Global Health, Human Rights, and Car Crashes

Speech to the American Public Health Association Annual Meeting, November 2025

Joseph J. Amon

My first thought when invited to speak at this American Public Health Association annual conference about current challenges in global health was of a time a couple of years ago when I was nearly in a car accident.

I was driving in the far-left lane on I-95 just north of Philadelphia. There’s a launch point a few miles north of the city where traffic speeds up. The road gets a bit wider, with a large shoulder. Oddly, there’s often a lot of living room furniture abandoned in the shoulder: sofas, side tables, the occasional laz-e-boy recliner.

But this particular day, just after that point, after everyone had stepped on the gas, the traffic came to an abrupt halt and I slammed on my brakes and looked in my rearview mirror. In the mirror I saw a guy in a Honda accord coupe barreling towards me. Then suddenly he’s in the shoulder next to me, struggling to keep control and at about a 45-degree angle inches away from my door. Then he crashes, into the car in front of me. The cars backed up behind me for miles.

That seems to me a good analogy for current challenges in global health.

Let me break it down. First, just like I-95, US global health work serves vital national interests. Second, global health work is sometimes clogged with debris—with bad approaches and poor execution. Third, there isn’t really an alternative to I-95, or engaging in global health work—we live in a world where we are intimately connected, where people and pathogens cross borders daily, and where our own self-interest is tied to ensuring that others around us are safe and prosperous. Fourth, sometimes you get lucky, but the person in front of you might not.

Present realities in global health 

As you surely are aware, one of the first acts that President Trump took once in office was to sign an executive order freezing US foreign development assistance. This was followed by the closure of USAID. Analyses by the Kaiser Family Foundation found that 80% of global health awards were terminated, affecting more than $12 billion in funding. Approximately 5,500 USAID staff were fired or placed on leave.

US funding suspensions in turn led to the termination of thousands of community health workers in countries around the globe. Some countries were better off than others, depending on how much their own contributions had been to health programs and how reliant they were on donor support.

The Trump administration then withdrew from the World Health Organization (WHO) and ordered the Centers for Disease Control and Prevention (CDC) to stop working with, and communicating with, the organization.

The administration zeroed out funding for international organizations like Gavi and cut funds to the Global Fund. CDC staff working in global health have also been cut, furloughed or have retired.

In September, the administration released the America First Global Health Strategy. The strategy has 3 broad pillars—making America safer, stronger, and more prosperous. These pillars would work, more or less, equally well in the Department of Transportation.

The government’s global health strategy focuses on HIV, TB, malaria, polio, and global health security. This is far from a comprehensive, or rational, approach to addressing global health issues.

An overall goal of the strategy is to transition countries to full self-reliance—that is, to end the US commitment to global health. Specifically, the strategy says that the US will provide 100% of current levels of funding for health commodities and frontline healthcare workers for a year—and then start reducing funding.

Overall, the administration’s FY 2026 budget request includes a 50% reduction in funding for global health. The administration also submitted to Congress requests to claw back just under a billion dollars in funding for PEPFAR and other global health programs.

These cuts have real world impacts.

Modeling studies have projected significant increases in maternal and child deaths and a significant rise in new global HIV infections. It doesn’t take very sophisticated modeling to figure this out. Reports from southern Africa indicate shortages of antiretroviral drugs and HIV test kits. Funding for TB programs has been significantly reduced and despite new vaccines, malaria deaths are expected to increase, primarily affecting children. The increasing burden of NCDs, environmental health, and sexual and reproductive health are disfavored.

Despite the administration’s interest in global health security, US funding cuts have undermined a network of 50 countries focused on surveillance of emerging diseases and an emergency response system that significantly reduced global outbreak response times is no longer in place.

The USAID-funded Famine Early Warning Systems Network (FEWS NET), which was started in 1985, was shut down in early 2025 due to funding cuts, crippling our ability to predict and respond to impending famines.

However, in June, FEWS NET was brought back to life. Of course, bringing back the ability to track and prepare for famine means little if funding for aid to address the famine is not restored.

Build Back Better

But it’s not enough to just identify challenges. We also need to look forward. We can learn from post-disaster recovery plans, such as the World Bank’s “build back better” initiative, which seeks to reduce vulnerability to disasters and build community resilience. We also need to emphasize human rights—a traditional foreign policy concern of the United States but not a high ranking one of the current administration.

Paying attention to human rights is crucial for achieving global health goals because it addresses the systemic inequities and discrimination that are root causes of poor health. A human rights-based approach acknowledges that health disparities are often a result of social, economic, and political factors rather than just a lack of medical care. By integrating human rights principles, global health efforts can become more effective and sustainable.

Human rights principles, such as nondiscrimination and equity, require global health initiatives to prioritize the most marginalized and vulnerable populations, and to address discriminatory laws and practices that create barriers for people who use drugs, sex workers, and LGBTQ+ individuals to access healthcare and improve health outcomes.

A rights-based approach transforms individuals from passive recipients of aid into active rights-holders who can hold governments and other powerful actors accountable. A focus on participation ensures that health policies and programs are developed collaboratively with communities, making them more culturally appropriate and effective.

Human rights also provides a legal framework that obligates governments to work toward the highest attainable standard of health, using the maximum available resources. Mechanisms for monitoring and reviewing states’ compliance with human rights standards promote transparency and accountability in health systems. This shifts the focus from simple charity to legal obligation, offering a more powerful tool for change.

