Introduction
The political and financial landscape for global health has changed dramatically in 2025.Reference Rasella 1 The world is entering what has been labelled “an era of global health austerity,”Reference Apeagyei 2 changing international politics and diplomacy in the process. Every country will have to adjust and find ways of responding to this new reality.
It was already evident before this year that all was not well in global health. The COVID-19 pandemic exposed that the remarkable progress achieved in global health governance during the 21st century rested on weak political and legal foundations when faced with an external shock such as a new pandemic.Reference Gostin 3
The additional shock in 2025 — that is financial in its outset but existential in its nature — has further exposed these fragile foundations. The price paid is stark, with severe impacts on trust, sustainability, implementation capacities, availability of commodities, livelihoods, survival, equity, human rights, health provision, disease burdens, and clinical research.
It is necessary to rethink global health policy. In Norway and Denmark, a renewal of the global health policy debate has recently made significant strides. Two Expert Groups on Global Health have worked in parallel — semi-coordinated yet fully independent — to kick-start a global health policy debate that was ripe for renewal in both countries. With sufficient analytical clout, the two expert groups offered tailored recommendations that considered the broader realities in the field while taking into consideration the national contexts in which they operated.
The specific political contexts in which the Norwegian and Danish groups emerged varied. So did the focus of their recommendations. However, the underlying questions to be addressed were very similar. They were about the critical challenges in global health and how the two countries could best shape their future contributions. The Expert Group model is interesting and has recently also been applied in Canada for similar reasons.Reference Evans 4
This column centers on the influence of Expert Group efforts in reenergizing global health policy in the Nordic context.
It starts by briefly placing Nordic leadership in global health in historical context before presenting key points from the work of the Norwegian and Danish Expert Groups and the follow-up from their respective reports. The column concludes that the Nordic countries are well-equipped to engage with the new global reality facing global health, including the new forms or partnerships required to help protect gains made while advancing health progress.
Nordic Leadership in Global Health
Nordic countries have traditionally been very active in the global health field. Common features of Nordic global health policy have long included a strong commitment to sexual and reproductive health and rights (SRHR) and human rights more broadly, child health, primary health care, equity, evidence-based approaches, vulnerable populations, national ownership, and in recent years a focus on universal health coverage, antimicrobial resistance (AMR), and mental health.
Among Nordic countries, Norway has maintained a prominent and widely recognized global health leadership role during the 21st century. In the context of the rapidly expanding global response to HIV/AIDS, the Norwegian government has advanced the national ownership and aid effectiveness agenda starting in the early 2000s. Norway was one of the original six donors that created GAVI and has had strong continued engagements with global health institutions. Strengthening these institutions, Norway was also a key partner in developing the Lusaka Agenda on the Future for Global Health Initiatives launched in 2023. This leadership has been accompanied by a relatively high level of investment in global health through official development assistance (ODA). However, recent years have raised concerns about whether this long-standing level of engagement and investment was being diluted and whether that would lead to a weakening of Norway’s leadership role at a critical juncture for the world. 5
In Denmark, the legacy of Danish medical doctor Halfdan Mahler’s impactful tenure as Director-General of the World Health Organization (WHO) from 1973 to 1988 — that brought significant attention to primary health care and human rights, enabling a stronger grounding for global health as an international legal obligation — remains alive in Danish global health policy.Reference Probst and Brostrøm 6 Nevertheless, since the late 2000s — following significant investment in sector-wide approaches (SWAPs) to health in partner countries during the 1990s and 2000s — health fell down the Danish development agenda, with attention shifting elsewhere (e.g. climate).Reference Kjær 7 Health was not a main priority in the three Danish development strategies from 2012 to 2024, although SRHR remained a significant political priority under other headings.
As WHO Director-General, Halfdan Mahler talked often about the responsibilities of internationalism in global health. He believed that developed countries had a double responsibility “to their own people and to the peoples of the developing countries struggling to extricate themselves from historical injustice and from the vicious circle of poverty and disease — there is a very close relationship between what a country does within its own boundaries and what it is able to do for other countries.” 8 In his 1979 opening speech to the World Health Assembly — a time when WHO was preparing to declare smallpox eradicated worldwide — Mahler challenged member states: “Plato said some 2000 years ago: ‘What is honored in a country is cultivated there.’ Do we today honor world health or do we not?” 9 Mahler’s poignant question remains relevant today. It is fair to say that the substance in the question reflects well the work of the Expert Groups in Norway and Denmark.
