As the first chapter in Global Health Watch 7 notes, the previous edition was “caught in the shadow of the COVID-19 pandemic.” This edition is being released under a different and more ominous shadow, that of Donald Trump’s return to the US presidency. We are in the midst of a massively disruptive transition in which the former US-dominated (neo)liberal world order is being transformed into a form not yet clear. The new Trump administration is driving this change, leaving global health churning in its chaotic wake. But as Chapter A1 reminds us, global health was not in very good shape before Trump’s re-election.

We are facing a deepening existential health ‘polycrisis’ (a syndemic of multiple crises) that include rising inequalities, worsening environments and the mass movement of peoples within and across borders fleeing or being displaced by poverty, drought, violence and conflict. A fourth element has since emerged: the rise in autocratic states, the number of which outstripped democracies in 2024 for the first time in over two decades. Three quarters of the global population now live under autocratic rule characterized by restrictions on free expression and independent media, partisan capture of the judiciary and military and an ideological assault on government workers, universities and institutions that express views contrary to rulers’ dictates. Civil society organizations are being shuttered, defunded, harassed, impugned or actively and violently repressed (as
noted in Chapter E3).1

The majority of these autocracies are categorized as ‘electoral autocracies,’ meaning they were initially voted into existence. Unless there is mass civil society opposition (as we’ve seen in Turkey after the arrest of the political leader threatening Erdogan’s rule) or a restraining ‘lawfare’ on executive power (which is being attempted in the USA), such electoral autocracies risk becoming closed single-party or military-rule states, a direction in which Trump 2.0 is rapidly heading. The good news is that whether closed or electoral, autocracies can be and have been reversed.2 The bad news is uncertainty over whether this democracy/autocracy pendulum can swing back in a more equitable direction before our existential health polycrisis reaches its final tipping points. By now, many GHW7 readers are likely aware of the multiple ‘executive orders’ issued by the US dictator-in-waiting that are having (or certainly will have) almost universally health negative impacts, a few key ones of which are summarized below:

• US withdrawal from the World Health Organization (WHO) and the resulting significant budgetary shortfall will put many funded health programs at short-term risk.3 But abandoning the Paris Agreement on Climate Change, deregulating environmental protection, fast-tracking new fossil fuel projects and eliminating emission standards will be more health-devastating in the medium-term, especially as the US decisions here are incentivizing many other countries and corporations to weaken or abandon recent efforts and commitments to net-zero carbon emissions by 2050.
• The abrupt suspension and commitment to end most foreign aid will kill tens of thousands of people in the poorest countries suddenly lacking access to treatments and care. A key concern here is the potential evis-
  ceration or elimination of the PEPFAR program (President’s Emergency Plan for AIDS Relief) introduced by earlier US Republican administrations and the major international source of financing for HIV prevention
  and antiretrovirals. This should be considered a form of mass murder, since modeling suggests that without its fully funded return or carefully managed multi-year sunsetting, an estimated 4.2 million new HIV deaths will occur by 2029.4 The most recent study estimates that US foreign aid cuts, as of May 23, have already led to over 92,000 adult and 190,000 child deaths. These numbers are estimated to rise to over 14 million all-age deaths, including around 4.5 million child deaths, by 2030.6 Dramatic foreign assistance cuts by other donor nations under Trumpian pressure to increase their defense spending is adding to the trauma, regardless of how much such assistance still reeks of neocolonialism and the dominating influence of rich countries’ ‘soft power’.
• By heading the US health portfolio with an anti-vaxx conspiracy theorist (Robert F. Kennedy Jr.), slashing its workforce, cutting research funding and withdrawing from global health networks and from treaties such as
  the International Health Regulations and the (new) Pandemic Treaty, the USA and much of the world is being placed in worse shape for the next pandemic than when COVID-19 first wrecked global havoc.

What is new with this edition
There are three innovations with Global Health Watch 7. First, unlike earlier editions, almost all of the chapters that follow involved writing groups and contributions representing the geographic breadth of People’s Health Movement (PHM). In striving to have this edition be an exercise in ‘movement building’ and not simply an analytical synopsis of global health issues, writing groups were encouraged to use their chapters as opportunities to discuss and engage across these geographies, allowing activists to learn with each other. Second, we chose to publish with a solidarity publisher (Daraja Press) where each chapter could be posted for free download and distribution as soon as it was completed. With all chapters completed, they are re-formatted with new front and end material as a single book, downloadable as a PDF or available in an on-demand print version. Third, we were able to publish individual chapters and the full book in both English and Spanish, partly an acknowledgement of the contribution of Latin American PHM activists in convening the 2024 5th People’s Health Assembly in Argentina.

Mobilizing for Health Justice: Global Health Watch 7