In recent years, the global health community has increasingly recognized the urgent need to reconsider foundational perspectives that shape the discipline. A new publication by Tuck, Gray, Akparibo, and colleagues argues persuasively for a fundamental paradigm shift from traditional frameworks to what they term the “transformative paradigm.” This shift is proposed as essential in the broader project of decolonizing global health, a movement gaining traction amid ongoing critiques of power imbalances and systemic inequities in health research and practice worldwide.
The authors begin by outlining the limitations inherent in dominant global health paradigms, which often perpetuate colonial legacies by centering Western knowledge, methodologies, and institutional dominance. These conventional approaches typically emphasize biomedical solutions and donor-driven policies, frequently sidelining the socio-political realities and indigenous epistemologies of the communities they aim to serve. The transformative paradigm, by contrast, calls for an epistemic overhaul that recognizes and values local knowledge systems and actively dismantles entrenched power hierarchies within global health governance.
Critically, the transformative paradigm is not merely about augmenting existing frameworks; it demands a wholesale reevaluation of how knowledge is produced, validated, and applied. It controls for the tendency within global health to universalize solutions without contextual sensitivity, promoting instead methodologies that are participatory, reflexive, and grounded in justice-oriented practices. This paradigm insists that addressing health inequities involves interrogating colonial histories and ongoing structural violence, rather than focusing narrowly on biomedical parameters or economic metrics.
One compelling aspect of the transformative shift is its emphasis on co-creation and collaborative leadership with historically marginalized communities. The authors highlight how sustained engagement with community stakeholders, including those from indigenous and postcolonial contexts, ensures that interventions are culturally congruent and ethically sound. Passing the reins of decision-making to those directly affected by health inequities represents more than symbolic inclusion; it restructures power dynamics to promote dignity, autonomy, and sustainability in health initiatives.
The publication meticulously discusses the challenges global health institutions face in adopting this new paradigm. Deeply embedded institutional resistance stems from inertia, vested interests, and the inertia of epistemic superiority. The authors call on organizations to commit to institutional reforms such as diversifying leadership, restructuring funding mechanisms, and implementing accountability frameworks that reflect decolonial values and principles.
Technically, the transformative paradigm leverages interdisciplinary methodologies that integrate social sciences, indigenous knowledge, critical theory, and systems thinking. These methodologies enable nuanced analyses of health phenomena that account for historical, cultural, political, and economic contexts. This holistic approach contrasts starkly with reductionist biomedical models, offering deeper insight into root causes of disparities and fostering innovative solutions rooted in equity and justice.
Further, the authors argue that incorporating the transformative paradigm challenges the typical metrics of success in global health. Conventional outcome indicators such as mortality rates or disease incidence are insufficient to capture progress toward decolonization. Instead, new evaluative criteria must include measures of empowerment, cultural integrity, and systemic change. This reframing demands ongoing critical reflection to ensure that transformation is genuine rather than performative.
The paper also details the interconnections between global health and broader political economies, underscoring how neoliberal agendas have shaped health priorities and resource allocation. The transformative paradigm explicitly rejects market-driven frameworks that commodify health services and marginalize vulnerable populations. Instead, it advocates for health as a human right, intrinsically linked to social justice and redistribution of power and resources.
Importantly, the authors stress that decolonizing global health through this paradigm is not a one-time intervention but a continuous, iterative process. It requires vigilance against co-optation and vigilance in fostering spaces where diverse voices encounter one another with mutual respect. This ongoing nature highlights that the work of transformation extends beyond academia and policy into lived experiences and everyday practices.
This radical reorientation holds profound implications for training and education within global health. Curricula must be reconstructed to include histories of colonialism and its legacies in health, critiques of existing paradigms, and tools for transformative practice. Capacity-building should prioritize scholars and practitioners from the Global South and indigenous backgrounds, rectifying historical exclusion and ensuring diverse leadership in future generations.
In their conclusion, Tuck and colleagues underscore that adopting the transformative paradigm is an ethical imperative for global health. The field’s historical entanglement with colonial and imperial projects imposes a responsibility to dismantle these legacies actively. Transformative decolonization offers a path toward more just, responsive, and effective health systems that prioritize marginalized communities’ rights and knowledge.
This publication has already begun to reverberate throughout international health forums and academic circles, fueling intense discussions about the future of global health governance. Its call for paradigm shift resonates not only as a critique but also as a roadmap for those committed to equitable partnerships and dismantling systemic inequities.
In an era marked by pandemics, climate crises, and widening health disparities, the stakes for meaningful change have never been higher. The transformative paradigm presents a vision for global health that centers human dignity and social justice, demanding not only new policies but fundamentally new ways of seeing and acting. It challenges practitioners, researchers, and policymakers alike to reconsider their roles and to embrace humility, collaboration, and justice as guiding principles.
As the global health community contemplates this shift, practical steps are emerging, including developing frameworks for decolonial research ethics, reallocating funding towards grassroots initiatives, and establishing international coalitions committed to shared leadership and accountability. These efforts signal a promising, if challenging, trajectory towards realizing the transformative paradigm’s ideals.
Ultimately, the article by Tuck et al. serves as a clarion call to rethink the architecture of global health itself. It advocates an inclusive, justice-oriented approach that situates health inequities within their broader historical and structural contexts, offering a robust theoretical foundation and practical guidance for transformative decolonization. This paradigm has the potential to reshape global health profoundly, fostering pathways toward equity that have long remained elusive.
The transformative paradigm thus represents more than a conceptual innovation; it is a moral and practical imperative capable of catalyzing systemic change. For global health to serve those most in need, it must confront its colonial past directly and chart a course grounded in empowerment, respect, and justice—hallmarks of the transformative vision Tuck and colleagues articulate with compelling clarity.
Subject of Research: Decolonization of global health through shifting paradigms
Article Title: Why do we need a shift to the transformative paradigm if we are to decolonise global health?
Article References:
Tuck, C., Gray, L., Akparibo, R. et al. Why do we need a shift to the transformative paradigm if we are to decolonise global health? Glob Health Res Policy 10, 46 (2025). https://doi.org/10.1186/s41256-025-00443-9
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