Redefining Global Health in the 21st Century, Chapter 1: The End of the Old Order – and What Comes Next

A Shot in the Arm Media in partnership with UCSF Institute for Global Health launched a nine-part series to explore the future of global health built around the book Redefining Global Health in the 21st Century, co-authored by Dr. mike Reid (UCSF Institute for Global Health Sciences) and Ambassador Eric Goosby (former U.S. Global AIDS Coordinator and former PEPFAR Chief Medical Officer). In this episode, what if the greatest threat to global health isn't a new virus — it's us? Our funding fatigue, our outdated playbook, our addiction to replication over adaptation. We've saved millions of lives. But are we sleepwalking inexorably into decline, into the enshittocene. Eric and mike don’t think so. And they’ve written a book, “Redefining Global Health in the 21st Century, that sets out an alternative, optimistic future. In this episode, they reflect on the end of the old order, and the implications for innovation and scale up into a new era in global health. mike and Eric are hosted by Ben Plumley from A Shot In The Arm Media. 00:00 Series Kickoff Recap 01:25 Early Wins Foundations 02:07 Global Fund and PEPFAR Tensions 04:40 What Worked Best 06:29 Malawi Dependency Shock 08:48 Why Systems Collapsed 12:50 Donor Ecosystem Incentives 18:30 Designing Better Partnerships 23:25 New Players Multipolar Era 27:21 Philanthropy Promise and Peril 31:44 Limits of Philanthropy 32:24 Gates Foundation Lessons 33:41 Sustainability Commitments 35:56 Country Led Coordination 37:45 Innovation Beyond Tech Fixes 39:28 Private Sector as Resource Motor 42:02 Equity Risks and Guardrails 44:24 Indigenous Knowledge in Trials 48:08 From Pilots to Scale 52:19 Access and Global Rollout Rules 54:34 Paradigm Shift Takeaways 55:25 Episode Wrap and Next Steps Learn more about the book: https://bit.ly/redefining-global-health More from UCSF Institute for Global Health Sciences: https://globalhealthsciences.ucsf.edu Check Out mike Reid’s Substack: https://substack.com/@reimaginingglobalhealth Check Out Ben’s Substack: https://substack.com/@benplumley1 Join the Conversation! What would it take for global health to avoid decline? Share your thoughts in the comments! Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health — and look out for a dedicated sub channel for Redefining Global Health in the 21st Century under A Shot in the Arm’s YouTube home. Redefining Global Health in the 21st Century: The Podcast (Playlist on Youtube) https://youtube.com/playlist?list=PLW7yagTEtywqvW9_bs6heRikREgwS9sE9&si=Tu-NEdwcA9Z-VKLH A Shot in the Arm Podcast Youtube (Main Channel) https://youtube.com/@shotarmpodcast