About the Series

Institutions: Stanford University and the Barcelona Institute for Global Health (ISGlobal)
Lancet Series Co-leads: Dr. Ruth Gibson and Professor Gary Darmstadt
Quantitative Lead: Professor Davide Rasella

Overview: This Lancet Series examines the profound effects of foreign engagement on global health in an era of escalating geopolitical crises. Inter- and intra-state conflicts are surging, development agencies face downsizing or dissolution, and the resulting health consequences are projected to reverberate across generations. In this Series, “foreign engagement” encompasses the full spectrum of interactions that shape global health, from cooperative state-to-state actions such as official development assistance (ODA) and humanitarian aid to coercive strategies including ODA withdrawal, military assistance to wage wars, sanctions, and blockades, as well as novel approaches involving private-sector actors, philanthropy, and debt relief. This broad framing captures both cooperative and coercive instruments of geopolitics and offers a pragmatic lens for understanding how health can be advanced or undermined amid crises. Although health rarely shapes high-level geopolitical decisions, health outcomes serve as a sensitive barometer of their human costs and long-term consequences. Written for health professionals, policymakers, and civilian leaders in medicine, development, and defense, the Series delivers empirical evidence and modelling to illuminate how foreign policy choices affect health.

Series

Series Paper 1: This paper establishes the conceptual foundation by defining key terms, analysing geopolitical shifts, and examining the implications of development, military, and novel forms of foreign engagement impacting global health.

Series Paper 2: This paper uses advanced complex systems modelling to project child and adult undernutrition, morbidity, and mortality in LMICs to 2040 under alternative scenarios of ODA defunding, conflict, sanctions, and other geopolitical shocks, while evaluating mitigation strategies.

Series Paper 3: This paper grounds the Series in present-day realities through country-specific mixed-methods case studies that combine rigorous quantitative analyses with qualitative research.

Series Paper 4: This final paper synthesizes evidence from the previous papers to propose concrete, time-bound pathways to self-reliance and a more equitable foreign-engagement architecture, with actionable recommendations and a call to action.