Last week I watched the Decolonize Global Health online conference at the University of Edinburgh , where Madhukar Pai, Director of Global Health at McGill University, said that the bright spot he sees in all this is the youth can see through the BS. And by BS, he means the “colonialism” in global health research, lack of diversity, inadequate reciprocity, and the excuses we make to explain away and perpetuate inequalities in who gets funding, who publishes, who leads research, what gets studied, and how the scales are tipped in the favor of older men, white people in the Global North, and researchers at a handful of elite institutions.Inspired by these conversations, this blog is my attempt to lay out some tangible steps I think we as researchers and funders can do now.

I have been faculty at two universities, worked as staff with the United Nations, and worked full time for two international NGOs and consulted for a handful of others. Thus, I’ve witnessed this game from a few different angles and have some thoughts, but you can take these with a grain of salt. I’m writing from a point of privilege within my own system (as tenure track faculty at a public university), but also globally as a white woman born, raised, and employed in the United States. Despite this privilege, I’m still “tenure-track” but not yet tenured. I might have also contributed to some of these inequalities, despite my efforts to counter them at times. Hence the grain of salt, but here’s what I think we could be doing to make global health more equitable, reciprocal and diverse”

1. More funding for foreign students: Most public health and global health degree programs are based in the Global North, and those who benefit most are students from high-income countries (HICs). Universities in HICs need to provide more funding for graduate students from lower- and middle-income countries (LMICs) in two ways: a) not just stipends, but also application fee & tuition support, funds to take entrance exams, funding to travel to start their studies, and funding to conduct research and b) funding for students from the global south for master’s degrees. Otherwise, we’re only providing the opportunity to students that are already well-off in their country of origin (and largely from a select few countries). In the US, universities often fund students to complete their PhDs (tuition and stipend), but not master’s, and in the Public Health field, you need a master’s before pursuing a PhD (not true in social science fields like Public Policy, Sociology, Economics, etc.). This is likely a major barrier to the PhD pipeline in Public (Global) Health in the US. Another possible solution to explore would be for HIC universities to offer online Master’s training at a lower (or subsidized) cost to LMIC trainees.
2. More core funding to research institutes and universities in LMICs: Funders should provide more core support to research institutes in LMICs for more flexible use so these institutes are not fully dependent on sub-contracts from HICs to collect data. Under the current model, researchers at these institutes don’t have enough time to design their own studies and/or write papers (beyond the reports to the donor), because they constantly need to get the next contract to maintain funding for their salaries and those of their support staff.
3. Institutionalized capacity building: “Capacity building” is possibly the most popular phrase in development right now, but we can do it better. What is needed is INSTITUTIONALIZED mentoring and capacity building. We can’t solely depend on the goodwill of individuals. While there are lots of people who mentor because it’s the right thing to do and they enjoy boosting the next generation of researchers, we need to institutionalize this process to provide opportunities to more students, in a more equitable fashion. There needs to be transparent, accessible opportunities that students can apply to, and not just have them rely on the networks of their professors and connections. This is something that’s relatively easy to do, with a modest amount of funding. Two concrete examples are Carta and the Transfer Project Fellowship. Carta is hosted by the African Population and Health Research Centre together with the University of the Witwatersrand, and the initiative supports African scholars to undertake doctoral training in Africa and provides them with postdoctoral opportunities, including in the Global North, with support from various funders. the Transfer Project, in collaboration with the African Economic Research Consortium, offers opportunities for African scholars within five years of completing their PhD to work with senior Transfer Project scholars on research using data from impact evaluations of government social protection programs, with funding from Sida and William & Flora Hewlett Foundation. (Kudos to Sida who support both of these initiatives!). Then of course there are the well-known Fogarty Training programs, in which the US National Institutes of Health (NIH) funds training and mentoring between institutions in the US and eligible LMICs.
4. Major changes in HICs tenure and promotion incentive structures: One of the main drivers of the inequalities in global health we see today are the incentive structures in tenure and promotion in HICs. Structural change is needed, whereby researchers in HICs could be equally rewarded for a mentoring role in which their partner/mentee from a LMIC is a first/last author on a peer-reviewed publication instead of the HIC researcher needing to be first/last author. Among the most important criteria for tenure and promotion in global health at research-intensive universities are 1) securing funding and 2) first and last authored publications in top peer-reviewed journals. For senior faculty who have achieved Full Professor status, they may have less incentive to insist on first or last author order. Mid-career professionals going up for promotion need these publications to keep their jobs, are the individuals most actively collaborating with partner researchers in the global south. Thus, the issue of authorship is not just an individual choice, but is driven by the system in which faculty, students, and post-docs find themselves dependent on for their livelihoods. In the meantime, researchers in HICs (at all levels) could make sure that one of the polar slots are reserved for LMIC collaborators where the study is conducted. It is also vital to support LMIC collaborators in authorship by providing protected time. For example, the HIC collaborator can invite the LMIC collaborator and provide space to analyze and write. This can be budgeted for in the proposal stage. Many LMIC collaborators either lack time or resources to concentrate and focus on analysis and writing. A successful example of this model is conducted by the University of California, San Francisco through their International Traineeships in AIDS Prevention Studies (ITAPS) program.
5. Reciprocity in Study/Research Abroad programs: US programs sending students abroad for research opportunities, clinical practice, and study abroad programs rarely budget for reciprocity. We need to institutionalize reciprocity in budgeting for study abroad programs. For example, for every 5? 10? 15? students sent abroad, we should fully fund one student from the receiving country to gain an equivalent experience in the United States. Yap Boum, a researcher at MSF Epicentre, has argued that this ratio should be 1:1.
6. Push back against all-HIC panels: As “manels,” or all-male panels are now recognized as unacceptable, so too should all-HIC panels and committees comprising only experts from HICs on global health topics. There is much expertise to be learnt from LMIC experts, and that should be tapped into. Global problems should be solved with global ideas, and when expert panels are continuously dominated by the same countries, this biases the solutions offered.

These are just some examples of concrete steps we can take now to decolonize Global Health and create more equitable opportunities for scholars around the globe. I have likely overlooked many more examples and look forward to keeping this conversation going with your suggestions.

About the author

Tia Palermo, Ph.D., is an Associate Professor Epidemiology and Environmental Health at the University at Buffalo (State University of New York). Her research examines the effects of social policy on population health. She holds a Ph.D. in Public Policy from the University of North Carolina at Chapel Hill and is an Affiliate of the Transfer Project, Faculty Fellow at the University at Buffalo’s Center for Global Health Equity. She would like to thank Drs. Lusajo Kajula and Madhukar Pai for helpful comments on a previous version of this blog.