A Discipline at a Crossroads: What Global Health Needs Next

A team of researchers has issued an urgent call for the global health community to stop treating symptoms and start building resilient systems from the ground up. The article, titled Health Policy and Systems Research: Where Are We and What Does the Future Hold?, was published in PubMed Central by a consortium of nine scholars including Tolib Mirzoev, Ana B Amaya, David Daniels, Rumana Huque, Aku Kwamie, Robert Marten, Zubin Cyrus Shroff, Goran Zangana, and Kumanan Rasanathan.

The work offers no new clinical data but instead maps the current state of health policy research to identify where the field stands and which directions it must take. The study was conducted across multiple institutions and reflects a growing recognition that evidence-based policy science is now under pressure from overlapping global challenges including climate emergencies, recurring pandemics, rapid urbanization, and aging populations.

A Discipline Built for Change — But Is It Changing Fast Enough?

The researchers begin by acknowledging what health policy research has accomplished over decades: building bridges between scientific evidence and public action while maintaining a focus on fairness across populations. The authors describe this discipline as relatively young yet multidisciplinary, dedicated to producing the kind of evidence that improves how governments design and run their health systems.

"We need to stop responding only after a disaster strikes," said senior author Tolib Mirzoev in the paper's framing remarks. "Future efforts must be participatory, inclusive, and committed to addressing the historical inequities that shaped our current systems."

The authors place particular emphasis on decolonization as a necessary step — meaning that research must move away from extractive practices where knowledge is harvested from communities without returning benefits, and toward models where local scholars lead investigations in their own regions rather than serving as distant observers of someone else's data.

The Crises That Demand Better Research

The paper identifies several shifting burdens that are reshaping what policymakers face. Communicable diseases remain a threat in many parts of the world, while non-communicable conditions such as heart disease and diabetes are rising sharply alongside urbanization. Infectious disease epidemics continue to emerge with increasing frequency, and climate change is adding new layers of complexity to every health challenge.

These pressures mean that research into how health systems actually work must adapt constantly. The authors argue that the evidence base for policy has grown significantly in recent years but that reflections on what the field itself needs — methodologically and ethically — have been too sparse. Without deliberate attention to these questions, health policy research risks becoming a side project of larger international health initiatives rather than its own pillar.

Robert Marten, another senior author, argued that without stable investment, the discipline faces a structural problem: "We cannot keep funding research only when something breaks," he said in the paper. "Policymakers must prioritize dedicated resources for locally led, evidence-based inquiry that builds resilience before the next shock arrives."

Building Capacity Where It Matters Most

The authors translate their findings into concrete recommendations for governments and international bodies. They call on decision-makers to commit to funding local research institutions directly rather than funneling money through distant headquarters. Partnerships must be restructured so that researchers in low-resource settings lead rather than participate peripherally, sharing power not just data.

Strengthening local research capacity is framed as essential for sustaining the discipline nationally and globally. The paper notes that geopolitical change and fiscal pressures are making this work harder, yet it remains more important today than ever before. Investing in these capacities does not mean waiting for problems to emerge — it means preparing evidence-based tools so they are available when governments need them most.

What This Means for the Future of Health Systems

The paper concludes with an optimistic but cautious note. Health policy and systems research has demonstrated its value, and its role will only grow as the world faces more complex challenges ahead. But that growth depends on a deliberate shift — one that centers equity, strengthens local capacity, and builds evidence before crises force attention.

The researchers hope this review will serve as both a mirror and a map: reflecting where the field has been while charting the directions it must take to remain relevant and just in an increasingly volatile world. Sustaining and growing health policy research can inform strong health systems and ultimately contribute to improved health and wellbeing for populations everywhere.

The full article is available for free access on PubMed Central under DOI 10.1371/journal.pone.0328649.