WHAT IS GLOBAL HEALTH RESEARCH

Writing this article feels like condensing my entire journey as a global health researcher into a thousand words. I start by asking a question whose answer I only discovered a few years ago: What is global health research, really? Typically, it has involved researchers from the Global North (GN) conducting  research  in  the  Global  South  (GS), travelling to the field site for a few weeks if needed. They are supported by local actors who are bestowed with the title of local Principal Investigator (PI), but the role is often reduced to that of a glorified data collector. I have been involved in projects where the study design was finalized before local teams  were  even  consulted,  with  our  role  limited  to translating  and  implementing  what  had  already  been decided  elsewhere.  While  an  international  partnership results in credibility within the local circle, it offers littleauthority to influence or shape the broader discourse.

Power inequities are also evident in access to resources and recognition. PIs in the GN typically have privileged access to datasets and lead authorship opportunities, supported by the dominance of English in the field. Even more importantly, the field depends heavily on funding from the GN. This dependence allows institutions in the GN not only to lead and design research but also to control its agenda. Local PIs, if they manage to secure a seat at the table, have toconform to the norms set by those in power corridors, which means upholding certain values even if they may conflict with their way of thinking, knowing, and being.

I have seen this top-down control reflected in the conceptualization of interventions in global health. Complex social realities are often simplified into technical fixes, designed by actors far removed from the lived experiences of the communities they aim to serve. These quick, “magic bullet” approaches strip us of context, treating our lives as if we exist in a vacuum, devoid of nuance. Health burdens such as maternal mortality are treated as logistical problems; for example, commuting innovations are hailed simply because they are funded by powerful philanthropic foundations in the GN, while ignoring that women may lack permission to leave their homes, have limited decision-making power, or, worse, be treated as disposable.

This   has   caused   much   dismay   to   the   clinical psychologist-practitioner in me, where taking decisions on the client’s behalf would be considered a gross violation of practice standards. Yet, in global health, we routinely design interventions for people rather than with them. The result has been decades of public health interventions that work on individual responsibility for behaviour change, often through community health workers making home visits, weakening systems when parallel agendas are run through existing structures (with greater power wielded by foreign funds), and neglecting the larger sociocultural context. I have seen community health workers advise mothers on nutrition in households that cannot afford diverse food, or lack access to clean water. No wonder, with a significant amount of funds flowing, Pakistan hasn’t seen much progress, for example, in reducing neonatal mortality.

However, for the past few years, I have seen the discipline moving toward a more reflective space that increasingly interrogates the political, historical, and ethical structures that shape it.  The  COVID-19  pandemic,  followed  by geopolitical  realities  including  the  genocide  in  Gaza, accelerated  an  already  emerging  discourse  on  the decolonisation  of  global  health.  This conversation has exposed persistent asymmetries in power, funding, authorship, and agenda-setting between institutions in the GN and GS. This academic discourse has emphasised that the discipline was birthed as a tool of the colonial empire, whereby local populations were surveilled to control them. While it has been great at untangling these historical realities, much of the current debate, led by those in the GN, has focused on critiquing these inequities and highlighting the influence of colonial hierarchies within research partnerships and knowledge production. Consequently, there has been a conscious attempt to shift visibility of local PIs, questioning who speaks at global conferences, who is named as an author, and who leads grants.

However, another challenge I observe is that, with greater access to funding and opportunities that the field in its current form offers, intellectuals in the GS can begin to lean toward thinking like donors. This results in them being content with generating evidence or simple fixes that do not strengthen systems or shift norms for sustainable change. Hence, I believe the conversation must move beyond identifying structural problems in the GN, toward asking for communities engaged not just as participants, but as co-designers of interventions, informing research agendas before funding calls are issued. In other words, striving for locally grounded research agendas and ethical frameworks that are responsive to the realities of our settings.

From the perspective of researchers and, importantly, institutions in the GS, this moment presents an opportunity not only to engage with the discourse and advocate for a greater share of the pie, but also to contribute new ways of thinking about global health itself. This includes how we lead, what we value, and how we centre the lived realities and dignity of the communities, rather than the researcher in the GS partnership. In this quest, we must not forget that our careers cannot come at the expense of the communities we claim to benefit.

Inevitably, the next question people ask is: But how do we begin? I have learnt that it starts with the self: interrogating the coloniality of our minds and questioning the norms and narratives. For me, this has also meant questioning why international publications are equated with impact, even when the communities see little meaningful change. Asking these questions has often received backlash from individuals and institutions who have benefited from the current system, as they naturally feel threatened. Being part of the change could mean giving up the power they have accumulated over the years.

This led me to question the structures that shape and incentivise our work. GN academia has trained us to believe that writing is the most effective form of change, placing those who are able to publish in ‘high-impact’ journals in authority to drive change. The truth is that designing interventions that truly serve our communities is a messy process because building trust takes time. Trust depends on the character of individuals, not on publications approved by editors, predominantly in the GN. It is built through repeated engagement, listening before prescribing solutions, and consistent presence.

In short, this self-interrogation must then extend to how we define our collective worth, because in the end, funding follows value. And unless we redefine what we value, we will keep reproducing the very systems we claim to change—albeit through different faces. Hence, change has to begin with the courage to resist the need for GN validation, breaking free from their criteria for measuring our worth, and placing the needs and dignity of communities at the center of our work.