The Chatham House analysis argues that global health reform cannot await a new world order, requiring immediate action from middle powers. Given the structural pressures on multilateral bodies like the WHO, the authors propose a dual strategy: middle powers must employ 'variable geometry' by building flexible, issue-specific coalitions (e.g., for pandemic preparedness) rather than waiting for slow, comprehensive global settlements. Crucially, reform must be driven by the Global South, necessitating that Western powers move beyond mere dialogue to genuine power-sharing negotiations. Failure to cede structural power and grant permanent representation to the Global South will undermine the legitimacy and effectiveness of any reformed global health architecture.
Health
This topic hub groups ThinkTankWeekly entries tagged Health and links readers back to the original publishers.
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The rescission of the 2009 endangerment finding removes the legal basis for federal climate regulation, despite the established scientific consensus that greenhouse gas (GHG) emissions pose a severe threat to public health. The article argues that this policy decision risks increasing emissions, compounding long-term public health crises from extreme heat, air pollution, and disease. Strategically, this signals an abdication of global responsibility, potentially eroding international climate consensus and allowing competitors, particularly China, to widen their lead in green technology and geopolitical influence.
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The Chatham House analysis argues that global pandemic risk is fundamentally driven by structural inequality, creating a mutually reinforcing cycle where outbreaks escalate into pandemics and deepen disparities. This finding is supported by the lessons from the COVID-19 and HIV epidemics, which demonstrate that inequality undermines global health security and scientific advances. Consequently, the report urges policymakers to abandon conventional, top-down approaches, advocating instead for a framework that centers structural inequality to build genuine and effective pandemic resilience.
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Analysis of U.S. healthcare spending reveals a substantial slowdown in growth between 2010 and 2024, driven primarily by technological advances and shifts from expensive inpatient to more cost-effective outpatient care. While this trend indicates increased productivity and improved health outcomes, the report cautions that some savings are linked to high-deductible plans, which may compromise necessary care. Policymakers should therefore shift focus from simply controlling spending to maximizing value, aiming to achieve better health outcomes while decreasing the overall share of health spending relative to GDP.
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The article argues that the Office of the Surgeon General is an unnecessary and politically compromised institution that should be dissolved. The author uses the repeated cycle of controversial nominations—citing examples like Dr. Neshiewat and Dr. Means—as evidence that the office has drifted from its apolitical public health role into a politicized 'bully pulpit.' The core finding is that this 'mission creep' undermines trust in legitimate health functions and wastes Congressional time. Policy-wise, the author recommends that Congress eliminate the office entirely and reassign any necessary public health duties to existing, appropriate federal agencies.
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Global immunization efforts are facing significant setbacks due to a combination of conflict, declining public confidence, and weak health systems, threatening global health security. Evidence shows that the United States is experiencing measles outbreaks, while international support mechanisms like Gavi face funding uncertainty and political headwinds. For policy, the findings underscore the urgent need to reinforce both domestic public health messaging and stable international commitments to prevent outbreaks and maintain vaccine-preventable disease elimination status.
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The analysis emphasizes that immunization gains in the Americas, despite historical leadership, are fragile and vulnerable to setbacks, as evidenced by recent measles outbreaks and coverage drops following the pandemic. Sustaining high, equitable vaccine coverage (e.g., 95% for measles) requires continuous effort, particularly targeting unvaccinated pockets at the subnational level. Policy recommendations stress that successful disease prevention requires more than episodic campaigns; it demands sustained political will, predictable financing, and robust technical cooperation among regional bodies like PAHO. Therefore, regional strategies must prioritize strengthening health systems resilience and ensuring consistent vaccine procurement to prevent the loss of elimination status for vaccine-preventable diseases.
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8.Health Care Access and Quality for New York Veterans Provided by the U.S. Department of Veterans Affairs and Community Care: Volume II, Methods and Supporting Data (RAND)
This RAND report provides a comprehensive data analysis of health care access and quality for New York veterans, focusing on the increasing reliance on the private sector through the Community Care program. Key evidence includes detailed analyses of geographic access (drive times) and wait times for specialized services like oncology and neurology, alongside systematic reviews of care quality. The findings argue that expanding eligibility for Community Care is a crucial policy mechanism to improve the timeliness and overall quality of care for the veteran population. Policymakers should use this data to strategically adjust VA guidelines, ensuring that the transition to private care maintains high standards of accessibility and quality.
