In a world increasingly grappling with the implications of global health disparities, a recent study by Daniel Krugman from Brown University and Alice Bayingana from the University of Sydney highlights the urgent necessity to rethink the frameworks that govern our approach to global health. Their research, published on May 21, 2025, in the open-access journal PLOS Global Public Health, advocates for a bold concept: "ruinous solidarity." This idea calls on institutions from the Global North to relinquish some of their influence and resources in support of their counterparts in the Global South, challenging deep-rooted norms in global health.
The Current Landscape of Global Health
Despite ongoing discussions about decolonizing global health, institutions in the Global North remain dominant. This dominance is perpetuated primarily by the "soft money" structure that characterizes funding in many universities, wherein faculty must rely on grants from donors to support their salaries and research projects. This structure creates a hierarchy in which Northern institutions wield significant ideological power, effectively marginalizing the voices and contributions of global health institutions in the Global South.
To delve into this phenomenon, Krugman and Bayingana conducted qualitative interviews with 30 faculty members at a major public health school in the United States, keeping the institution anonymous for confidentiality. The findings revealed an unsettling paradox: while many faculty members endorsed the idea of transferring power and resources to South-based institutions, they also expressed significant anxiety over the implications this shift would have on their own careers and funding.
The Tug of War Over Funding
The tension between supporting equitable global health and maintaining personal job security was palpable during the interviews. Faculty members acknowledged the need to empower researchers and institutions from the Global South; however, they hesitated to let go of the funding mechanisms that prop up their own livelihoods. The current environment necessitates that these researchers chase after grants, often at the expense of their well-being and the impact of their work.
One tenured professor articulated this predicament, describing themselves as a "hunter for grants," a sentiment echoed by many interviewees. The cycle of continuous grant applications can lead to burnout and shift focus away from the very communities that researchers seek to assist. In some instances, changing donor priorities even resulted in shuttering long-term projects, demonstrating how deeply entwined funding dynamics are with global health outcomes.
Rethinking the Power Dynamics
In light of these findings, Krugman and Bayingana argue for a radical reorientation of the funding framework in global health. They propose that for genuine transformation to occur, Northern institutions must be willing to accept the potential loss of resources— a cornerstone of what they term "ruinous solidarity." This willingness to sacrifice comes with risks, especially considering recent cuts in science funding in the United States.
Their argument suggests that the path toward equitable global health cannot solely rely on symbolic gestures or goodwill; concrete changes are needed in the material systems that underpin the field. If institutions from the Global North continue to cling to their privileged positions and funding structures, the systemic inequities in global health will persist, stymying the progress that many activists and scholars envision.
Toward Meaningful Change
The crux of the argument presented by Krugman and Bayingana illuminates a vital aspect of decolonizing global health: it cannot simply be an intellectual exercise. Instead, it must be accompanied by tangible shifts in how research and funding are managed. The authors emphasize that having discussions about power and equity isn’t enough; elite Northern global health actors must actively engage in restructuring their financial systems even if it threatens their job security.
The stress and challenges faced by faculty in the Global North serve as a microcosm for larger global inequities. Researchers who are constantly battling for limited funding often find themselves sidelined, unable to engage in meaningful partnerships with their colleagues in the Global South. This vicious cycle must be broken to foster a more collaborative and impactful approach to global health.
Conclusion
Rethinking global health through the lens of "ruinous solidarity" calls for an urgent reconsideration of funding and power dynamics in the field. The existing "soft money" structures perpetuate ideologies that disadvantage Global South institutions and misalign research goals with community impact. For meaningful change to occur, it is imperative that institutions and researchers from the Global North reevaluate their positions and embrace a model that prioritizes equity and support for Global South partners.
As the conversation around decolonizing global health evolves, we must push for action that extends beyond rhetoric. The study by Krugman and Bayingana serves as a critical beacon, urging stakeholders to confront uncomfortable truths about funding, power, and the future of global health collaboration. Only through genuine commitment can we redefine a global health paradigm that truly serves all communities, not just those in privileged positions.
