Health sovereignty builds resilience in a volatile world. Here are 3 countries working towards it

Changes underway in the US represent a seismic shift in global health governance, with policies that seek to reshape international relations, funding mechanisms and policy priorities changing.

A retreat from multilateral engagement, a sharpened focus on national interests and deep cuts to foreign assistance are compelling many low-and middle-income countries (LMICs) to reassess their long-term health strategies.

While the world is still recovering from the upheaval of COVID-19, political tremors in the Global North – and their ripple effects on the South – once again raise urgent questions. The pandemic paved a way toward greater self-reliance, with countries accelerating capacity for pandemic preparedness and evaluating their supply chains. Now, shifting priorities in the White House renew an urgent call for the same.

Historically the largest contributor to global health, the US’s departure from the World Health Organization (WHO) not only weakens the collective response capacity to global health challenges, but also signals a broader retreat from shared international responsibility. While intended to prioritize domestic interests, this shift may inadvertently undermine trust, cooperation and the pooled resources needed to manage transnational health threats. The resulting vacuum in the wake of these disruptions invites nations to reassess their reliance on external support, and to take decisive steps towards greater self-sufficiency: a pursuit known as health sovereignty.

Several nations are health sovereignty exemplars. Their experiences offer valuable insights into how reliant and robust health systems can be established even in the face of limited resources and external pressures:

Cuba’s health system is globally recognized for its emphasis on preventive care, community-based services and a highly trained health workforce. Despite economic constraints and limited official development assistance (ODA), the Latin American island nation has managed to achieve remarkable health outcomes and a universally accessible healthcare model. In 2021, public spending on health accounted for 13.79% of Cuba's gross domestic product (GDP), above average for the region. This approach has enabled the country to maintain high life expectancy (approximately 78.9 years in 2021) and low infant mortality rates (historically, four to five per 1,000 live births) – figures comparable to higher-income nations – at the same time striving for efficiency in state-funded allocations toward health. Cuba’s experience demonstrates that a strong commitment to preventive care, investments in human capital and efficient resource allocation can contribute to health sovereignty, even under challenging economic conditions.

Brazil’s Unified Health System (SUS) represents one of the world’s largest public health systems, providing comprehensive care for over 200 million of its 216 million people. By integrating health services across various levels of government and investing in domestic pharmaceutical production, Brazil has sought to reduce its dependence on external suppliers and align health policy with national needs. The SUS pioneered principles of social inclusion and health equity, committing sizeable amounts of its budget to health investments. In 2021, the nation spent 9.89% of its GDP on healthcare, only a 0.28% increase from its expenditure pre-pandemic. This minimal rise suggests that Brazil’s investments in health have remained relatively stable, reflecting a pre-existing commitment to universal health coverage (UHC) through the SUS rather than surges in spending during the pandemic. Despite facing turbulent economic and political challenges, the SUS model offers a compelling example of how a country can assert its health sovereignty through a commitment to universal access and health equity.

Thailand’s journey toward health sovereignty is epitomized by its UHC programme, lauded as one of the most successful in the developing world. Launched in the early 2000s, the scheme expanded access to quality healthcare for millions of Thais, reducing catastrophic health expenditures and improving overall population health. In 2021, the South-East Asian nation spent 5.16% of its GDP on healthcare – significantly lower than Brazil and Cuba – yet achieved over 98% health insurance coverage of its population. This shows that health sovereignty is not solely dependent on high expenditure but markedly benefits from a cost-efficient system design. While Thailand has received official development finance (ODF) in areas like government and civil society, energy and transport sectors, its reliance on foreign aid through ODA for health has remained minimal. The Thai model illustrates the potential of well-designed, publicly financed health systems to deliver equitable care while asserting national control over health priorities and positioning itself as a leader for UHC.

The experiences of Cuba, Thailand and Brazil give us an idea on how nations can re-evaluate their health system to achieve a higher degree of sovereignty. The four quadrants shown in the infographic below are each valuable on their own, but transformative together:

A robust primary care system is the backbone of health sovereignty, ensuring prevention remains central to public health. Investments in local primary clinics, trained community health workers and essential medicines relieve pressure from costly tertiary health systems, nudging nations towards universal health coverage. Cuba, Thailand and Brazil are examples of strong primary care systems that address population health needs, reduce catastrophic health expenditures and decrease reliance on external aid.

Decentralized and inclusive health governance emphasizes a whole-of-society approach to health, promoting community engagement in decision-making. Decentralization ensures health solutions are adapted to population needs, not just state priorities. By shifting power closer to local populations, health systems increase their efficiency and responsiveness in times of crises. Effective decentralization of governance for health fosters accountability, equity and representation of underserved groups, reinforcing the foundation for health sovereignty.

Regional collaboration in innovation and research is a game-changer for self-reliance in the Global South. Investments into joint research initiatives, innovative health solutions and pooled procurement of vaccines and medicines reduce dependence on external suppliers. Success stories from innovative regional disease surveillance networks in ASEAN highlight how stronger regional partnerships enhance health sovereignty.

Sustainable, equitable and cost-effective financing and resource allocation are essential for health sovereignty. Even with limited resources, LMICs can mobilize local economies, design fiscal strategies and build equitable public-private partnerships. Countries reliant on ODA can create exit strategies, ensuring aid funds are used to fortify long-term independence. Social protection, health insurance and transparent public financial management are some strategies that can help shield populations from catastrophic health expenditure. Depending on each nation’s unique cultural and economic contexts, different strategies can be employed to shape sustainable financing for health sovereignty.

Global health governance is undergoing an evolutionary change – one characterized by a greater impetus to pursue health sovereignty in sync with global health cooperation. A focus on strong primary care, inclusive governance, robust research and innovation, and sustainable financing will channel nations toward greater health sovereignty, all in the balance between local capacity and global collaboration.

Health sovereignty is about empowerment and resilience: ensuring every nation can meet the health needs of their people without excessive reliance on external actors. Health sovereignty is not a call to disengage from global health efforts, but the creation of a more equitable global health order – one that honours national autonomy, while fostering cooperation to address shared challenges in an ever-changing and increasingly globalized world.