Five ways we can respond to a Trump Administration
By Veronica Le Nevez
This article was first published on croakey.org and is reproduced with permission.
As the news started to filter out from America that Donald Trump had been re-elected to the White House, hearts sank across the global health community. As a President who sees little value in institutions like the World Health Organization (WHO) and who has sought to withdraw from or de-fund them, his re-election is certainly worrying.
But it would be foolish to focus solely on Trump. He will come and go, but unless the causes of political dissatisfaction are addressed, more Trump-like figures will fill the void.
Indeed, even if Kamala Harris had won the election, it is likely that she would have faced a divided and combative Congress that has struggled to find consensus on many issues for the last several years.
So, the question is not so much how to deal with Trump (diplomats and policy makers will already have well-formed ideas on that), but how to rebuild trust in the foundations of our democratic institutions, including global health bodies like the WHO.
1. Take a systems approach
A systems approach recognises that in complex situations, simple fixes rarely exist.
Solutions need to come from working together across specialities. The relationships and feedback loops within systems need to be recognised and addressed rather than focusing on a narrow slice of the issues.
Back in 2006, I was working on the establishment of a marine conservation reserve in NSW. Some of the fringe opponents of the reserve regularly raised their belief that it was a plot by the UN ‘World Government’ to undermine their (perceived) rights to fish anywhere.
Fringe debates about personal rights versus community good have been amplified by the algorithms of social media, fed by state-sponsored bad actors and adopted by populist leaders as a route to power.
We need to take a more sophisticated approach to global health, consider the wide range of inputs and feedback that affect it, and restore community faith in democracy.
For example, a couple of weeks ago I met with climate activists from Kiribati and Tuvalu, two of the most vulnerable nations to climate change. They spoke about how their drinking water is becoming brackish because of saltwater intrusion caused by rising sea levels, and how this has caused health impacts.
It has also impacted their ability to grow their own food, and they rely heavily on imported food. The change in diet towards more highly processed foods has caused a sharp rise in non-communicable diseases such as type-2 diabetes, hypertension and cardiovascular disease.
And not everyone has equal access to scarce fresh water and food – some foreign embassies have greater access than local populations as they have funded their own supplies.
There is a complex interplay between environmental issues, health, governance, financing and commercial interests. We need to continue to support and advocate for cross-sectoral collaboration including community participation and co-production to achieve meaningful progress.
2. Sharpen the ‘why’ for global health
The election of Trump is a loud rejection of the status quo. If we accept the view that every election is about the economy, we should look at inequality as a fundamental cause of political dissatisfaction.
At the macro level in the US, growth is relatively high, inflation has been reducing and wages have risen. However, income inequality remains high; in 2022 it was 25 percent higher in the US than the OECD average, and the relative poverty rate was 50 percent higher.
The high cost in the US of basic services, including healthcare and a limited social safety net, are impacting households.
If people on average incomes can’t afford to get sick, why would they want their government financing health in other countries?
Advocates need to re-engage with policy makers on what makes global health a sound investment to a potentially hostile audience.
A greater focus on co-benefits to donor nations and quantifying the benefits and costs of investments will be necessary. Achieving the green light on investments from the US will likely need the personal endorsement of people the Trump administration trusts.
We will be operating in a changed decision-making environment, where the patronage of powerful people like Elon Musk and others is likely to be increasingly important.
We need to actively consider and counteract disinformation. It will be vital that advocates explain how failure to address global health issues has negative impacts in the countries where investment decisions are being made.
3. Engage in ‘shoe leather diplomacy’
As US Secretary of State, Hillary Clinton visited 112 countries building relationships through direct, personal communication.
We need to be like Hillary and engage in active leadership, advocacy and diplomacy for global health. This means engaging policy makers across parties in the US and building coalitions of support across a diverse group of nations.
As Moisés Naím writes in ‘The Revenge of Power’, “The way to strengthen democracy is not to withdraw from universalist bodies, which are the battleground for influence, but to build up alliances and… use them more effectively.”
This requires all of us to more effort to keep our multilateral institutions not just alive, but vital.
While global health isn’t a priority of the incoming administration, maintaining American power and influence is. The U.S contribution to overseas development assistance as a share of total GDP is 0.2 percent, half the OECD average.
Even a 30 percent reduction is not likely to have a material impact on the budget position of the government, but it may have a negative impact on relationships with allies and building trust in the U.S as a reliable global partner.
Development assistance for health is also a key ‘soft power’ tool – good health benefits everyone, and costs comparatively little.
The UN estimates that to achieve universal healthcare for all by 2030 would cost $58 per person per year, or $371 billion per year globally.
In comparison, the US alone spent $820 billion or 13 percent of the total federal budget on its military in 2023.
The argument we need to make is that global health is a good investment – not just for health, but to maintain international relationships that strengthen trade and security as well.
4. From little things, big things grow
One of Australia’s biggest successes in global health is the development and rollout of the HPV vaccine against cervical cancer. The technology behind the vaccine was developed by Dr Ian Frazer at the University of Queensland.
Australia rolled out one of the first vaccination programs in 2007 and is now on track to eliminate cervical cancer. The knowledge and expertise developed is now being shared across the Indo-Pacific through the EPICC program, and on 21 September, the Quad Countries Launched the Cancer Moonshot Initiative.
While continued support under the Trump administration is not guaranteed, programs like this have demonstrated benefits in both high and low/middle-income countries and are more likely to receive support from an administration with a transactional approach.
We need to take these beacons of success and grow them further. Integrating non-communicable disease screening and follow-up into existing programs such as vaccination rollouts, where appropriate, can be an effective way of increasing our impact efficiently.
Similarly, we should be looking to build in measures that strengthen primary healthcare within the target populations so that health continues to improve across multiple dimensions after the initial program has ended.
5. Be patient and determined
COP29 is currently under way in Azerbaijan. The US Special Envoy, John Podesta said that “The fight is bigger than one election, one political cycle, and one country…we are all living through a year defined by the climate crisis in every country in the world.”
Despite valid concerns about what the future might hold, progress continues. The UK Prime Minister announced ambitious new goals to cut emissions by 81 percent by 2035. New carbon market financing standards have been agreed – and more commitments and agreements will come as the conference progresses.
So I am hopeful and I encourage others to be hopeful too. Doom and gloom, however justified, sows more disengagement and undermines what we are all trying to achieve. We need to move forward with purpose, patience, determination, clarity and empathy.
Public policy will always be contested space – nowhere more so than on the international stage – and progress takes sustained effort over a long period.
We should not be too disheartened by changes in political direction, which are par for the course.
The challenge is to ask yourself what you can do in the context in which you work to advance global health. If we all take advantage of the opportunities we have to make progress, we will achieve it.
