To truly decolonize global health, institutions in the Global North must be willing to practice “ruinous solidarity,” a study suggests. Published on May 21, 2025, in PLOS Global Public Health, the research, led by Daniel Krugman of Brown University and Alice Bayingana of the University of Sydney, highlights the financial and ideological structures that continue to reinforce Northern dominance in global health.
Despite growing efforts to decolonize the field, Global North institutions still hold significant power due to their financial resources. These institutions are primarily funded through “soft money” systems—where research departments depend on competitive grants. This setup not only sustains their financial dominance but also strengthens their ideological influence.
Krugman and Bayingana conducted interviews with 30 faculty members from a major, unnamed public health school in the United States. While most participants supported the idea of transferring power to Global South institutions, they expressed concerns about how this shift could be implemented. The main challenge lies in funding, as moving resources away from high-income countries would threaten faculty members’ jobs and career progression.
In the current system, researchers rely on grants to fund both their salaries and projects. This often forces faculty to work on multiple projects to cover their full salary. One professor described the process as “hunting for grants”—where success means survival, and failure means losing funding. Many faculty members reported that this system distracts from the goal of positively impacting Global South countries, contributing to burnout and frustration. Moreover, when donors shift their priorities, projects are often forced to close, leaving long-term partnerships in jeopardy.
However, when the authors proposed redirecting funding directly to Global South institutions, most faculty expressed anxiety over the potential impact on their livelihoods. This reluctance reflects the deeply entrenched financial structures that continue to prioritize Northern institutions.
Krugman and Bayingana argue that for meaningful change to occur, Northern researchers and institutions must accept the possibility of losing significant resources. This, they say, is essential for transforming global health, especially now as funding for scientific research in the United States is shrinking.
The authors further explain, “Our study shows how inequity in global health research is perpetuated by the soft-money systems at North American schools of public health. These structures force researchers to chase grants, causing high stress and limiting the impact of their work. They also prevent the changes they want to see in the field. To truly decolonize global health, elite Northern institutions must restructure their financial systems—even if it means sacrificing their own financial security and jobs.”
Without these material changes, the study concludes, power will continue to be concentrated in the hands of Northern institutions, undermining efforts to redistribute resources and opportunities to the Global South.
Related Topics
