America First Global Health Strategy Draws Criticism as a Return to Colonial-Era Extraction

A sweeping new United States foreign health policy has ignited a fierce debate among global health researchers, who argue that the approach marks an unprecedented retreat from decades of multilateral cooperation and echoes the extractive logic of colonial governance. In an opinion article published in PLOS Mental Health, a team of researchers from Canada, Singapore, Denmark, and Malaysia examines the America First Global Health Strategy, introduced in September 2025, and concludes that it entrenches a model of health diplomacy in which aid is no longer framed as a global public good but as a strategic asset to be traded for national advantage. The authors contend that the strategy, arriving on the heels of abrupt US funding cuts that gutted local service delivery and research programs worldwide, exploits a fiscal vacuum left by many high-income countries withdrawing development assistance for health.

The technical architecture of the strategy is central to the critique. Under its second pillar, which aims to make the United States stronger, so-called recipient countries are expected to meet co-financing targets, absorb procurement risk, and share health data without the option to negotiate terms, timelines, or any guarantee of reciprocity. The authors argue that these bilateral agreements, negotiated from a position of fiscal desperation, extend American oversight deep into national health systems. In the case of Nigeria, where a five-year agreement was announced by the US State Department, funding is explicitly tied to compliance with US priorities, a linkage the authors attribute in part to domestic electoral politics within the United States.

One of the most contested features of the Nigeria agreement is its shift toward faith-based health service delivery. The authors acknowledge that faith and spirituality can play meaningful roles in health and wellbeing, but they warn that prioritizing faith-based organizations aligned with US foreign policy, combined with domestic shifts toward religious exclusion in American policy, risks aggravating existing social tensions. They describe this fusion of religious dominance with governance structures as a colonial tactic, one that reshapes both healthcare delivery and the scope of permissible care. Secular and rights-based health services, along with the workers who provide them, face severe restriction under this model.

The consequences for vulnerable populations are a particular focus of the analysis. The authors argue that the narrowing of service provision falls hardest on LGBTQ+ individuals and women seeking life-saving reproductive care, building on what they characterize as a broader US assault on global reproductive rights. Sexual and reproductive health services are expected to contract significantly, with moralized framings producing greater stigma and self-exclusion among people who need these services. From a mental health perspective, the authors warn that leaving communities without discreet and affirming care heightens the risk of anxiety and depression, embedding structural psychological harm directly into the design of the strategy rather than treating such effects as incidental.

Perhaps the most explicitly transactional element documented in the article concerns strategic resources. In Zambia, the United States threatened to withhold health financing unless it was granted preferential access to critical minerals used in renewable energy and technology, including copper, cobalt, and lithium. Zambia ultimately pushed back, insisting that any health deal must be uncoupled from minerals access, and the authors cite this rejection, alongside a Kenyan high court ruling against the strategy, as evidence that countries are increasingly willing to contest the terms of cooperation and assert control over their priorities, resources, and data.

Yet the authors argue that the most valuable resource being extracted under the strategy is largely invisible: health data. Under the third pillar, intended to make the United States more prosperous, recipient countries are expected to supply surveillance data and biological specimens while procuring American health products and innovations. Health data is a national asset with direct implications for health sovereignty, and the authors contend that under these conditions the countries providing it are unlikely to hold intellectual property, shape research agendas, or reliably access the resulting products. Instead, their health systems become structurally oriented around US supply chains, undermining the very self-reliance the strategy claims to pursue.

The routine capture of health data also carries grave ethical and wellbeing implications, according to the analysis. Patients may lose confidence in, and awareness of, where, how, and by whom their data will be stored, processed, and used. This uncertainty is especially corrosive for individuals seeking care for stigmatized concerns such as mental, sexual, and reproductive health, where perceived confidentiality is crucial to building the trust required for people to seek care without fear of social judgment or discrimination. The authors argue that this extractive model is fundamentally incompatible with the long-term care systems needed to address physical and mental health, because transactional arrangements create dependencies that leave communities exposed to any shift in the demands or conditions attached to them.

Beyond its immediate effects, the strategy is described as setting a dangerous precedent for an already fragile global health governance system. By signaling that health assistance need not be presented as a global public good, the authors write, the approach lowers the bar for what counts as global health at all and marks an unabashed return to structural extractivism. They argue that the field depends on stable, locally driven, and context-specific systems rather than arrangements that shift with geopolitical interests, and that the familiar rhetoric of solidarity and soft diplomacy will not suffice to manage powerful actors operating under this new logic. If the strategy signals a broader turn toward openly transactional arrangements, they contend, global health reform must include counter-arrangements that treat the negotiation of power within global governance as a central design factor.

The authors point to historical and contemporary models of resistance and self-determination. They draw lessons from the anti-colonial, pan-regional movements that spread across the Global South in the twentieth century, whose legacy persists in institutions such as the African Union and the Association of Southeast Asian Nations. They argue that reform proposals must deliver health sovereignty and subsidiarity-based models of governance, enabling countries to mobilize domestic resources for health, strengthen their own contributions to national health budgets, develop regional manufacturing capacity, and build health infrastructure and regional institutions as a more reliable and sustainable layer of support than bilateral dependence on a single donor.

Ultimately, the article frames the stakes in stark terms. Achieving health sovereignty and dismantling colonial models of health governance, the authors argue, is about ensuring that every person, regardless of where they live, has the freedom and the capacity to access the health care they need. Only then, they conclude, can lives and livelihoods be protected from becoming geopolitical bargaining chips. As countries such as Kenya and Zambia demonstrate that the terms of these agreements are not beyond challenge, the debate over the America First Global Health Strategy is likely to shape the future of global health cooperation for years to come, testing whether the international community can rebuild a system grounded in equity or whether transactional extraction becomes the new normal.

Subject of Research: The impact of the America First Global Health Strategy on global health governance, health sovereignty, and mental health in recipient countries

Article Title: Unvarnished colonialism: America first is setting a dangerous precedent

Article References: Jaspal, A., Rahman-Shepherd, A., Aluquin, D., Evaborhene, N. A., & Bandara, S. (2026). Unvarnished colonialism: America first is setting a dangerous precedent. PLOS Mental Health, 3(10), e0000745. https://doi.org/10.1371/journal.pmen.0000745

Image Credits: AI Generated

DOI: 10.1371/journal.pmen.0000745

Keywords: global health, America First Global Health Strategy, health sovereignty, colonialism, health data extraction, US foreign policy, Nigeria, Zambia, reproductive rights, mental health, development assistance, global governance