Abstract Global infrastructure projects have emerged as pivotal instruments in shaping economic growth and geopolitical dynamics in the contemporary world. Infrastructure, traditionally associated with physical structures like roads, bridges and utilities, now extends to include services vital for societal standards and economic progress. This evolution reflects a broader recognition of infrastructure’s role in fostering development, with distinctions drawn between physical infrastructure such as transport and energy networks, and services-oriented infrastructures encompassing health and education. Scholarly discourse on the correlation between infrastructure development and economic growth varies significantly. While some researchers assert a positive relationship, citing infrastructure’s stimulative effects on economies, others argue that this link is not universally conclusive, highlighting nuances in variables and methodologies used in studies. Nevertheless, the consensus underscores the critical role of infrastructure in enhancing economic activities, particularly in developing countries where the infrastructure gap remains stark. Central to contemporary infrastructure dynamics is China’s Belt and Road Initiative (BRI), a global development policy launched in 2013 aimed at enhancing connectivity and economic integration across Asia, Europe and beyond. The USA and its allies have also initiated the Partnership for Global Infrastructure and Investment (PGII), to promote sustainable infrastructure development aligned with Western values and global governance standards. As these global powers focus on infrastructure development, the implications for health and well-being emerge as critical considerations. Infrastructure projects not only promise economic benefits but also present opportunities to address public health challenges, enhance connectivity and promote sustainable development goals. However, they also pose challenges such as environmental impact, debt sustainability and geopolitical tensions, underscoring the complex interplay between infrastructure development, global governance and human welfare. This paper explores the multifaceted dimensions of global infrastructure projects, examining their implications for health and well-being amidst evolving geopolitical competition. By analyzing key initiatives like BRI and PGII, it aims to provide insights into how infrastructure investments can be leveraged to foster equitable socio-economic development while navigating the challenges posed by climate change, governance issues and geopolitical rivalries. Understanding these dynamics is crucial for harnessing the transformative potential of global infrastructure projects to promote health and well-being on a global scale.