The second Trump administration has already made major changes in US policies that affect health and health systems worldwide.

We use the Health System Performance Assessment categories developed by the European Observatory on Health Systems and Policies to identify areas in which US actions affect the health systems and policies of European states and the EU, and presidential Executive Orders supplemented by campaign statements to understand US actions.

We identify relevant US policies in the areas of finance, resource generation (regulation, vaccines, artificial intelligence, supply chain resilience, workforce, research, education) and governance (geopolitical turbulence, climate change, US departure from the World Health Organization, and foreign aid). We then identify opportunities for states or the EU to strengthen their health systems, potential threats to their health systems that might arise from US actions, and serious confirmed threats.

The second Trump administration is creating heavy demands on European governments in many areas, which might undermine their fiscal capacity and willingness to fund health systems or new ventures, but diminished US investment in areas such as multilateralism, pandemic response, research, education, and aid (especially in areas such as gender and reproductive health) all create opportunities for European policymakers to strengthen their health systems, health-related economic sectors, and influence in global health governance.