EPISODE 18: Is Global Health Keeping Fit For Purpose? with Ilona Kickbusch In this wide-ranging conversation about the future of global health, leading health policy thinker Ilona Kickbusch delivers a sobering assessment: the global health system as it currently exists is no longer fit for purpose. Speaking with host Mukesh Kapila, she describes an increasingly crowded ecosystem of powerful institutions including the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi, the Vaccine Alliance, UNAIDS, UNICEF, and the World Bank, alongside humanitarian giants such as Médecins Sans Frontières and the International Red Cross and Red Crescent Movement. Together they represent a vast network of programs, financing streams, and initiatives that aim to improve health outcomes around the world. But Kickbusch argues that the very scale of this architecture has become part of the problem. The system, she says, is marked by fragmentation, overlapping mandates, and competition for resources. Many organizations operate in silos, often pursuing their own agendas while funding structures remain opaque and heavily influenced by donors. Development aid for health is declining in several countries, forcing smaller NGOs to shrink or close entirely. In such an environment, she asks a fundamental question: Is the global health system still capable of delivering coordinated solutions to today’s health challenges, or has it become too complex to function effectively? Kickbusch believes reform is unavoidable. She suggests that the global health architecture must be streamlined, with some organizations merged or even closed and others forced to refocus their missions. Yet she acknowledges the political difficulty of such reforms. Institutions develop constituencies, funding relationships, and bureaucracies that make them hard to dismantle. If creating new organizations has been easy over the past two decades, who now has the authority and the political will to rationalize the system? Beyond institutional reform, Kickbusch raises another concern that may define the next era of global health inequality: the rise of digital health technologies and artificial intelligence. These tools promise transformative advances in diagnosis, treatment, and health system management. But they are largely controlled by a small number of powerful technology companies and wealthy actors. Countries in the developing world often depend on external partners to build digital health infrastructure, creating new geopolitical dynamics. As nations adopt digital health systems, who controls the infrastructure, and what price do countries pay for access to these technologies? One of the most valuable assets in this emerging landscape is data. Health data, in particular, is becoming a strategic resource. Kickbusch warns that some countries may effectively exchange access to their population data in return for technological support, creating new forms of inequality and extraction. Without strong governance frameworks, this could reshape global health power structures. Will the next era of health inequality be defined not only by access to hospitals and medicines, but also by who owns and controls health data? The digital transformation of health systems also raises concerns about information integrity. As more people turn to the internet for health advice, distinguishing between scientific evidence, misinformation, and disinformation becomes increasingly difficult. Without stronger mechanisms to regulate and verify online health information, public trust in health systems may erode. Despite these challenges, the conversation ends with a sense of urgency rather than resignation. Kapila praises Kickbusch for a career devoted to confronting global health inequalities and pushing institutions to evolve. Her central mission remains unchanged: narrowing the gap in health outcomes between countries and populations. Yet the question she leaves hanging over the future is profound: Will technological and institutional transformation help close those gaps, or will it deepen them in ways the world is only beginning to understand?
