Roheena M. Malik, OD, is an optometrist and public health advocate committed to advancing equitable eye care, community-rooted health programs, and dignified access for all. She champions health equity, interdisciplinary collaboration, and inclusive care through her roles as a Clinical Director for Special Olympics New Jersey Opening Eyes and Community Outreach Director for the Richard J. Favreau, OD Health Foundation. She also serves on the Advocacy Committee of the New Jersey Public Health Association and the Legislative and Clinical Care Committees of the New Jersey Society of Optometric Physicians.

In a time of shifting priorities, young leaders have the chance to redesign global health partnerships from the ground up with courage, creativity, and community.

When robust systems retreat, it's easy to feel powerless.

But moments of disruption are also invitations to step in, reimagine, and rebuild.

Today's emerging generation of health leaders stands at a crossroads, and the future of global health may depend on how boldly we answer the call.

The Great Disruption and the Hidden Opportunity

For decades, the United States has been a major driver of global health investment, funding programs that address a range of issues, from HIV to maternal mortality. However, this leadership role has gradually shifted, not just during the Trump administration, but across several presidential administrations. According to a 2024 report from the Kaiser Family Foundation, U.S. global health funding fell by 12% compared to pre-pandemic levels, the most significant decline in nearly two decades.

This pullback has left a vacuum. Health workers on the ground in places like Malawi, Bangladesh, and Guatemala are feeling the tremors. International NGOs are scrambling to recalibrate. Communities that once relied on predictable flows of support now face new uncertainty. It would be easy and understandable to feel overwhelmed.

But history tells a different story: every significant disruption holds the seed of innovation. After the Ebola crisis, West African countries didn't just rebuild their health systems; they reimagined them by investing in local surveillance networks and community-led response teams. We didn’t always see this same response globally after the COVID-19 pandemic, but with new international efforts, such as the pandemic treaty taking shape, there is growing momentum toward more equitable and cooperative preparedness.

We don't wait for someone else to rebuild the house when the old scaffolding falls. We design new blueprints together.

This is the moment for the next generation to stop being bystanders. It's time to be builders.

What Builders Look Like: Three New Models of Leadership

If the old model was money flowing from "donors" to "recipients," the new model is more mutual, dynamic, and just. Here's what it looks like:

1. Skills Exchange and Mutual Learning

Today's best global health partnerships aren't based on dollars but on relationships.

Young professionals are crossing borders not just geographically, but also relationally, to share expertise, learn local practices, and co-create solutions. For example, African and German university hospitals are partnering to tackle antimicrobial resistance, enhancing mutual learning through innovative health apps and collaborative data platforms.

Global health is no longer a one-way street. It's a two-way exchange.

2. Grassroots-First Innovation

Real solutions are born closest to the problem.

In Kenya, over 100,000 community health workers use open-source apps powered by the eCHIS platform to deliver maternal health services and critical care in their communities. They didn't wait for Silicon Valley to innovate for them; instead, they designed tools tailored to their specific needs, proving that real innovation can be hyperlocal.

When we invest in local leaders as drivers of change, not just as "beneficiaries," we get lasting solutions.

3. Advocacy and Systems Change

Leadership today isn't just about delivering services. It's about changing the systems that make health inequities possible in the first place.

At the Global Model WHO 2024 conference in Geneva, over 350 students from more than 50 countries gathered to simulate real-world global health negotiations and advocate for youth-led policy solutions.

These gatherings show the future of leadership emerging from every region, not just traditional power centers. Programs like this create space for voices from the Global South to shape the next generation of health policy.

Advocacy is no longer a side project. It's central to leadership.

A Global Health Future Built on Solidarity, Not Charity

Old models too often framed global health as "us helping them." Solidarity flips that script.

It says: our struggles are connected.

The same forces that leave a mother in rural India without prenatal care are tied to the same forces that underfund clinics in rural Alabama. Solidarity means shared struggles and shared solutions. It means listening before acting, building alongside rather than above. It's a commitment to dignity, not dependency.

We're seeing it already. In Isiolo County, Kenya, traditional birth attendants have been integrated into the formal health system. This integration has led to a significant reduction in maternal mortality rates and has empowered communities to take charge of their health transformations.

While not an example of cross-border solidarity, it reflects the type of community-driven leadership global health must support: adaptable, inclusive, and rooted in lived experience.

During the COVID-19 pandemic, it became clear that pathogens don't respect borders. Neither should our compassion nor our commitment.

However, we must ensure that solidarity is not merely rhetorically invoked in words but also absent in action. Genuine solidarity requires sustained engagement, not symbolic gestures.

Under international human rights law, including the Committee on Economic, Social and Cultural Rights' General Comment No. 14, which interprets the International Covenant on Economic, Social and Cultural Rights (ratified by most, though not all, countries), wealthier nations have a duty to cooperate in fulfilling the right to health worldwide.

Legal scholars Lawrence Gostin and Benjamin Mason Meier emphasize that global health law imposes shared legal duties, both through binding instruments such as the International Health Regulations and through broader normative frameworks, holding states accountable under human rights law to cooperate in addressing global health challenges.

The strongest health systems in the future will be the ones built on partnerships, recognizing our shared humanity.

The Invitation Ahead

The next chapter of global health won't be written by governments alone.

It will be written by all of us, based on every act of bridge-building, every new idea born from courage, and every refusal to look away. In a world full of fractures, we are the ones who can become architects of healing.

Moments of disruption don't just break old systems; they also create new ones.

They offer us a choice: rebuild what was or imagine something better.

The question now isn't whether young leaders will rise.

It's: what will we build together?