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Indiana maintains strict cannabis laws despite significant public support for legalization and a large, growing market estimated at $1.8 billion annually. The primary policy challenge is the existence of a gap between state law and the proliferation of largely unregulated, intoxicating hemp products sold in local retail outlets. Furthermore, the state's potential path to legalization differs significantly from most existing academic research, which is based on states that previously legalized medical cannabis. Policymakers must navigate this complex regulatory environment, balancing public demand, federal legislative uncertainty, and the need to mitigate public health risks associated with unregulated sales.
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10.Health Care Access and Quality for New York Veterans Provided by the U.S. Department of Veterans Affairs and Community Care: Volume I, Understanding the Impact of Proposed Policy Changes (RAND)
This RAND analysis examines the impact of proposed policy changes that would expand Community Care eligibility for New York veterans, who often face limited geographic access to VA facilities. While expanding eligibility could improve veterans' geographic access to care, the report finds that the implications for care quality and timeliness are mixed or unclear, noting that VA facilities generally maintain higher outpatient quality standards than private providers. The authors conclude that while policy changes may improve access, the current lack of comprehensive, publicly available data on wait times and expenditures prevents a definitive assessment of the overall impact. Therefore, the report strongly recommends that the VA and New York State release detailed data to enable accurate policy modeling and decision-making.
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Global public trust in vaccines is declining significantly, posing a major threat to decades of immunization progress. This skepticism is fueled by the proliferation of misinformation and the increasing politicization of public health, manifesting in partisan divides (e.g., the U.S.) and across multiple regions. The consequences are already visible, including the loss of measles elimination status in several European countries and rising outbreaks. Policymakers must therefore treat vaccine hesitancy not merely as a medical issue, but as a complex challenge requiring strategies to counter misinformation and rebuild public trust and political will.
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The RAND evaluation concludes that depot buprenorphine (DB) provision has expanded markedly in England following new grant funding, exhibiting a rapid, S-shaped uptake curve. Key evidence shows a sharp increase in provision, with recipients often being younger women with lower disability rates compared to other opioid substitution treatment groups. The report advises policymakers that while DB offers benefits like improved adherence, its high cost and limited real-world evidence base require careful management. Therefore, the findings are intended to guide the Department of Health and Social Care in optimizing the provision of this long-acting injectable treatment to maximize recovery outcomes and ensure cost-effectiveness.
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13.Integrated care for people who use alcohol and/or other drugs: A case study analysis of the current landscape in England (RAND)
The analysis reveals that while integrated care for substance use and co-occurring mental/physical health issues is critical, service provision across England remains highly fragmented. Key evidence shows that the limited specificity of supplementary funding (SSMTRG) and the sheer scale of the challenge contribute to substantial variation in care quality across local areas. Policymakers must therefore focus on systemic improvements, moving beyond localized funding mechanisms to mandate robust collaboration between specialized drug services and broader Integrated Care Systems (ICSs). This suggests a strategic need for national guidelines and coordinated investment to ensure comprehensive, gap-free patient support.
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14.The barriers and facilitators to supporting, commissioning and working with Lived Experience Recovery Organisations in systems of care in England (RAND)
The report argues that Lived Experience Recovery Organisations (LEROs) are vital components of recovery-oriented systems of care, but their integration is hampered by systemic barriers, primarily a lack of consistent definition among stakeholders. Key evidence shows that the sustainability and autonomy of LEROs are highly dependent on funding models; stable, direct commissioning is crucial, whereas fragmented or short-term grants lead to instability and limited visibility. For policy, the findings imply that authorities must standardize LERO definitions and shift away from fragmented funding. Strategic commissioning must prioritize direct, ring-fenced allocations to ensure LEROs maintain autonomy and consistent engagement within the local care system.
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This methods report details the rigorous evaluation framework for the UK's Drug Strategy Investment in Treatment and Recovery (D-SITAR). The study employs a comprehensive mixed-methods approach, integrating administrative data, local authority records, and extensive input from public and expert advisory groups across six priority areas. By utilizing Implementation Research Logic Models, the evaluation aims to rigorously assess the effectiveness and implementation of major public health interventions, such as workforce transformation and depot buprenorphine provision. The resulting evidence will be critical for the Department of Health and Social Care to refine, optimize, and guide future national drug treatment policies and resource allocation in England.
