Reclaiming the new era in global health: A proposal for an equity-centered paradigm

Global health is facing unprecedented upheaval, with significant donor disruptions requiring a reconfiguration of the global health landscape. While recently proposed frameworks for the next phase of global health represent meaningful progress in grappling with this context, their central weakness is not technical but normative. In this Essay, we argue that if the new global health architecture is defined without meaningful interrogation of its central purpose, then the system will reproduce the very problems it aims to solve. On the other hand, explicitly centering health equity as the organizing principle of the new "global health" brings to the foreground the shared struggles and movements of marginalized communities worldwide. In doing so, it demands a more fundamental, global reckoning with the structural determinants - politics and power - that produce ill health across and within countries. From this logic flows substantive shifts in global health functions, predicated on a social-ecological model: from substitution to mutual aid; from technical assistance to knowledge sharing; from global public goods to multisectoral common goods for all; and from mechanisms that facilitate global coordination to ones that also critically address the distribution of power and resources.