Deciphering the Decipherless: UNGA, U.S. Global Health, and the Seismic Shift

In a new episode of Apinions, Michael “Dersh” Dershem, founder and CEO of Apierion, sat down with Hugh Dugan, a career diplomat who spent more than three decades at the State Department advising 11 U.S. ambassadors to the United Nations. The two tried to make sense of a post-UNGA moment that feels less like a policy adjustment and more like a tectonic shift in how the U.S. approaches global health. The central question: if Washington is scaling back multilateral funding, is it walking away from global leadership—or redefining it?

Dugan’s answer came without hesitation. Money, he said, doesn’t equal leadership. The United States isn’t retreating; it’s recalibrating—moving from bulky, high-overhead international programs toward leaner, more accountable partnerships. The old system, in his view, rewards process over progress. “Let’s stop with the fluff,” he said. “Show us results on the ground.”

That call for accountability runs through Dugan’s critique of what he calls the “aid industry.” He describes a $68-billion ecosystem of organizations that have little in the way of objective performance metrics. To change that, he’s helping launch Multilateral Accountability Associates, a group aiming to rate global institutions with the same kind of “buy, hold, or sell” framework that investors use to evaluate companies. The idea is to inject a dose of market discipline into a space long insulated from it—and to create consequences for underperformance, not just criticism.

The ethical tension, of course, is that cuts in funding can have real-world costs. Dersh pressed that point, asking whether tightening the purse strings risks worsening conditions for maternal health or crisis-zone care. Dugan didn’t dismiss the concern but argued that the real problem is data. In many regions, births and deaths go unregistered, disease burdens are inconsistently tracked, and outcomes are rarely tied to specific programs. The result, he said, is predictable misallocation. “Non-communicable diseases cause roughly three-quarters of global deaths,” he noted, “but they get a tiny fraction of the money. When you can’t measure, you can’t manage.”

Dugan framed the U.S. shift as an “America First” approach that’s more about realism than retreat. The phrase he uses—“safer, stronger, more prosperous”—captures a worldview rooted in national interest but dependent on a stable, cooperative global order. That means more direct bilateral partnerships, closer field collaboration between the CDC and local agencies, and fewer high-friction intermediaries. “Too little of every dollar gets to the end user,” he said. “We’re forcing a reset.”

That reset has geopolitical implications. Dugan contrasted China’s “infrastructure-first” global health diplomacy—what he called “Belt and Road in scrubs”—with the European Union’s emphasis on solidarity and universality. Both, he said, are heavy on symbolism and light on measurement. The U.S., in his view, should compete not by hosting more summits but by proving that innovation, transparency, and data-driven care can achieve better results. “Don’t out-conference them,” he quipped. “Out-perform them.”

The conversation also zoomed out to the changing face of health itself. In parts of the developing world, obesity now poses a greater threat than hunger. Cancer rates are rising as populations age and environmental exposure increases. The pandemic revealed how fragile global supply chains—and the U.S. healthcare system itself—can be. Dugan’s refrain was simple: we can’t manage what we don’t measure, whether that’s disease trends, food environments, or the resilience of medical supply networks.

Both men see technology as the way forward. Dugan believes AI, digital health platforms, and new funding models could “leapfrog” traditional systems just as mobile phones bypassed landlines. “In a multipolar world,” he said, “let the poles be great ideas.” The next great leap, he argues, won’t come from new institutions but from interoperable data, outcome-based incentives, and capital that flows to what actually works.

At home, Dugan sees the U.S. increasingly treating health as a matter of national security—a shift toward prevention, domestic manufacturing, and tackling what he calls “lifestyle drag” embedded in modern living. The process is messy, but he views it as a necessary self-correction: a nation trying to embody the resilience it preaches abroad.

The takeaway from the discussion was clear. This isn’t an American retreat from global health; it’s a realignment toward results. Expect to see more bilateral engagement, sharper scrutiny of performance, and new accountability tools for the world’s biggest health institutions. For innovators and NGOs alike, that opens the door to a new kind of competition—one measured not in conferences or communiqués, but in outcomes.

“Cutting checks is easy,” Dugan said near the end. “Cutting waste without cutting outcomes? That takes good leadership. If we align data, incentives, and delivery, we can spend less and do more—for Americans, and for the world.”