Editorial by Prof Tiago Correia | EHMA newsletter

An editorial by Prof Tiago Correia, Professor of Global Public Health at Institute of Hygiene and Tropical Medicine – NOVA University of Lisbon and former EHMA Board Member, written for the April 2025 edition of the health management newsletter.

A shifting world, a shared responsibility: health management in the age of geopolitical disruption 

As the world grapples with a cascade of geopolitical and economic shocks, health systems find themselves increasingly at the frontlines not just of disease, but of diplomacy, economics, and global power shifts. The events of 2025 mark a turning point. The re-election of Donald Trump and his administration’s tariff regime have brought a new urgency to the conversation on ‘economic warfare’ and its implications for global health​. In parallel, the erosion of U.S. leadership in global health governance has left many low- and middle-income countries (LMICs) scrambling to reconfigure their research and funding landscapes​.

This editorial reflects on recent developments, challenges, and opportunities shaping the field of health management. It calls on EHMA members and partners to reassert health leadership where it’s needed most through collaboration, innovation, and a rethinking of how health policy is governed, funded, and practiced.

Economic warfare: an emerging health determinant 

In the past, public health responded to the visible destruction of armed conflict. Today, we face a more insidious adversary: economic warfare. Trade sanctions, currency manipulation, and targeted tariffs now threaten the supply chains of medicines, access to healthcare, and even life expectancy in vulnerable populations. Evidence already suggests that sanctions can lead to a measurable decline in population health, disproportionately affecting vulnerable populations​.

Health management professionals must now be equipped not only to plan hospitals and health budgets, but to measure and mitigate the health impacts of global economic decisions. This demands a new generation of evidence that is robust, timely, and sensitive to political and economic volatility.

The unravelling of multilateralism: what happens when leadership retreats? 

The United States has long been a cornerstone of global health financing, shaping priorities and sustaining large-scale programmes like PEPFAR. But as its policies grow increasingly domestic and security-focused, a vacuum is emerging​. Cuts to WHO and the failure to reauthorise core initiatives undermine multilateral coordination at precisely the moment we need it most.

For low- and middle-income countries (LMICs), this presents a dual challenge and opportunity: the need to rapidly diversify funding and take control of their own research agendas. It also opens space for regional bodies such as the Africa CDC to evolve into central platforms for coordination, policymaking, and capacity-building.

For other high-income countries (HICs), particularly in Europe, this moment demands a rethinking of roles and responsibilities. With U.S. influence receding, the European Union and its Member States are uniquely positioned to assume greater leadership in sustaining global public goods, financing research collaborations, and defending multilateral approaches to health governance. However, EU responses have often been cautious or insufficient in scale. The recognition of global health as a strategic priority exists, but matching this recognition with sustained investment, strategic foresight, and coherent external action remains a work in progress. If Europe is to lead, it must act not only as a funder, but as a convener of global dialogue and a champion of equitable partnerships.

Challenges for health managers: planning in an unstable landscape 

In this changing context, health managers must operate in a terrain marked by fragmentation, uncertainty, and contested accountability. The impact is felt across core areas of health system governance: supply chain reliability, human resource planning, infrastructure maintenance, and the sustainability of essential health programmes.

The imperative is clear: we must build more resilient systems that can weather not only pandemics but political and economic storms. This includes strengthening data systems, promoting health policy research that reflects local realities, and fostering cross-country learning beyond the confines of traditional donor relationships.

Toward a new model of global health governance 

What comes next must be rooted in equity, accountability, and shared governance. This applies as much to relationships between high-income and low-income countries as it does within the structures of health research, funding, and management.

South-South cooperation, regional networks, and local leadership are no longer optional; they are essential. The rise of private and philanthropic funders introduces new dynamics, but also risks, particularly if market priorities overshadow community needs​. Transparency, stewardship, and inclusivity must anchor all new partnerships.

A call to health managers and policymakers 

At EHMA, we believe that the current moment demands more than reaction; it calls for reflection, adaptation, and bold leadership. We encourage our members to:

• Engage with emerging research on the health effects of economic policies;

• Strengthen collaborations that amplify LMIC leadership and regional coordination;

• Advocate for health in all policies, including economic and trade decisions;

• Co-produce solutions with communities and ensure equity remains at the centre of all we do.

Health management must evolve to meet the challenges of a reshaped world. And while the future is uncertain, it is also rich with possibility if we choose to act, together.