Preparing for Human Rights Challenges in Global Health

Benjamin Mason Meier, Neha Saggi, and Padmini Murthy
 
The 2024 US election campaign offered divergent approaches to US leadership in global health, with former President Trump campaigning on a platform that would undermine human rights, reject public health, and abandon international institutions. The challenges presented by the incoming Trump administration raise an imperative for renewed human rights advocacy in global health.
 
The first Trump administration threatened human rights
 
Rejecting the fundamental notion that all people are equal in dignity and rights, the first Trump administration rapidly pursued divisive rhetoric and discriminatory policies that threatened marginalized populations. In the opening days of the first administration, President Trump issued an Executive Order establishing the so-called “Muslim Ban,” which restricted all refugees and immigrants from seven Muslim-majority countries.[1] Attacks on immigrants would expand under a “zero tolerance” policy that prosecuted migrants, separated families, and upended lives.  
 
President Trump also challenged sexual and reproductive health and rights (SRHR), immediately reinstating and expanding the “Global Gag Rule” to restrict American foreign assistance for reproductive health services throughout the world.[2] This attack on SRHR, echoing previous Republican efforts to limit funding for abortion services, undercut programs to address HIV/AIDS, maternal and child health, and LGBTQIA+ health and rights, as the Trump administration led international campaigns against gender-affirming care and withdrew funding to the UN Population Fund (UNFPA).[3] 
 
The administration pursued an “America First” agenda that abandoned international institutions to nationalist ends. US engagement in the United Nations was long seen as essential to ensure human rights in global governance; however, this new US isolationism prevented the coordination necessary to achieve shared public health goals.[4] Rejecting global solidarity, the first Trump administration withdrew from the 2015 Paris Climate Agreement and later sought to withdraw from the World Health Organization (WHO) amid an unprecedented pandemic response.[5]
 
Human rights violations in the COVID-19 response and 2020 campaign
 
These violations of human rights, challenges to public health, and isolationism in international affairs shaped the Trump administration’s response to the COVID-19 pandemic. When faced with this new disease, the administration reacted with discrimination, referring to COVID-19 as the “China virus” to stoke division, and implementing international travel bans without public health justification.[6] Public health data and expertise were repeatedly dismissed, the severity of the disease was initially denied, prevention measures were rejected, unproven treatments promoted, and health officials attacked.[7] This abandonment of public health expanded globally, with the US withdrawal from WHO underscoring a nationalist shift amid a global threat. These institutional attacks extended into Trump’s 2020 presidential campaign, with unsubstantiated claims of election fraud and direct attacks on American democracy culminating in an attack on the US Capitol to prevent the peaceful transfer of the presidency.
 
The 2024 Campaign targetted human rights  
 
Following the Biden Administration’s reengagement with global health governance, Trump’s 2024 presidential campaign renewed promises to rollback human rights and global health.[8] This campaign was framed by Heritage Foundation’s “Project 2025,” which calls for cutting global health funding, expanding the Global Gag Rule, and withdrawing from climate agreements and global partnerships.[9] President-Elect Trump’s proposed cabinet and staff nominations reinforce a sweeping rejection of science-based health guidance, enlisting policymakers who oppose childhood vaccination, health research, and public health regulations. Trump has stated that he intends to withdraw the United States from WHO once again and end US engagement in international negotiations to prepare for future pandemics.
 
Rising challenges ahead
 
The Trump administration will challenge human rights in global health, withdrawing from global governance, neglecting public health and human rights, and eroding democratic governance in global health.
 
Withdrawal of US leadership in global governance
 
The prospective US withdrawal from WHO will threaten efforts to realize human rights in global governance. Bringing nations together to realize health as a human right, WHO has served as the central leader in global health governance for over 75 years.[10] WHO has long sought to advance a rights-based approach to health, beginning in early efforts to combat discrimination in the HIV/AIDS response and extending into contemporary efforts to ensure vaccine equity in the COVID-19 response.[11] US withdrawal will reduce funding and leadership for ongoing WHO efforts to implement human rights in meeting the Sustainable Development Goals and developing a Pandemic Agreement.
 
Neglect of human rights and public health
 
The absence of US leadership in global health will be compounded by new attacks on human rights and public health initiatives. The resurrection of the expanded Global Gag Rule will likely block SRHR programs, shift funding to faith-based organizations, and obstruct women’s access to health information and life-saving healthcare.[12] Threatening health systems, the promotion of science denialism promises to neglect public health data and expertise. This rejection of evidence-based policy will undermine the right to health, neglecting necessary health care (where policymakers question essential medicines), weakening determinants of health (through cuts to welfare systems and environmental programs), and reducing public health collaborations (under US scientific leadership).
 
