Redefining Global Health in the 21st Century, Chapter 2: A New Epistemology for Global Health — Embracing Complexity and the "Both/And" Approach

Ben Plumley speaks with Dr. mike Reid and Eric Goosby about their new book Redefining Global Health in the 21st Century, focusing on epistemology—how global health defines knowledge, evidence, and success. They argue global health has overprioritized biomedical metrics and donor-driven targets, often sidelining local knowledge, community co-design, and broader measures like sustainability, equity, and trust. Using examples from HIV/TB programming, maternal health, differentiated service delivery, and integration vs vertical programs, they discuss how humility and partnership shape effective, resilient responses and how “measurement is rarely neutral.” The conversation addresses threats to key populations under current political decisions, the need for epistemic justice and a preferential option for the poor, failures in academic authorship equity, and how shifts in US leadership and the climate crisis may reshape global health governance. They also stress better explaining global health’s value to taxpayers. 00:00 Local Wisdom vs Evidence 00:55 Meet the Authors 01:45 Epistemology and Priorities 05:09 Epistemic Humility 08:51 PEPFAR Lessons on Partnership 10:39 Measurement Is Not Neutral 13:18 Motivation and Co-Design 21:09 Integration vs Vertical Programs 25:05 Equity and Key Populations 32:06 Politics and Funding Dilemmas 34:31 Moral Case for Care 36:09 Domestic Front Lines 36:56 Beyond Us Versus Them 40:10 Epistemology and Donor Power 44:15 Inclusive Leadership Priorities 47:37 Vacuum After US Retreat 51:09 Climate as Next Crisis 55:34 Decolonizing Academic Incentives 57:55 Preferential Option for Poor 01:00:27 Selling Global Health at Home 01:04:36 Three Arguments for Taxpayers 01:06:56 Closing Reflections and Next Episode 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=TuNEdwcA9Z-VKLH A Shot in the Arm Podcast Youtube (Main Channel) https://youtube.com/@shotarmpodcast