibility framing. This trend suggest that global health priorities are now shaped by power asymmetries, short-term metrics, and political expediency rather than solidarity across shared interests (Abimbola, 2021).

Human Rights Implications

We have already begun to feel the consequences of these shifts. UNAIDS (2025) warns of the impact felt in countries like Tanzania and Uganda, which have seen closures and disruption in HIV clinics and other essential services. These disruptions, as documented by Physicians for Human Rights (2025), threaten to reverse decades of progress in HIV prevention and treatment. UN agencies are also warning that gains in preventable death reduction from maternal health programs could be lost (World Health Organization, 2025b). These disruptions disproportionately affect marginalized populations and violate core human rights obligations (Meier & Gostin, 2018; Gostin & Meier, 2020; UNRIC, 2025). The WHO has reported that over 70% of surveyed countries are experiencing similar health system breakdowns due to aid withdrawals (World Health Organization, 2025c). These outcomes show the severe impacts of eroded accountability measures within global health governance (Parker & Garcia, 2021).

Domestic Consequences

High-income countries are not exempt from the consequences of the retreat from global health. Parker and Garcia (2021) argue that isolationist health policies create blind spots that leave even wealthy nations vulnerable to transnational threats. Weakened pandemic preparedness, undermined surveillance systems, and limited coordinated response capacity are all side effects of reduced engagement (Bond, 2025). Perhaps more significantly, the public is experiencing a breakdown of trust in health institutions. Amid a growing crisis of confidence in public health leadership, calls for renewed efforts to restore institutional legitimacy are on the rise (Leslie, 2023; Cooper, 2025). Withdrawing from global health commitments not only abandons vulnerable populations globally but also compromises the moral leadership and resilience of high-income countries.

Closing Reflection

Beyond restored funding, a reorientation of values is necessary for a rights-based recommitment to global health. This requires the abandonment of performative pragmatism for enforceable obligations to solidarity and justice. It demands the centering of marginalized voices, the rebuilding of institutional trust, and the recognition of global health as a shared infrastructure of resilience, rather than a zero-sum game of political maneuvering. The consequences of this retreat – from disrupted HIV clinics to weakened pandemic preparedness – must be confronted as we forge a new path rooted in justice. Furthermore, for a more equitable and secure world, it is a strategic imperative that we reclaim global health as a human right.