10 JANUARY-FEBRUARY 2026 | THE FOREIGN SERVICE JOURNAL In a letter accompanying the strategy, Secretary of State Marco Rubio wrote that the administration must “keep what is good about our health foreign assistance programs while rapidly fixing what is broken.” He argued that decades of U.S. investment have saved millions of lives yet also created “inefficiency, waste, and dependency.” The document calls for shifting major programs into bilateral government-togovernment agreements, with the goal of transitioning many countries toward greater self-reliance and national ownerRelease of “America First Global Health Strategy” After nine months of cuts to global health programs, the Trump administration has released its first comprehensive blueprint for the future of U.S. foreign assistance in the sector. “America First Global Health Strategy,” a 35-page document issued by the State Department in September 2025, lays out a dramatic shift in how the United States intends to deliver global health support, negotiate with partner governments, and position U.S. engagement abroad. I took an oath to this country. This is a lifetime oath to do the right thing and to obey the Constitution and to enforce the Constitution. And no threats and intimidation by the president are ever going to stop me from carrying out that oath. —Representative (D-Colo.) and former Army Ranger Jason Crow on NPR on November 21, 2025, responding to President Trump’s threat to have him and five other members of Congress executed for their role in creating a video reminding military members that they are required to refuse unlawful orders. Contemporary Quote ship. It also proposes consolidating U.S. global health efforts by moving away from disease-specific initiatives and integrating data systems, supply chains, and service delivery. The strategy states that funding for frontline health workers and essential medical commodities will be maintained, while technical assistance and overhead costs will be significantly reduced. It also positions global health engagement as a means of strengthening bilateral relationships and expanding international markets for U.S. medical and pharmaceutical products. The department aims to complete most bilateral agreements by the end of 2025 and begin implementation in April 2026. Global health experts have raised concerns about the strategy, including Stanford researchers Ana Maria Craw- ford and Michele Barry, who argue that the plan focuses only on how much is spent and not on health outcomes. They note that despite high expenditures, Site of the Month: The Steady State The appearance of a particular site or podcast is for information only and does not constitute an endorsement. This month, we highlight The Steady State, an organization of more than 340 former U.S. national security professionals spanning intelligence, defense, diplomacy, and homeland security who have united around a simple mandate: defend the U.S. Constitution over partisan politics. Founded in 2016 amid growing concern about authoritarian drift in U.S. governance, the group continues to publish sober, expert-driven analysis on national security, rule of law, and democratic resilience. Their membership includes former senior officials from across the national security community, and their work ranges from legal filings and congressional letters to public statements, open letters, and policy commentary. The Steady State recently released “Accelerating Authoritarian Dynamics: Assessment of Democratic Decline,” a sweeping, intelligence-style analysis authored by former U.S. intelligence officers. Drawing on open-source indicators and structured analytic tradecraft, the report concludes that the United States is on a trajectory toward “competitive authoritarianism,” where democratic institutions persist in form but are increasingly manipulated to entrench executive power. The document examines trends including executive overreach, judicial erosion, politicization of the Civil Service and intelligence community, weakening congressional oversight, and sustained assaults on public trust and civil society. With its steady stream of resources, the organization has become a wellspring for readers seeking principled, factbased assessments during a period of accelerating institutional strain. Visit https://thesteadystate.org/ for more.
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