Introduction

In 2019, a piece was published in the U.S. National Public Radio blog, Goats and Soda, outlining the lack of acknowledgement of Dr. Jean-Jacques Muyembe’s contributions and leadership role in discovering and studying the Ebola virus in the 1970s. At the time, Global North researchers were credited with the discovery, which catapulted them towards further grant funding, prominence and standing in public health and medicine, and leadership careers in global health; Muyembe, on the other hand, was “written out of history [1].” Unfortunately, stories like these are common within the global health community. Prior to 2019, many investigators in global health had begun to question academic structures that advantage Global North investigators over Global South investigators [2,3,4]. This has only been accentuated by the 2020 global reckoning with systems of racism embedded within societies and academic communities. Aspects of racism and colonialism have been frequently documented and labelled “parachute research,” where a global health investigator (usually from the North) “drops into a country,” conducts primary research by utilizing local resources, and returns home to submit an article for a prestigious journal [5,6,7]. Dr. Seye Abimbola, from University of Sydney, advocated for recognition of this ‘Foreign Gaze’ that occurs with journal authorship in global health, and called for a questioning of investigator positionality (questioning whether the ‘foreign gaze’ is necessary, inconsequential, corrupting) in allocating authorship order [8]. These same questions can be asked about leadership, publications and roles in Global North-South collaborative projects.

Increased pressure for decolonization has prompted academics to grapple with promotion and tenure criteria at Global North institutions, as these criteria often motivate Global North dominance in the global health arena. Generally speaking, Global North academic institutions set criteria for promotion and tenure of faculty, often through a shared governance process, such that faculty are required to hold leadership positions on publications, funding, and conference presentations for professional advancement. Promotion and tenure files are then evaluated and voted upon by peers based on these criteria, and promotion and tenure is awarded once academic administrators (e.g. deans, provosts) concur with faculty evaluations. However, these criteria are often set in Global Health fields without the inputs of global partners, ultimately at the expense of Global South investigators [9]. In addition, promotion and tenure criteria were not developed with broader structural factors in mind, such as inequalities in accessing research funds and inequalities in the types of roles local investigators play on the ground where global health research is conducted [10].

A bibliometric analysis was conducted by Adam et al. and demonstrated that Global South first authorship represents only 4% of publications listed under health policy and system research [11]. Bibliometric studies have also consistently shown that Global South researchers are listed as authors at all, let alone as first authors, despite the amount of work they contribute and given that much of the work is in their locale [12,13]. These studies have been replicated and show Global South first authorship is consistently behind those of Global North first authorship, despite some recent increase [10,11]. Further, Adam and colleagues included a survey to assess funding opportunities, and Global South respondents consistently reported stagnant funding from their local governments ranging from 11% to 15% [9]. In other words, Global South investigators must rely on international or bilateral mechanisms for much of their funding. These factors undermine equitable partnerships in global health research, creating asymmetrical resource and power dynamics [14]. Together with soft money academic structures (such as federal grants or private funding), these dynamics incentivize Global North researchers, faculty, and ultimately, universities to continue parasitic practices and to promote their own agendas while erasing the role of Global South investigators in the work [15,16].

Sometimes, collaboration efforts have reproduced unequal power relations [14]. An ideal collaboration can be defined using Samoff and Carrol’s framework as:

“a collaboration that can reasonably be expected to have mutual (though not necessarily identical) benefits, that will contribute to the development of both institutional and individual capacities to advance [global health] at both institutions, that respects the sovereignty and autonomy of both institutions, and that is itself empowering.”[17]

This type of collaboration is rarely present in global research partnerships, where Global North researchers have set the research agenda and Global South researchers have been recognized solely for supporting roles at best. Global South investigators are further erased through lack of recognition and the inability to attend conferences due to visa access [3,18]. Samoff and Carrol’s framework in conjunction with the literature and Eichbaum et al.’s discussion of the intersection of colonialism, medicine, and global health demonstrate problematic collaboration efforts that privilege Global North investigators [19]. In essence, unequal power relations suggest colonial and racist overtones that oppress and undermine scholars from the very communities that this research affects.

These realities can be traced back to unequal power dynamics; several articles framed power dynamics through French philosopher and sociologist Pierre Bourdieu’s concepts of habitus, capital, and field where “power imbalances and inequities exist at each stage of the research process [20].” From the researcher and their positionality (habitus) to the resources they bring to the country of interest (capital) and finally to the agenda setting and journal submissions (field), each step clearly demonstrates disproportionate power where Global North investigators dominate [21]. Studies have shown that Global North researchers gain significantly more opportunities professionally, including prominent authorship positions, conference presentation and attendance, and more funding support at their home institutions compared to Global South researchers [14]. Further, even the travel process (vaccines, travel fees, visa) creates costly barriers that prevent most Global South researchers from “having a seat at the table” and promoting their work at conferences and workshops [22]. Due to their positionality and opportunities presented to them, Global North researchers often set the research agenda, including what to study and how research is conducted, and receive most of the credit. Reese et al. conducted a mixed methods study to survey global health researchers from the Global North and the Global South on their perception of collaboration in pediatric research [23]. Responses from both groups suggested that:

“more than two-thirds of total respondents...perceived that high-income country Global North investigators had set the research agenda in previous work conducted in the Global South, with the most commonly cited reason across all respondents being that Global North investigators who had set the research agenda had access to funding.”[23]

With less funding, Global South investigators are disadvantaged in every step of the research process, and their contributions often go unrecognized. Locally driven agendas are often set by what is funded by global north funding mechanisms, which are sometimes disconnected with local priorities. An imbalance develops that supports the careers and priorities of Global North researchers at the expense of Global South researchers [24]. Therefore, the purpose of this paper is to explore ways that Global North investigators and institutions can encourage and value taking supportive, rather than leadership roles in global health research. Moving in this direction is taking a proactive stance against racism, colonialism, and oppression.