Norway: Reduce Global Health Inequality and Strengthen Health Security
The high-profile Norwegian Expert Group, which included a former health minister and was chaired by a former director of Norway’s Institute of Public Health, was commissioned by a coalition of seven development or humanitarian NGOs and think tanks. Their main guiding question was: “What are the biggest challenges and opportunities in global health leading up to 2050, and how can Norway best contribute internationally in this field, both economically and politically, with the aim of contributing to global development and Norway’s own interests?” 10 The 2050 timeframe shows the inspiration drawn from the 2024 Lancet Commission on Investing in Health report, which assessed the “challenges — as well as the opportunities for investment in health in increasingly turbulent times — up to 2050,” and presented a roadmap to halve premature mortality by this date. 11
The Norwegian Expert Group’s response included a framework for increased investments in global health, with a dual focus on (1) reducing global health inequality, both within and between countries, and (2) strengthening health security in Norway and other countries, with the Expert Group proposing that future “budgets must clearly indicate how much is allocated to each of the two objectives.” 12 The Expert Group was explicit in recommending that the reduction of global health inequality should be a main priority in Norway’s development policies. At the same time, it recommended that Norway should sustain its “role as a normative leader in sexual and reproductive health and rights, including maternal and child health, both at national levels and in global forums.”
The final report, “Norway Can, Norway Should: Take the lead in halving premature death by 2050,” contained 21 recommendations, with inequality, international solidarity, health security, and strengthening of health systems informing the approach taken. The Expert Group called for an increase of the Norwegian aid budget to more than one percent of gross national income — which would increase foreign assistance even as many other countries are decreasing such bilateral aid. The Expert Group reasoned that increased investment in health security should not happen by weakening efforts to reduce global health inequalities and poverty.
To make progress, the Expert Group underlined the importance of following up on the Lusaka Agenda. The Lusaka Agenda calls for global health institutions “to make a stronger contribution to primary health care by effectively strengthening health systems” and to align “behind the objective of financial and programmatic sustainability for health services.” The global health institutions should also “strengthen their joint approaches for achieving equity in health outcomes” — with special focus on supporting how public and private sector providers reach the most vulnerable and marginalized groups and supporting integrated services for unreached communities. 13 The Expert Group recommended that Norway use its governance roles in these international institutions to ensure adherence to this Agenda.
Denmark: Shaping a New Generation of Nordic Political Leadership and Partnership in Global Health
The Danish Expert Group was commissioned by the Danish Alliance for Global Health, which was established in 2024 to create a movement that informs development priorities in Denmark and beyond. The Danish Alliance brings together civil society, the private sector, foundations, and research institutions under a common mission: “bolstering support for global health and maintaining Denmark’s frontrunner position” as well as increasing and improving development support for the world’s poorest and most vulnerable populations. 14 The Expert Group was among the Alliance’s first major initiatives.
The launch of the Danish Expert Group report in December 2024 was timed to influence the new Danish development cooperation strategy that was to be developed in 2025.Reference Chang 15 It also coincided with Denmark taking on a non-permanent seat in the UN Security Council (2025–2026) and preparing for the Presidency of the European Union starting in July 2025.
Like in Norway, the Danish Expert Group report, “A Prescription for Denmark in Global Health: Leading the Way in Times of Crises,” had a strong emphasis on the need to reinforce leadership on SRHR, arguing that Denmark should anchor its global health investments in human rights. The expert group also backed the focus on reducing health inequality and the Lancet Commission’s aim of halving premature mortality globally by 2050.