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The RAND evaluation found that the Housing Support Grant (HSG) successfully addressed housing insecurity for individuals with substance use issues by implementing an intensive, person-centered, and holistic approach. Key evidence shows that the grant filled critical gaps in local service provision, with stakeholders praising its adaptability and flexibility to meet diverse local and individual needs. The report concludes that such locally tailored, flexible funding models are effective strategies for improving public health outcomes in addiction and recovery services. Policymakers should consider adopting similar mechanisms to stabilize housing and improve access to treatment.
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17.Implementation of the Treatment and Recovery Portfolio of the 'From Harm to Hope' drug strategy in England: Results from a process evaluation (RAND)
This RAND process evaluation assesses the implementation of the 'From Harm to Hope' Treatment and Recovery Portfolio in England, analyzing the centralized distribution of £780 million in funding to local authorities. The study uses a mixed-methods approach to determine if the national strategy was executed as intended, focusing on the mechanisms by which central government guidance influenced local service delivery. Key findings identify specific pathways that are effective and highlight structural challenges in the current funding and governance model. The report provides critical policy recommendations aimed at improving the central delivery structure to optimize the national drug strategy and enhance local treatment outcomes.
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18.Factors that influence employees' perceptions and experiences of working within the treatment and recovery sector in England (RAND)
This RAND evaluation assesses the implementation of England's major workforce transformation program for drug and alcohol treatment and recovery. The study argues that employee perceptions and job sustainability are critically influenced by a combination of contextual resources and staff attitudes, analyzed through the Job Demands-Resources (JD-R) model. Key findings highlight that simply increasing funding is insufficient; true sustainability requires systemic improvements in service delivery. Policymakers must therefore prioritize developing clear career pathways, improving supervision quality, and managing caseloads to stabilize the workforce and ensure consistent, high-quality care.
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Measles is experiencing a global resurgence, threatening the elimination status achieved in many countries, including the US. This decline is driven by a combination of factors: post-pandemic disruptions, rising vaccine skepticism, and critical cuts to global public health funding and surveillance networks. The resulting gaps in coverage and weakened infrastructure make outbreaks highly likely, even in previously protected regions. Policy efforts must therefore prioritize restoring robust international funding and combating disinformation to maintain herd immunity and prevent a return to widespread, preventable disease outbreaks.
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The article argues that recent federal and state regulatory changes, exemplified by Virginia's new laws, constitute a return to prohibition by creating a 'regulatory cliff' for hemp-derived products. Key evidence includes Congress redefining hemp with strict THC thresholds and Virginia imposing an extremely low 2mg cap, provisions that will eliminate most low-cost, low-dose products and clear the market for existing, state-licensed medical operators. This policy shift has severe implications, as it forces compliant small businesses to close and pushes consumers who rely on these products out of the legal market. Consequently, the demand for these substances is likely to shift toward the illicit market, increasing risks associated with potency and lack of transparency.
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CATO critiques the Center for American Progress's (CAP) proposed health care regulations, arguing that further government intervention will fail to deliver affordability and may increase costs. The analysis points to the rising spending projections for Part D plans and the limited success of previous interventions, such as the IRA and Obamacare, as evidence of regulatory failure. The author contends that proposals like price caps on hospitals or tightening Medical Loss Ratio (MLR) rules are flawed because government price-setting often increases market inefficiency and overall spending. Consequently, the brief implies that the US needs a fundamental shift away from regulatory overreach to achieve affordable and universal care.
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Western aid is undergoing a fundamental shift from altruistic framing to explicit conditionality tied to donor national interests, exemplified by the US threatening to withdraw health funding from Zambia to secure preferential access to mineral resources and pathogen data. Driven by fiscal constraints and domestic populism in donor countries, G7 development assistance has fallen 28 percent since 2024, with recipient countries increasingly rejecting unfavorable deals that could impact an estimated 23 million lives by 2030. This transparency paradoxically enables more honest negotiations and stronger recipient accountability, though only if countries build stronger safeguards into aid agreements with longer transition periods. Policymakers advocating for aid should emphasize global health interdependence and shared security interests rather than pure altruism to maintain political viability in fiscally constrained environments.