Complicating The Narrative

What happens when the global health architecture built over 80 years is changed drastically in 16 months and what should replace it?

Dr. Gbenga Ogedegbe is the Dr. Adolph & Margaret Berger Professor of Medicine and Population Health and the director of the Division of Health & Behavior in the Department of Population Health at NYU Grossman School of Medicine. His research focuses on the prevention and treatment of cardiovascular diseases among minority and low-income populations in the US and sub-Saharan Africa. Dr. Benjamin Mason Meier is Professor of Global Health Policy in the Department of Public Policy and the Department of Health Policy and Management at the University of North Carolina at Chapel Hill. His research focuses on human rights frameworks in global health law.

Gbenga and Ben join Salma, right after WashU's Building for a New Era of Global Health convening, to trace how the post-war global health system was built, what it achieved, and the tensions it carried from the start: vertical, siloed, funding; neocolonial dynamics; the securitization of health; and a deficit-focused, donor-centric approach that left recipient countries with infrastructure they didn't control. They then turn to what has changed over the past year—the simultaneous withdrawal of U.S. funding across USAID, PEPFAR, and NIH, the exit from WHO, and the decline of European contributions—and what that means for active programs on the ground, from HIV clinics in Lagos to safety-net health centers in Brooklyn.

The conversation then moves to what comes next. Gbenga makes the case for reciprocal innovation drawing on his own work adapting task-shifting strategies between Ghana, Brooklyn, and Nigeria. Ben argues for the enduring power of global normative standards and human rights frameworks to guide health policy even when funding disappears. Both push for a shift in how the field communicates and for governments in the Global South to increase domestic health financing rather than wait for donor systems to return.

This episode offers a clear-eyed history of global health as we know it, an honest account of the crisis it faces, and reason for hope about what comes next.

 

Useful resources:

WashU School of Public Health. Building for a New Era of Global Health. 2026. https://www.youtube.com/watch?v=3mLohUgBu9U

Host: Dr. Salma Abdalla

Editors: Catalina Melendez Contreras

Marketing: Kinkini Bhaduri

Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

 

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.

How do public health institutions experiencing declining public trust go about becoming trustworthy again?

Erin O'Malley is the Executive Director of the Coalition for Trust in Health and Science, a coalition of more than 90 organizations working to enhance public trust in health and science. With nearly two decades of experience in health policy, advocacy, and cross-sectoral partnership, Erin leads an organization grappling daily with one of public health's most pressing and contemporary questions.

Erin joins Salma to discuss trends in trust in health and science in the United States—from the lasting impact of the Covid pandemic to the role of political polarization in eroding institutional trustworthiness—and what it actually takes to rebuild it. They discuss what the coalition has learned about the mechanics of trust-building across the health and science ecosystem, why community-level listening and interpersonal communication matter as much as institutional messaging, and how the language we use can impact public engagement and trustworthiness.

This episode will challenge how we talk about and classify information, explore the difference between being trusted and being trustworthy, and offer practical frameworks for how individuals, practitioners, and organizations can navigate an increasingly complex information landscape.

Useful resources:

Resources: Knowledge. Coalition for Trust in Health and Science. https://trustinhealthandscience.org/resources/category/knowledge/

Host: Dr. Salma Abdalla
Editors: Catalina Melendez Contreras
Marketing: Kinkini Bhaduri
Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.

By some estimates, hundreds of thousands of Americans die each year who would still be alive if the United States had the mortality rates of other wealthy countries. What makes this even more unsettling is that it wasn't always this way. In the mid-twentieth century, Americans actually lived longer than their counterparts in other rich nations. Something changed, and it's been getting worse for over four decades. 

Dr. Andrew Stokes is an associate professor of global health at the Boston University School of Public Health. A demographer and sociologist by training, he founded the Uncounted Lab, a research initiative focused on mortality that official statistics miss, whether from pandemics, chronic diseases, or public health emergencies. 

Dr. Stokes joins Salma to discuss what excess mortality reveals about who is dying in America and why. The conversation is anchored in the "Missing Americans" concept, which estimates how many US deaths each year would have been averted if the country simply matched the mortality rates of its peers. They trace why the US mortality disadvantage has grown steadily since the early 1980s, how the Covid-19 pandemic both exposed and deepened it, and why the burden has fallen disproportionately on Americans without a college degree, driven less by the "deaths of despair" narrative that dominates headlines and more by cardiovascular diseases. The conversation closes with GLP-1 drugs and the need to celebrate progress while still looking for structural interventions to prevent and mitigate the impact of obesity in the US. 

This episode offers a new lens for analyzing preventable mortality in the United States and for thinking through what it can take to address it. 

