The contemporary global health landscape is increasingly characterised by a convergence of complex and interconnected challenges. Declining international health financing, humanitarian crises, emerging and re-emerging infectious diseases, antimicrobial resistance (AMR), climate change, socioeconomic inequalities, unequal access to essential healthcare, health-related disinformation, and growing challenges in scientific communication and publishing are placing increasing pressure on health systems worldwide. These challenges are not isolated; they interact and amplify one another, creating particular vulnerabilities in low-resource settings, where health systems may already face shortages of healthcare professionals, infrastructure, medicines, equipment, and financial resources.
Declining international health financing is a major concern because inadequate investment can weaken the foundations of healthcare delivery, particularly in low-resource settings. Insufficient funding may contribute to shortages of healthcare professionals, inadequate infrastructure, limited access to essential medicines and vaccines, and poorly equipped hospitals and laboratories. These weaknesses become particularly evident during emergencies, when health systems must rapidly increase their capacity to provide care. Sustainable financing should therefore support primary healthcare, workforce development, disease surveillance, essential medicines, emergency preparedness, and resilient infrastructure. Ensuring that resources reach underserved and vulnerable populations is equally important for reducing health inequalities and advancing universal health coverage.
Equitable access to essential healthcare is a fundamental component of universal health coverage. However, geographical location, poverty, displacement, gender, and socioeconomic circumstances continue to influence whether individuals can obtain timely and affordable care. Essential surgical care illustrates these inequalities. Millions of people remain unable to access safe surgery because of shortages of trained surgeons, anaesthetists, nurses, equipment, medicines, blood supplies, and appropriate infrastructure. These challenges are particularly pronounced in low-resource settings. Strengthening surgical systems requires investment across the entire continuum of care, including referral networks, emergency services, anaesthesia, infection prevention, postoperative care, and rehabilitation. Improving access to surgery can reduce preventable disability and mortality and represents an important step towards health equity.
Emerging and re-emerging infectious diseases present another major global health threat. Globalisation, urbanisation, population displacement, international travel and trade, environmental degradation, and increasing contact between humans and animals can create opportunities for pathogens to emerge and spread. Climate change may further influence the distribution of infectious diseases by altering temperature, rainfall, ecosystems, and vector populations. These changes can increase exposure to pathogens and allow diseases to appear in new geographical areas. In low-resource settings, limited laboratory capacity, surveillance systems, healthcare infrastructure, and access to vaccines can make early detection and effective outbreak control more difficult. Strengthening primary healthcare, surveillance, laboratory capacity, vaccination, and rapid emergency response is therefore essential.
The One Health approach is particularly important in addressing emerging infections because many infectious diseases originate at the interface between humans, animals, and the environment. Changes in land use, biodiversity loss, intensive farming, wildlife trade, and environmental degradation can increase opportunities for pathogens to cross species barriers. One Health promotes collaboration between medical, veterinary, environmental, agricultural, and public health sectors to identify and manage these risks collectively. Importantly, One Health strategies must also consider equitable access to healthcare, as communities in low-resource settings may have fewer resources to prevent, detect, and respond to emerging infections.
Antimicrobial resistance further demonstrates the need for integrated global action. The inappropriate and excessive use of antimicrobial medicines, inadequate infection prevention and control, poor sanitation, and inappropriate prescribing contribute to the development and spread of resistant organisms. AMR is not only a human health problem; antimicrobial use in animals and environmental contamination can also contribute to resistance. A One Health approach can therefore support coordinated antimicrobial stewardship across human healthcare, veterinary medicine, agriculture, and environmental management. AMR can make common infections increasingly difficult to treat and threaten essential medical interventions such as surgery, cancer treatment, transplantation, and intensive care. In low-resource settings, limited access to appropriate diagnostics and effective medicines can further complicate the management of resistant infections.
Humanitarian crises intensify these vulnerabilities. Armed conflicts, forced displacement, political instability, and natural disasters can destroy healthcare facilities, disrupt supply chains, and restrict access to essential services. Displaced populations may experience overcrowding, inadequate sanitation, food insecurity, and limited access to clean water and healthcare, increasing the risk of infectious disease transmission. Interruptions to vaccination and routine healthcare can also allow preventable diseases to re-emerge. Strengthening primary healthcare and maintaining equitable access during crises are therefore essential components of outbreak prevention and health-system resilience.
Climate change further connects human, animal, and environmental health. Extreme temperatures, flooding, drought, air pollution, water scarcity, and food insecurity can directly affect population health while also altering ecosystems and disease patterns. Climate-related disasters can damage hospitals, disrupt medical supply chains, and reduce access to essential and surgical services. These effects can be particularly severe in low-resource settings, where infrastructure and health systems may have limited capacity to absorb and recover from environmental shocks. Climate resilience should therefore be incorporated into health-system planning through resilient infrastructure, sustainable healthcare practices, early-warning systems, disaster preparedness, and protection of vulnerable communities.
An increasingly important dimension of these converging crises is the rapid spread of health-related misinformation and disinformation. Digital platforms have transformed access to health information, but they have also enabled inaccurate, misleading, or deliberately manipulated information to circulate rapidly across borders. During outbreaks and other health emergencies, false claims about diseases, vaccines, treatments, or public-health interventions may spread faster than evidence can be generated and communicated. Such information can undermine vaccination programmes, antimicrobial stewardship, infection-prevention measures, and adherence to evidence-based recommendations. It may also contribute to distrust in healthcare professionals, scientists, governments, and public-health institutions. Communities affected by social marginalisation, political instability, limited health literacy, or restricted access to reliable information may be particularly vulnerable to these effects.
