North American universities are increasingly investing in centers, programs, institutes, and departments of global health. This focus is driven both by a general move to globalize university education and by student and junior faculty demand. At the same time, governmental funding for global health activities has stagnated or declined, leading to questions about the sustainability of these academic endeavors. In order to remain successful, universities will need to confront several key challenges to sustainability, including funding, faculty recruitment and retention, and graduate employment prospects. They must also recognize that adapting to a changing funding and policy environment will present several opportunities for growth of their global health program. In examining the opportunities and challenges for the development of sustainable global health programs at North American universities, START developed a framework for assessing the sustainability of global health programs and examined changes in global health activities and funding since 2009 and explored anticipated changes in the coming five years.