Imbalances of Power in Global Health Partnerships: Decolonizing Public Health Interventions
What does it mean to have a global health partnership? Is it always a collaboration between a high-income country (HIC) and a low- or middle-income country (LMIC)? Does it simply involve the transfer of resources or aid to an LMIC? And how do we measure the balance or imbalance of power within these partnerships? These are the questions we should be asking.
When I began my journey in public health a few years ago, decolonization was not a concept I expected to engage with deeply. I understood the importance of sustainable interventions and the need to empower communities to continue programs beyond external support. We were taught to “ask what the community needs” and “provide resources to help them sustain it.” But I later realized that this approach, while well-intentioned, was incomplete. Providing aid, building clinics, or implementing health programs does not guarantee sustainability. The real question is: what happens after we leave? Is the local workforce adequately trained and resourced to continue? What if funding is cut, or a shipment of supplies is delayed? When systems are built on dependency rather than equity, sustainability becomes fragile and so do the communities that depend on them.
The power in these partnerships often lies with the HIC institution implementing the program. Even when community input is sought, control over resources, timelines, and decisions still largely rests in the hands of external partners. Collaborating with local institutions or gathering community insights does not automatically equal shared power. Academic partnerships, for example, are often shaped by HIC-driven research grants, and LMIC collaborators frequently contribute significant data and expertise without appropriate recognition. Understanding and addressing these structural imbalances is central to truly decolonizing global health.
With current NIH funding uncertainties and the shifting landscape of global aid, we must rethink the foundations of global health collaboration. Transferring power is not just about “inclusion” or token participation in decision-making; it requires reimagining how we design, conduct, and disseminate research. While 84% of the global disease burden exists in LMICs, most research agendas, funding bodies, and leadership still reside in HICs [1]. Even global health conferences which are spaces meant for shared dialogue and innovation, are overwhelmingly hosted in HICs, with limited LMIC representation due to high travel costs and restrictive visa processes. How can we claim to address global health inequities when the very people most affected are absent from the discussion?
So, how do we begin to fix this? This question has circulated in global health for decades, yet progress remains slow. Decolonizing global health is not a checklist but a shift in mindset. It means changing our approach from helping to partnering, from taking to sharing, and from creating dependence to fostering independence. True equity means ensuring that LMIC institutions lead research conducted in their communities, set priorities that reflect local needs, and are credited for their intellectual contributions.
The path forward lies in humility, accountability, and shared power. Global health needs to outgrow its colonial mindset and focus on equity where progress is built through shared ownership and partnership, not one-sided aid.
References:
Velin, L. et al. Conference equity in global health: a systematic review of factors impacting LMIC representation at global health conferences. BMJ Glob. Health 6, e003455 (2021).