Addressing health disinformation therefore requires more than correcting individual false claims. Public-health systems need sustained strategies for risk communication, health literacy, community engagement, and transparent communication of scientific uncertainty. Healthcare professionals and scientific organisations have an important role in providing accessible, timely, and evidence-based information while acknowledging uncertainty when evidence is incomplete. Building trust before crises occur is particularly important, because effective communication during emergencies depends on established relationships between institutions, healthcare professionals, communities, and the media. Disinformation and weaknesses in scientific communication should consequently be regarded as health-system challenges rather than solely communication problems. Their effects can intersect with almost every major global health threat. During infectious disease outbreaks, they can reduce acceptance of vaccination and public-health interventions. In antimicrobial resistance, they can encourage inappropriate demand for antibiotics or unproven treatments. During humanitarian crises, information disruption can impede access to healthcare and increase distrust. In climate-related emergencies, misleading information can weaken preparedness and delay protective action. Protecting the integrity of health information is therefore increasingly important for strengthening preparedness, resilience, and public trust.
At the same time, global health is facing growing challenges within the scientific publishing ecosystem. The rapid expansion of biomedical literature has increased access to scientific knowledge but has also contributed to information overload, variable methodological quality, publication pressure, predatory publishing, and the rapid dissemination of findings before sufficient validation. The increasing cost of scientific publishing represents an additional concern. Researchers may face expenses for open-access publication. Although open access improves the dissemination of scientific knowledge, high publication costs may create important barriers for researchers and institutions with limited financial resources. These inequalities are particularly relevant in low-resource settings, where research funding and institutional support may already be limited.
Financial barriers are compounded by the academic culture of “publish or perish”, in which career progression, research funding, and professional recognition are often strongly influenced by publication output and bibliometric indicators. Excessive pressure to publish may encourage quantity over quality, contribute to research duplication and fragmented publications, and create opportunities for predatory or low-quality publishing practices.
These challenges are therefore also an issue of global health equity. Researchers in low-resource settings may have more limited access to research funding, scientific editing, mentorship, international collaborations, and resources to cover publication fees. Language barriers may create additional costs and disadvantages. As a consequence, locally generated evidence may remain underrepresented in the international scientific literature and, ultimately, in the evidence used to develop global health policies and recommendations.
These challenges are increasingly complicated by digital technologies and artificial intelligence. Automated tools can facilitate literature synthesis, scientific writing, translation, data analysis, and dissemination of health information, potentially reducing barriers to scientific participation and improving access to knowledge. However, they can also facilitate the large-scale generation and dissemination of inaccurate, fabricated, or misleading scientific and health-related content. Responsible use of artificial intelligence therefore requires transparency, human oversight, verification of scientific claims and references, protection of research integrity, and clear accountability for published material.
Importantly, inequalities also extend to the production and dissemination of scientific knowledge. Researchers and healthcare professionals in low-resource settings may face limited access to research funding, databases, publication infrastructure, mentorship, and opportunities for international collaboration. Publication fees and linguistic barriers can further restrict participation in global scientific discourse. Strengthening global health therefore requires not only equitable access to healthcare but also greater equity in knowledge production, scientific collaboration, authorship, editorial representation, and access to reliable scientific information.
In conclusion, global health in an era of converging crises requires a shift from fragmented and reactive responses towards prevention, preparedness, resilience, equity, trustworthy scientific communication, and collaboration. A One Health approach provides a framework for recognising that human health cannot be separated from animal health or the environment. However, effective One Health strategies must also prioritise equitable access to healthcare, particularly in low-resource settings where health-system capacity may be constrained. At the same time, protecting the integrity of scientific information and addressing health-related misinformation and disinformation must become integral components of global health preparedness.
Strengthening primary healthcare, essential surgery, vaccination, disease surveillance, antimicrobial stewardship, emergency preparedness, climate resilience, scientific literacy, and reliable communication is fundamental to reducing preventable illness and mortality. Scientific institutions must also strengthen research integrity, editorial quality, transparency, responsible use of emerging technologies, and equitable participation in knowledge production. Through sustained investment, international cooperation, integrated One Health policies, and a stronger and more trustworthy scientific information ecosystem, countries can strengthen health-system resilience, improve access to essential healthcare, advance universal health coverage, and promote global health equity.
References
Sartelli M, Mossialos E, Coccolini F, Jammer I, Labricciosa FM, Barie P, Biffl WL, Memish ZA, Maeurer M, Kobinger GP, Ippolito G, Zumla A, Catena F; Global Consortium for Solidarity to Overcome Challenges, Restore Trustand Advance Science for a Sustainable Future. Global health at crossroads: uniting together to overcome challenges, restore trust and advance priorities for a sustainable future. World J Emerg Surg. 2025 Nov 10;20(1):84.
Bonnechère B. Building equitable health partnerships: addressing racial disparities in global health. Front Public Health. 2025 May 26;13:1604892.
Author
Massimo Sartelli
Italy
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