I am aware that this vision is, shall we say, out of sync with current administration priorities.

But often in public health we are uncomfortable or unfamiliar with rights-based approaches, preferring technocratic solutions which ignore on the ground realities.

Let me give you an example.

A few years ago, I was at a meeting at UNAIDS in Geneva on the issue of “HIV hot spots”—focusing attention on places where HIV transmission was acute.

But the framing of “hot spots” epidemiologically elides a political reality. “Hot spots” are not just places where “key populations” like sex workers, people who use drugs, and men who have sex with men gather, they are places where police often harass and abuse individuals whose behaviors, or identities, are criminalized and interfere with their access to HIV prevention.

Rather than mapping “hot spots” US global health programs should map human rights violations, such as where HIV peer educators are being arrested for distributing condoms, or stockouts of HIV medicines are occurring, or the quality of health care is poor, or  “hot spots” of stigma and sexual violence abound. In other words, they could map the drivers of HIV transmission.

Another failed approach in my view is the way public health practitioners identify individuals as “hard to reach”. In my experience, it is not that individuals are hard to reach as much as that no one is trying to reach them.

Public health researchers, too, seem to be hard to reach at times, failing to investigate the political determinants of health that drive public health inequities.

This is perhaps the real challenge facing global health, and domestic public health as well—how, as a field, do we acknowledge the complexity of those we are trying to reach—the different needs they have and barriers they face to prevention and treatment, rather than using one size fits most models.

Thirty years ago, Jonathan Mann wrote about how the dialogue between public health and human rights can define more clearly the challenges we face and spark new approaches to advance public health. At the same time, he warned that human rights would be unfamiliar to many within the field and that resistance to adopting rights as the foundation of public health would be common, because addressing root causes requires societal transformation—an approach that would be seen as too radical.

But perhaps not quite as radical as the policy decisions coming from a few blocks from here in Washington D.C.—slashing global health assistance and multilateral partnerships and reimagining global health in transactional terms.

Mann wrote that the strength—and weakness—of traditional public health is that it develops its programs, activities, and services within the existing societal framework. He recognized that governments (and public health practitioners) may well wish to avoid confronting root causes, in favor of addressing only the “surface expressions of these causes” that is, specific diseases. With Trump’s America First Global Health Strategy we see again this emphasis on addressing diseases in silos, rather than acknowledging what makes individuals vulnerable across multiple threats from viruses, protozoan parasites, bacterial infections, as well as from environmental health threats and non-communicable disease.  

In my work with the Global Fund evaluating rights-based interventions over the past five years, I have found models of how root causes can be addressed and the right to health advanced. For example, the Global Fund has supported, as part of its “breaking down barriers” initiative, integrated teams of peer educators, paralegals, social workers, psychologists, lawyers, and public health experts working together to ensure that individuals coming to health centers are able to navigate all of the potential rights issues they face—from fears of discrimination and uncertainty about HIV disclosure to the need for protection from domestic abuse or the provision of sexual and reproductive health care.

Unlike many public health programs that engage in a kind of magical thinking that slogans can change deep prejudice, the programs I saw were based on close listening and support.

Clearing the car crashes

Coming back to my analogy of a car crash, the ways in which we have done global health in the past are, figuratively, in a pile up just north of Philadelphia. There are injuries, chaos, bad and good actors, and the traffic is not going to clear up quickly.

The journal Foreign Affairs published this past July an article entitled “The End of the Age of NGOs?”. The article explores the decline of non-governmental organizations (NGOs), which have been the main implementing strategy for US engagement in global health for decades.

The authors describe how during the 1990s, which is when my career in global health started, NGOs flourished, gaining influence in global governance, advocating for human rights and development, and delivering humanitarian aid. They were seen as vital players in shaping policies and providing services, often filling gaps left by governments.

Things have changed. The sector has faced political repression and financial challenges. Legitimate questions have been raised about the effectiveness and accountability of NGOs and, less legitimately, governments have increasingly restricted NGO activities, particularly in authoritarian regimes, where leaders fear that NGOs could foster democratization or challenge their authority.

Countries like Russia, India, and Ethiopia have implemented laws to limit foreign-funded NGOs, often accusing them of political interference. Meanwhile, nondemocratic states have benefited from the suppression of NGOs, reclaiming power and reducing external pressures to uphold liberal norms.

I’d like to end this presentation on a positive note, but honestly it is difficult to look at the field of global health today and see anything other than a car crash.

I’ve been asked in the past, in reference to my work on health and human rights, how I have managed a long career fighting difficult battles and seeing—and pushing back against—human rights abuses. My answer is always that there is no alternative but to push forward, to fight to ensure that the values we share—to advance the right to health globally—are realized, and to understand that this won’t come quickly, it won’t come without obstacles, and it won’t come without periods of moving backwards.

Car crashes are eventually cleared. Traffic picks up its pace. There’s no other road to travel but to work toward the realization of the right to health for all.

Joseph J. Amon, MSPH, PhD, is Desmond M. Tutu Professor in Public Health and Human Rights, director of the Center for Public Health and Human Rights, and a distinguished professor of the practice in the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, and editor-in-chief of Health and Human Rights.