The Expert Group recommended that “Denmark should take leadership in reform processes to promote accountable, efficient governance within global health multilaterals,” including advocating for better spending practices and promoting flexible financing. This included actively championing the Lusaka Agenda and supporting “regional health bodies and regionally distributed manufacturing and supply chains, for instance through support to the African Union’s ‘Agenda 2063’ and New Public Health Order.” 16
As part of the Expert Group’s 19 recommendations, the experts argued that Denmark should leverage its strength in health innovation, research, and science because solutions to “manage the global disease burden are a significant driver of the Danish economy.” 17 This potential to leverage Danish strengths should translate into new ways of conducting equal partnerships across a range of areas, including food security, nutrition, and climate adaptation. In addressing climate change, it was recommended that Denmark should increasingly focus its leadership role and level of investment in climate adaptation towards climate-related health challenges.
The Danish Expert Group called for a new generation of Nordic political leadership in global health by fostering even stronger Nordic collaboration, including by aligning global health strategies among the countries in the region. Recognizing the importance of Nordic leadership, this recommendation drew on the fact that the Nordic countries combined are the world’s fifth largest ODA donor.
From Recommendations to Results
The Norwegian and Danish Expert Groups launched their reports in November and December 2024 respectively. The Norwegian launch received widespread national media coverage, which was followed by broad engagement with most of the political parties in the Norwegian Parliament, as well as the Ministry of Foreign Affairs, the Ministry of Health and Care Services, and the Office of the Prime Minister.
COVID-19 aside, this report has sparked more Norwegian public debate on global health than anything else in years. It has been cited repeatedly in Parliament and prompted numerous op-eds in large national newspapers — including by Bill GatesReference Gates 18 and Muhammad Ali Pate, Nigeria’s Minister of Health and Social Welfare.Reference Pate 19
In March 2025, several of the NGOs and think tanks that had commissioned the Norwegian Expert Group organized a strategic symposium on “Nordic Leadership in Global Health,” bringing together Nordic and international experts and leaders in the field. Looking ahead, the symposium concluded that the Nordic countries must turn “their shared commitment to equity and human rights into decisive, collective action for global health.” 20 With discussions in the Nordic countries often turning to equity and human rights as a starting point for this work, this shared commitment will likely shape continuing Nordic engagement.
The report of the Danish Expert Group on Global Health has similarly led to significant policy outcomes, creating the political momentum for the return of health as a main priority in the new Danish development cooperation strategy, “A Changing World. Partnerships in Development,” launched in June 2025. 21
Health is now one of 5 priority areas under the Danish strategy, included among: (1) Job creation, economic growth, trade, and investment; (2) Response to conflicts, forced displacements, and irregular migration; (3) A just, sustainable, and green transition; (4) Democracy and Human Rights; (5) Education and Health. This inclusion was not regarded as a likely outcome in December 2024, but 6 months later, it was achieved. The Danish Expert Group has been credited for their vital contribution to this outcome. This renewed focus on health changes an almost 20 year trend and has the potential to provide a new baseline for Denmark’s engagements in global health.
The Danish Expert Group’s recommendations have also spurred dialogue with African leaders on how to further advance the recommended types of mutually beneficial, cross-sectoral partnerships in health. The first ever African-Nordic Health Summit, a concept codeveloped by members of the Expert Group and the group of women African ambassadors to the Nordics, will convene high level decision-makers in health across the two regions.
Conclusion: The Nordic Countries, from Donor to Partner
These efforts to renew global health policy in Norway and Denmark have become even more timely in 2025 amid the US government defunding of global health and de facto closure of USAID. Given this US retreat, the Nordic countries combined are now the fourth largest ODA donor. The Nordics cannot fill the gap left by this sweeping US retrenchment. They are, however, well-positioned to engage with the new global reality, help drive needed reforms forward, and ensure that principles of equity, human rights, solidarity, equal partnership, local ownership, and international obligation will remain prominent in shaping the future of global health policy.
This is a new global health landscape where equal partnerships must be matched with national ownership and the localization agenda. Drawing from the work of Expert Groups, the Nordic countries are well positioned to transition from donors to partners in health, thereby evolving traditional political dynamics in development cooperation and anchoring global health in its most relevant context — as public health at country level. For this to occur, a renewed emphasis on mutual accountability will be required in the years to come, but Nordic countries are already talking steps towards this future for justice in global health.
Acknowledgements
I would like to thank Hanna Ohm Cleaver from the Danish Alliance for Global Health and Fride Nordstrand Nilsen from the Norwegian think tank Langsikt for their valuable input during the process of researching and drafting this article.
