Anna Rouw

This analysis uses FY 2024 foreign assistance obligation data, downloaded from ForeignAssistance.gov on November 20, 2025. ForeignAssistance.gov is the U.S. government’s centralized data portal for budgetary and financial data provided by more than 20 federal agencies that manage foreign assistance programs. Obligations are binding agreements that will result in outlays of funding, immediately or sometime in the future.

As indicated in the name, “public” health is primarily shaped and supported through the public sector, i.e., governments. In the U.S., public health powers and responsibilities are shared across federal, state, and local levels of government. Legal authorities for public health powers are derived from the U.S. Constitution and relevant federal, state, and local laws (see Box 2 for an overview of the legal basis for U.S. public health powers).

Starting on his first day of his second term in office, President Trump and his administration have taken several executive actions that directly impact U.S. global health efforts.