Erosion of democratic norms
 
The weakening of public health alongside the rise of autocratic governance will erode the democratic norms upon which a rights-based approach to health depends, impairing nondiscrimination efforts, public participation, and governmental accountability.[13] The incoming administration has already exploited divisions to consolidate power, promoted misinformation to advance policy, and punished those who question official positions. In weaponising public health to persecute migrants, attacks on marginalized groups will undermine collective action through public health.[14] Amid the health challenges of armed conflicts, this neglect of common humanity, vulnerable populations, and humanitarian assistance threatens the global solidarity necessary to address common challenges and promote human rights.
 
An imperative for advocacy
 
The future of global health depends upon the defense of human rights, raising an imperative to ensure that public health advocates engage with human rights obligations and political processes to uphold human rights in health policy.  Where US policies will pose challenges to global health, political advocacy will be central to public health practice, requiring political training in the public health curriculum and recognizing the political fight ahead to realize health as a human right. 

Benjamin Mason Meier, JD, LLM, PhD, is a Professor of Global Health Policy at the University of North Carolina at Chapel Hill, USA.
 
Neha Saggi is a Health Policy & Management student at the University of North Carolina at Chapel Hill, USA.
 
Padmini Murthy, MD, MPH, MS, FRSPH, is a Professor of Public Health at New York Medical College School of Health Sciences and Practice, USA.
 
 
References

[1] The White House, “Executive Order Protecting The Nation From Foreign Terrorist Entry Into The United States – The White House,” trumpwhitehouse.archives.gov, (2017), Available at https://trumpwhitehouse.archives.gov/presidential-actions/executive-order-protecting-nation-foreign-terrorist-entry-united-states-2/.
[2] “Presidential Memorandum Regarding the Mexico City Policy – The White House,” trumpwhitehouse.archives.gov, (2017), Available at https://trumpwhitehouse.archives.gov/presidential-actions/presidential-memorandum-regarding-mexico-city-policy/.
[3] A. Ahmed and T. McGovern, “Sexual and Reproductive Health and Rights: Advancing Human Rights to Protect Bodily Autonomy and Sexuality,” in L. O.  Gostin and B. M. Meier (eds), Global Health Law & Policy (Oxford University Press, 2023).
[4] L. O. Gostin, A. Constantin, and B. M. Meier, “Global Health and Human Rights in the Age of Populism,” in L. O.  Gostin and B. M. Meier (eds), Foundations of Global Health & Human Rights (Oxford University Press, 2020).
[5] R. Garden, “Statement by President Trump on the Paris Climate Accord – The White House,” trumpwhitehouse.archives.gov, (2017), Available at https://trumpwhitehouse.archives.gov/briefings-statements/statement-president-trump-paris-climate-accord/; M. Ortagus, “Update on U.S. Withdrawal from the World Health Organization,” United States Department of State, (2020), Available at https://2017-2021.state.gov/update-on-u-s-withdrawal-from-the-world-health-organization/.
[6] C. R. Williams, J. Getgen Kestenbaum, and B. M. Meier, “Populist Nationalism Threatens Health and Human Rights in the COVID-19 Response,” American Journal of Public Health 110/12 (2020), pp. 1766-1768.
[7] C. F. Parker and E. K. Stern, “The Trump Administration and the COVID-19 crisis: Exploring the warning-response problems and missed opportunities of a public health emergency,” Public Administration 100/3 (2022).
[8] L. Pace and S. C. Kim, “Strengthening Global Health Security Under the Biden-Harris Administration,” Journal of Law, Medicine & Ethics (2025), Available at https://doi.org/10.1017/jme.2024.177.
[9] The Heritage Foundation, “Policy | Project 2025,” www.project2025.org, (2023), Available at https://www.project2025.org/policy/.
[10] L. O. Gostin, B. M. Meier, S. Abdool Karim, et al. “The World Health Organization was born as a normative agency: Seventy-five years of global health law under WHO governance,” PLOS Global Public Health 4/4 (2024).
[11] L. O. Gostin, D. M. Chirwa, H. Clark, et al. “The WHO’s 75^th anniversary: WHO at a pivotal moment in history,” BMJ Global Health 8 (2023).
[12] A. Bernstein, A. Friedrich-Karnik, and S. Damavandi. “10 Reasons a Second Trump Presidency Will Decimate Sexual and Reproductive Health,” Guttmacher (November 2024). https://www.guttmacher.org/2024/11/10-reasons-second-trump-presidency-will-decimate-sexual-and-reproductive-health
[13] A. E. Yamin and T. Boghosian, “Democracy and Health: Situating Health Rights within a Republic of Reasons,” Yale Journal of Health Policy, Law, and Ethics 19 (2019). 
[14] Z. Kanno-Youngs and H. Aleaziz, Inside Trump’s Search for a Health Threat to Justify His Immigration Crackdown, NY Times, Jan. 9, 2025, https://www.nytimes.com/2025/01/09/us/politics/trump-title-42-migrants.html.