 

Useful resources: 

Bor J, Raquib RV, Wrigley-Field E, Woolhandler S, Himmelstein DU, Stokes AC. Excess US Deaths Before, During, and After the COVID-19 Pandemic. JAMA Health Forum. 2025;6(5):e251118. doi:10.1001/jamahealthforum.2025.1118 

Bor J, Stokes AC, Raifman J, et al. Missing Americans: Early death in the United States—1933–2021. Galea S, ed. PNAS Nexus. 2023;2(6):pgad173. doi:10.1093/pnasnexus/pgad173 

Paglino E, Wrigley-Field E, Stokes AC. Diverging Mortality Trends by Educational Attainment in the US. JAMA Health Forum. 2025;6(6):e251647. doi:10.1001/jamahealthforum.2025.1647 

Stokes AC. Public health should embrace GLP-1 drugs without abandoning obesity prevention. STAT. November 28, 2025. https://www.statnews.com/2025/11/28/weight-loss-drugs-obesity-prevention-importance/ 

 

Host: Dr. Salma Abdalla  
Editors: Catalina Melendez Contreras  
Marketing: Kinkini Bhaduri  
Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/  

 

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.

This is a Purple Public Health Project episode.

Dr. Itai Bavli is a Research Associate and lecturer at the W. Maurice Young Centre for Applied Ethics at the University of British Columbia, as well as the author of the Substack When Public Health Goes Wrong. His research focuses on developing a framework for understanding public health decisions and actions that have gone wrong and caused harm, with particular attention to how these errors intersect with social inequalities, medical racism, and the ties between governments and the pharmaceutical industry.

In this Purple Public Health conversation, Dr. Bavli joins Salma to discuss public health errors, which are different from medical errors but can also result in harms to the population. By exploring a wide array of examples—including the approval of Oxycontin in the US and Canada—they discuss the difference between errors of commission and errors of omission and highlight the importance of having conversations about these errors within the field. They also discuss the importance of identifying the errors versus assigning blame, the role that polarization has played in prioritizing some errors over others, the key role that transparency about errors can have on trust, and explore when has enough time passed to determine if an error has been made.

This episode will invite you to think beyond ideological, partisan, and professional lines, to understand, identify, and confront public health errors to improve the health of all.

 

Useful resources:

Bavli, Itai. When Public Health Goes Wrong. Substack, accessed March 19, 2026. https://itaibavli.substack.com/

Bavli I. When Public Health Goes Wrong: Toward a New Concept of Public Health Error. J Law Med Ethics. 2023;51(2):385-402. doi:10.1017/jme.2023.67

 

Host: Dr. Salma Abdalla
Editors: Catalina Melendez Contreras
Marketing: Kinkini Bhaduri
Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

 

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.

Why does the US spend more on healthcare than other high-income countries and still have lower life expectancy?

Dr. Jose Francisco Figueroa is an Associate Professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health, Assistant Professor of Medicine at Harvard Medical School, and a practicing Internist and Associate Physician at the Brigham and Women's Hospital. His research focuses on the drivers of healthcare spending and clinical outcomes and whether reforms aimed at improving healthcare quality and costs lead to better population health outcomes.

In this episode, Dr. Figueroa walks through three of his papers to build a case that is more nuanced than it first appears. The US healthcare system, it turns out, performs reasonably well on the things it controls—screening, diagnosis, chronic disease management. The problem lies outside the system: roughly 70% of the increase in avoidable deaths in the US is driven by drug use, alcohol, suicide, homicide, and traffic accidents, which are causes that clinical care cannot fix. Meanwhile, public health policies that could address those causes—such as regulations, taxes on harmful products, firearm laws—lag well behind peer countries. Also, a major policy lever of the past two decades, value-based payment reform, hasn’t moved the needle, in part because it was designed to change what happens inside the system rather than what drives people to die prematurely outside of it.

This episode will give you insights about why improving healthcare alone will not close the gap the US is currently facing. It makes the case for stronger public health infrastructure targeting the root causes of premature death.  

Useful resources:

Figueroa JF, Duggan CE, Joynt Maddox KE. Value-Based Payment in Medicare: Progress, Challenges, and Future Directions. Journal of Health Politics, Policy and Law. 2025;50(6):1059-1079. doi:1215/03616878-11995200

Papanicolas I, Niksch M, Figueroa JF. Avoidable Mortality Across US States and High-Income Countries. JAMA Intern Med. 2025;185(5):583. doi:1001/jamainternmed.2025.0155

Papanicolas I, Sawaya T, Bleich SN, Figueroa JF. Comparing US prevention efforts to other high-income countries. The Lancet Public Health. 2025;10(11):e988-e1000. doi:1016/S2468-2667(25)00222-1

Host: Dr. Salma Abdalla
Editors: Catalina Melendez Contreras
Marketing: Kinkini Bhaduri
Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.