Turns disease – the Global North perpetuates the “coloniality of power” and brackets out non-western forms of medicine – that makes a global health crisis inevitable because a technological focus cannot solve for collective health.

Our case study of Latin America’s place in global health as it developed over the past three to four decades demonstrates that the field’s conceptualisation of the ‘global’ is much more limited than the word indicates. It suggests that the definition of what ‘counts’ as the domain of global health – what is included and prioritised, and what is not – has changed over time in largely unexamined ways. We argue that the political dimensions and consequences of these changes exhibit the need for more sustained critical analysis of how the field of global health has developed over time.

As the research that does address this topic reveals, the transition from what was previously described as ‘international health’ to what today is known as ‘global health’ began to take shape in the 1980s, deepened significantly during the 1990s, and became more clearly consolidated in the 2000s and 2010s (Macfarlane et al., 2008; Packard, 2016). Latin America’s approach to public health research and practice made significant contributions to the emergence of global health during the 1980s and 1990s, especially in emphasising the importance of social epidemiology, social medicine, and what came to be known as ‘collective health’ (Abel, 1996; Breilh, 2021, 2023; Carter, 2019; Lima, 2007; Susser & Myer, 2007; Waitzkin et al., 2001). These traditions were central in shaping what were viewed as highly successful responses to HIV and AIDS across the region, as well as in promoting access to health as a fundamental human right (ABIA, 2000; Badilla, 2006; Paiva et al., 2013). Latin American policymakers and ambassadors were also recognised for key strategic contributions to emerging structures and processes of global health governance as they developed during the 1990s, with active involvement in the changing institutional architecture of the field through intergovernmental agencies such as the WHO, the World Bank, UNAIDS, and the WTO (Buss & Tobar, 2017).

As the field was shifting from a framework of international to global health at the start of the new millennium, Latin America seemed poised to take on a new leadership role. The region was at the forefront of developing an emphasis on South-South collaborations, and its focus on confronting social and economic inequalities offered exciting alternatives to the more limited frameworks that had dominated approaches to worldwide health science and practice during the phases of tropical medicine and international health (Birn & Muntaner, 2019; Carrillo Roa & Santana, 2012). But despite these potentially transformative contributions, as the global health ‘boom’ began taking off in the 2000s, Latin America’s prominence in global health interventions, knowledge production, and public health practice declined. Moreover, changing understandings of ‘global’ worked to steadily diminish the region’s eligibility within the category, with significant consequences for public health.

During the late 2000s and 2010s, Latin America was relegated to the margins of the field, as largescale Global Health Initiatives, dominant funders such as the BMGF, and an emphasis on metrics as the primary source of evidence (as promoted by the Institute for Health Metrics and Evaluation, among others) became hallmarks of the global health era. Funders and donors from the global North, such as the BMGF and PEPFAR, shifted their priorities to other regions, where the burden of disease was determined to be greater. Consequently, Latin American actors’ involvement in the global health assemblage waned, and the approaches to health on a global scale that had favoured ‘collective health’ in the region also shifted in important ways, especially as the ‘pink tide’, a shift towards progressive policies, social reforms, and a focus on addressing inequality and poverty, began to pass (Ellner & Santos, 2020; P. H. Smith & Sells, 2017).

In addition, over the course of the 2010s, political changes at the regional level intersected with those taking place globally, such as the rupture of liberal democracies in many parts of the world (Castells, 2018), a growing crisis in what has been characterised as ‘progressive neoliberalism’ in the global North (Fraser, 2019), and the rise of nationalist populism in many countries, both North and South (Cox, 2017; Roth, 2017). Although some important work did consider the health impacts of growing populist politics, especially after the emergence of COVID-19 (Falkenbach & Greer, 2021; Garrett, 2017; Williams et al., 2020), the vast majority of the global health field – and the institutions that coordinate it – seem to have paid relatively little attention to this changing political climate. Carrying on with business as usual, they have – largely uncritically – adopted a growing emphasis on biomedical and pharmaceutical solutions in an attempt to circumvent the need for more complex or far-reaching forms of social change. This was perhaps most obvious in the global response to HIV and AIDS in the 2010s, as the dynamic of ‘global scale-up’ came to focus almost exclusively on expanding access to antiretroviral treatment (and reliance on treatment as prevention), with indicators of success focusing solely on biomedical markers (Kenworthy et al., 2018; Sandset, 2021).

Within this context, any previous receptiveness to Latin American contributions to health inequality has given way to a narrowing epistemological focus on the Northern-dominated world of global health. As Latin America’s significance and participation in the field declined as a result of these changes, so too did its successes in responding nationally and locally to key global health challenges. This derailment is evident in mounting setbacks within Latin America’s previously successful responses to HIV and AIDS (Berkman et al., 2005; Oliveira-Cruz & Kowalski, 2004; UNAIDS, 2011) and, more recently, in its significant early challenges in addressing COVID-19 (Burki, 2020; The Lancet, 2021). Based on our analysis, it is only possible to fully account for these changes if we analyse the ways in which politics and political processes, within and across local/national and global/transnational actors, have shaped the field of global health over time. It is important to note that a primary limitation of this paper is its focus on HIV and AIDS as the main case study. Given the limitations of space, we have chosen to draw on our ongoing engagement with the politics of HIV and AIDS in the region where we have had the greatest experience. We hope that this case study will serve as an invitation for other scholars to explore how processes of marginalisation have manifested across various health outcomes, in this as well as in other regions, within the broader field of global health.

Finally, the narrowing of global health considered here should be analysed as a manifestation of what Latin American scholars have described as the coloniality of power (Quijano, 2000) – a form of domination that impacts how resources are distributed and how knowledge is produced and valued. By distancing itself from the preceding structure of international health, especially during the 2000s and 2010s, the field of global health has contributed to the growing epistemicide of Southern theory and thinking. We must listen to and learn from Latin American scholars and health professionals who continue to advance understandings of health as shaped by sociopolitical factors (Alianza Latinoamericana de Salud Global, 2016; Nunes & Pimenta, 2016), and offer valuable critiques of unequal distributions of power and resources in reproducing health inequities globally (Franco-Giraldo, 2016).