In the evolving conversation surrounding global health, a transformative approach demanding substantial reconsideration of financial and institutional power dynamics is gaining urgency. Recent research published in PLOS Global Public Health by Daniel Krugman of Brown University and Alice Bayingana from the University of Sydney delves into the entrenched mechanisms perpetuating inequity within the global health academic landscape. Their study challenges conventional strategies of decolonizing global health, introducing the provocative notion of “ruinous solidarity” as a necessary stance Northern institutions must adopt to rebalance power and resource allocation more equitably.
Global health, historically dominated by institutions from high-income countries often referred to as the Global North, remains entrenched within a “soft money” structure that profoundly influences both funding and ideological control. Soft money refers to funding that academics must continuously secure through competitive grants, rather than stable, institutional budget lines. This grant-dependent model underpins many research institutions’ financial health but paradoxically fuels systemic inequities by enabling Northern institutions to maintain disproportionate control over project agendas, resources, and global partnerships.
Krugman and Bayingana base their analysis on an interview series involving 30 faculty members from a prestigious unnamed School of Public Health in the United States. Their findings underscore a tension among faculty: while there is philosophical support for power shifting toward the Global South, practical anxieties loom large regarding job security and career continuities under a restructured funding model. This dilemma highlights the paradox wherein researchers’ livelihoods are interwoven with frameworks that inhibit the equitable redistribution of power the field ostensibly seeks to advance.
The “soft money” model intensifies precarity for global health researchers who often juggle multiple grants just to maintain their salaries—a practice one participant described evocatively as hunting for grants to survive. This relentless competition for funds diverts valuable intellectual and temporal resources away from the collaborative and impactful work necessary for meaningful global health interventions. Faculty testimonies reveal how frequently changing donor priorities force abrupt discontinuations of projects, compounding uncertainties for long-term global health partners in the Global South and undermining sustainable research relationships.
An in-depth exploration reveals that beyond abstract debates about decolonization and symbolic shifts in power, material systems such as funding mechanisms play a crucial role in reproducing structural imbalances. The financial necessity of securing grant overhead creates perverse incentives for institutions to maintain control over funding flows rather than devolve authority to Southern partners. This structural inertia perpetuates a cycle that benefits Northern actors financially and ideologically, complicating efforts to shift the paradigm toward genuine equity.
The concept of “ruinous solidarity” as introduced in the study is compelling and radical. It posits that for Global North institutions and researchers to enable authentic transformation, they must be willing to endure substantial losses—both institutional and personal. This willingness entails the potential destabilization of traditional career pathways and funding prestige in exchange for systemic change. Such an approach requires courage to embrace financial and professional uncertainty as a form of solidarity with Global South partners, signaling commitment beyond rhetoric.
The timing of this call is critical. In the context of retrenchment in US federal science budgets and a broader environment of constrained funding, the authors argue that the field is at a crossroads. The inclination for Northern institutions might be to double down on tried-and-tested mechanisms ensuring ongoing flows of “soft money.” However, perpetuation of these systems is likely to exacerbate the inequities and inefficiencies plaguing global health research, leading to burnout and diminishing impact across the sector.
Methodologically, Krugman and Bayingana’s qualitative anthropological and linguistic case study foregrounds narratives that are rarely heard publicly—those of faculty caught between moral imperatives and structural constraints. The researchers illuminate how these academic actors experience the system from within, describing emotional and practical challenges that obstruct transformative aspirations. The study’s rigor offers nuanced insights into how institutional logics operate and resist change, providing a vital empirical foundation for policymakers and advocates aiming to disentangle this complex web.
Significantly, the research highlights the dichotomy between symbolic power—visible shifts in rhetoric and representation—and material power embedded in financial structures. The authors compel us to recognize that symbolic gestures alone will be insufficient to dismantle the entrenched dominance of Northern institutions. Real-world reform requires financial restructuring that undermines dependency on Northern-led grant economies, thereby redistributing control and opportunity to Global South institutions and researchers.
This study invites a broad reconsideration of the academic industrial complex within global health. While many celebrate growing awareness around decolonizing the field, Krugman and Bayingana urge pragmatic reckoning with the financial architectures sustaining it. Unless Northern actors accept potential personal and institutional “ruin,” the perpetuation of “soft money” driven power asymmetries will likely continue unabated, thwarting efforts to foster truly equitable partnerships and sustainable global health improvements.
In extrapolating these findings to the broader global health community, we see an imperative for funders, institutions, and scholars to engage in frank dialogues about reconfiguring funding modalities. This includes exploring models that prioritize direct investment in Global South institutions, longer-term core funding, and mechanisms that decouple researcher salaries from grant acquisition pressures. Such avenues could help align incentives with the ethical commitments to equity that decolonizing global health demands.
Ultimately, the study’s insights resonate as a call to action—ending the era where financial survival trumps principled change requires courage and sacrifice at the heart of global health academia. The aspiration to shift from rhetoric to substantive transformation hinges on the willingness of privileged actors in Northern academic centers to embrace “ruinous solidarity,” creating a pathway for justice that transcends comfort and conventional norms.
Subject of Research: Financial and institutional dynamics underpinning power inequalities in global health academic structures
Article Title: Soft money, hard power: Mapping the material contingencies of change in global health academic structures
News Publication Date: 28-May-2025
Web References: http://dx.doi.org/10.1371/journal.pgph.0004622
References: Krugman DW, Bayingana A (2025) Soft money, hard power: Mapping the material contingencies of change in global health academic structures. PLOS Glob Public Health 5(5): e0004622.
Image Credits: The City of Toronto
Keywords: global health, decolonization, soft money, research funding, institutional power, Global North, Global South, grant dependency, academic precarity, ruinous solidarity
