Global Health Futures research network aims to re-envision global health

The past few decades have been good for population health. Worldwide, life expectancy has risen from 46 years in 1948, when the World Health Organization was founded, to 73 years in 2024, driven largely by dramatic drops in maternal and child mortality and steady improvements in adult mortality. Global health programs, which are typically funded and led by people and institutions based in wealthy countries, have played a key, but at times controversial, role in this achievement.

But now, priorities in some high-income countries are shifting. Funding streams are drying up, and political will to support global health efforts is weakening. At the same time, public health leaders in low- and middle-income countries are seeking a greater say in how global health research is conducted and programs are delivered. 

WashU School of Public Health has launched the Global Health Futures research network to re-envision the future of global health at this moment of change. The network aims to find innovative ways to advance collaborative research that builds on the success of the past, but with an increased emphasis on closing health gaps among and within countries; translating global knowledge, insights and interventions to local contexts; and strengthening international partnerships to achieve shared health priorities. Global Health Futures will host its inaugural convening, “Building for a New Era of Global Health,” on April 14 at WashU and online. The event will bring together leading voices to discuss the future of the field. To attend, register here. 

“The rapidly shifting global health landscape, especially the changing governance and funding structures, will create new frontiers to improve the health of the global population,” said Salma Abdalla, MBBS, MPH, DrPH, an assistant professor at WashU School of Public Health and one of three co-directors of the network. “Global Health Futures aims to anticipate these transformations and develop adaptive approaches grounded in the strengths of WashU and emphasizing connections between local and global contexts.”

The network is focusing on addressing the underlying forces and factors that shape the health of populations everywhere in the world: political and social structures, economic systems, the environment, health systems, demographics, and the cultural and social context. 

Consider cardiovascular disease. Until the early 20^th century, infectious diseases were the No. 1 cause of death worldwide. But sanitation, improved living conditions, antibiotics and vaccines have pushed infectious diseases out of the top spot. That position is now occupied by cardiovascular disease, which is responsible for a third of all deaths. The aging of the world population, inadequate health systems, unhealthy eating and physical activity habits, and structural inequities — each contributes to why cardiovascular disease kills an estimated 20 million people every year. 

“The playbooks for cardiovascular disease are quite clear,” said cardiologist Mark Huffman, MD, MPH, the William Bowen Endowed Professor of Medicine at WashU Medicine, a member of the secondary faculty at WashU Public Health, and a co-director of Global Health Futures. “We know how to prevent, screen, diagnose, treat, and control cardiovascular diseases. Yet it’s not done. Globally, most people who have had a heart attack or stroke take zero medicines to prevent another one. There are a lot of social, structural, political reasons why that is. That’s where Global Health Futures is focused. We’re trying to think about, ‘If you have this playbook and yet it’s not implemented, why is that? And what can be done to change that?’”

Answering that million-dollar question — “What can be done to change that?” — requires rigorous research and well-designed interventions, tailored to cultural and social contexts. Historically, public health work has been conducted in populations in high-income countries or by researchers based in high-income countries, and then adapted for low- and middle-income countries. But there is growing recognition that richer countries don’t have a monopoly on good ideas, and that tackling a problem of the magnitude and complexity of cardiovascular disease requires sharing knowledge on a global scale.  

“In my view, the promise of global health research is the opportunity to look at specific disease areas and say, ‘Where are we succeeding; where are we not succeeding; how can we take lessons learned from the places where we are succeeding, adapting those lessons, and seeing what we can implement in other locations so that we’re bringing them along?’” said Joshua Bogus, MPH, senior network manager for Global Health Futures.  

One of the goals of the network is to promote so-called global-to-local translation, transforming the historical one-way pipeline into a web in which evidence, insights and solutions flow in all directions. For example, the U.S. could learn a lot from other countries about how to encourage people to eat less salt, said Huffman. High salt intake is associated with high blood pressure and increased risk of stroke. 

“I recently participated in a meeting on front-of-pack food labeling using a nutrient profiling system in Nigeria,” Huffman said. “Nigeria set national standards for how much sodium can be in food. That’s a mandatory limit based upon data that we collected in Nigeria. Boy, it would be great to create a healthier, level playing field in the United States through similar policymaking. That’s been under discussion for decades and never implemented, despite the health benefits that have been observed in a lot of other countries.”

St. Louis is a natural place from which to take on the work of global health because it is a microcosm of the contrasts that exist around the world. The urban center of a rural area, the St. Louis region faces both urban and rural health challenges, as well as a political and cultural divide that partially breaks along urban-rural lines. The state of Missouri spends $7 per resident per year on public health, the smallest sum among all 50 states and the District of Columbia. There is an argument to be made that Missouri is a resource-limited setting when it comes to public health, and that it shares common challenges with settings in low- and middle-income countries.

“Scarcity is something that you can think about across contexts,” Abdalla said. “For example, a lot of work on how to provide HIV care under conditions of health-care scarcity has been done in South Africa. Now it is being applied to rural Missouri.”

Global Health Futures is one of six research networks at WashU School of Public Health that together form an interconnected system to advance innovative research to solve the biggest public health challenges. It also will build on a strong foundation of global health research at WashU. The university is home to leading scientists who have made notable achievements in traditional global health areas such as improving child nutrition and eradicating parasitic worm diseases. The university also has strengths in fields that were historically outside the scope of global health, but that are increasingly recognized as worldwide problems that could benefit from a global perspective, such as mental health and injury prevention. The network leadership is working to build connections among researchers across and outside the university, and facilitate the translation of expertise and skills gained locally into global contexts. 

Tamara Schneider, MPH, PhD, is the assistant director of communications and senior science writer at WashU Public Health. She holds a double bachelor’s degree in molecular biophysics & biochemistry and in sociology from Yale University, a master’s in public health from the University of California, Berkeley, and a PhD in biomedical science from the University of California, San Diego. She joined WashU as a science writer in 2016.