This paper outlines a range of current promotion and tenure policies academic institutions (often in the Global North) engage in and explores how these policies provide powerful incentives and barriers that can either address or reinforce oppressive practices. Further, this paper will explore ways that Global North investigators can take supportive roles in global health research by incorporating anti-racism and decolonization components into their promotion and tenure practices within global health research. We held a set of discussions with global health professionals at an academic global health conference, exploring incentive areas of promotion and tenure, anti-racism/anti-colonialism curriculum, research agenda setting and collaboration, mentoring practices, and capacity strengthening initiatives based in the Global South.

Materials & methods

The Consortium of Universities for Global Health (CUGH) holds an annual conference, typically in a Global North location, to address current and persistent global health challenges. For the 2022 conference, a planning committee of nine faculty from two global health institutions in the United States (US) sought to create a three-hour pre-conference session entitled, “Incorporating Anti-Racism, Anti-Colonialism, and Anti-Oppression Efforts into Faculty Promotion.” The conference discussions examined current promotion and tenure policies exploring ways Global North academic institutions could change to embrace fair and equitable practices in global health through anti-racist and anti-colonial lenses. Participants’ institutions paid membership fees, which then enabled session attendees to attend for free. Further, this workshop was held via an online platform, which created another incentive to easily join the discussion.

Prior to the workshop, the planning committee invited faculty with interests in diversity, equity, and inclusion from nine Global North institutions and six Global South institutions. Faculty from three Global South academic partner institutions and two Global North institutions served as co-facilitators of the session. Prior to the workshop, facilitators collected information from institutions within their academic global health networks in a survey, which sought to document current practices that incorporate anti-racism, anti-colonialism, and anti-oppression efforts into faculty promotion. The survey inquired about criteria for faculty appointment and promotion into global health academic units (e.g. teaching, grant funding, publications). Seven global health academic units responded, and facilitators compiled and presented the information provided as example promotion criteria to participants of the workshop [25]. Before submission, this study’s protocol was submitted to the UW Institutional Review Board (IRB) and given a non-research determination and deemed exempt from review.

Results

Discussion

Throughout the workshop, participants insisted that structural change needs to occur for equity to exist within global health research. This was brought up alongside needs for changes to the promotion and tenure process within Global North participants’ institutions. Further analysis refined this discussion into the categories of explicit structural changes (updating promotion and tenure guidelines within departments) and implicit structural changes (creating an equity-focused mindset within departments). Moreover, within the promotion and tenure discussion, participants argued for developing an anti-racist/anti-colonialist curriculum that faculty can clearly demonstrate in their packets. Participants suggested a shift within their collaboration with Global South partners through their agenda setting. Aligned with many journals’ calls for authorship equity, participants in our workshop also called upon global health researchers to encourage Global South first authorship in papers, while recognizing the challenges achieving this.[28] Finally, departments can begin to institutionalize equity practices within their promotion and tenure process by recognizing mentoring and capacity strengthening partnerships. By integrating these components throughout the promotion and tenure process, faculty will be encouraged to find ways to collaborate equitably with their Global South partners for generations to come. These discussions aligned with the research published about inequities in global health research where hidden systems and Global North agendas are prioritized. (2) Subsequent to these discussions, CUGH put out a position statement that takes into account many of the principles discussed here [29]. Finally, while it was not directly mentioned in the recorded discussion, there needs to be a change within the National Institute of Health (NIH) policy to increase indirect cost recovery for Global South institutions. Currently this is only at 8%, an amount that significantly limits strengthening institutional capacity for research administration. Addressing this change can lead to more funds and resources to help build high quality research administrative capacity in the Global South for Global South investigators. Recently the Fogarty International Center announced that $1.7 million has been earmarked to be distributed for administrative oversight and furthering the goal of developing more diverse global health institutions [30]. Finally, some institutions involved in facilitating this workshop have begun to revise faculty promotion handbooks, and others have begun to develop Global South partner advisory boards to drive their collaborative work. While these are steps in the right direction, much more needs to be done.

We wish to acknowledge that there is some limitation in this study, specifically regarding the sample size. While we had 33 attendees actively participating, many studies have included a larger sample to obtain a richer level of data, but we were limited to participants who chose to attend a pre-conference workshop. Thus, these findings have limited generalizability. Additionally, the sample size had a disproportionate number of Global North investigators to Global South, reflective of CUGH member institution locations. Despite our outreach efforts, there were issues with time zone inconveniences related to time of day that this session was offered. Finally, we noted in the large group discussion that Global North participants were more vocal, and Global South scholars shared more during the smaller breakout sessions. Thus, we must also acknowledge that structural inequities were present within the workshop discussions, as well. Future discussions on this topic would benefit from an awareness of these challenges, and benefit from a plan to challenge these limitations.

Conclusions

Despite the honorable intentions of global health researchers, several practices within the discipline have been problematic, with unequal power dynamics occurring throughout research processes that are maintained by traditional academic structures and funding constraints. Global North researchers are incentivized to uphold current practices and thus, unintentionally undermine Global South investigators’ opportunities and advancement. This paper presents initial discussions of some potential pathways towards structural change in order to change the Global North dominated system. We recommend that institutions begin implementing strategies mentioned here to test their effectiveness.

Acknowledgments

We wish to acknowledge and thank the participants of the CUGH Virtual Satellite Session Incorporating anti-racism, anti-colonialism, and anti-oppression Efforts into Faculty Promotion for their insight and the CUGH Consortium for their continued support of this important work.