Endocrine disorders represent a vast and heterogeneous category of conditions including diabetes mellitus, thyroid dysfunctions, endocrine-related cancers, obesity, infertility, and numerous rare diseases. Despite their extensive burden, these conditions often remain underfunded and insufficiently studied. Current data reveal that endocrine research has been allocated less than four percent of Horizon 2020’s biomedical and health funding—statistics that underscore a critical disparity given the prevalence and societal impact of hormonal diseases. EndoCompass emerges as a strategic solution to bridge this funding gap by identifying urgent priorities and advocating for the equitable distribution of research resources throughout Europe, promoting scientific innovation and clinical translation.

This visionary roadmap is the product of an extraordinary two-year collaborative effort involving 228 leading academics, clinicians, and scientists from diverse European countries. Complementing this scientific breadth, nine prominent patient advocacy groups and ten esteemed partner societies have contributed to ensuring the roadmap not only reflects cutting-edge research needs but also incorporates patient-centered perspectives and the social dimensions of endocrine health. The collective engagement underscores a unified recognition within the endocrine community of the necessity to jointly shape a forward-looking research agenda aligned with public health imperatives.

EndoCompass delineates priority research axes across eight specialized endocrine domains, encompassing adrenal and cardiovascular endocrinology, calcium and bone metabolism, endocrine oncogenesis, metabolic disorders including diabetes and obesity, growth regulation, neuroendocrine tumor biology, reproductive and developmental endocrinology, and thyroid pathophysiology. Beyond domain-specific challenges, the roadmap addresses five overarching thematic areas critical for advancing endocrine science: integration of data and emerging technologies, environmental influences on endocrine health, addressing health inequalities, life-course endocrinology, and the role of endocrine laboratory medicine. This multifaceted approach ensures that both biological complexity and societal determinants are adequately considered.

The integration of data science and artificial intelligence within the EndoCompass framework exemplifies the roadmap’s commitment to leveraging transformative technological advances. By promoting the development of new analytical tools and standardized big data infrastructures, the initiative aims to accelerate biomarker discovery, improve diagnostic accuracy, and enable precision medicine approaches tailored to individual hormonal profiles. Additionally, environmental endocrinology receives particular attention given the increasing evidence of endocrine-disrupting chemicals adversely impacting human health. Research recommendations include mechanistic studies of environmental exposures and mitigation strategies to protect vulnerable populations.

Health disparities linked to socioeconomic status, geographic location, and access to healthcare are also highlighted as critical areas requiring urgent research investment. Understanding how these inequities influence endocrine disease prevalence, progression, and treatment efficacy is essential to designing inclusive healthcare policies and outreach programs. The emphasis on life-course endocrinology further reflects an understanding that hormonal influences span from early developmental stages through aging, necessitating longitudinal studies to unravel complex temporal dynamics affecting health outcomes.

Rare endocrine diseases, representing a constellation of often debilitating but understudied conditions, form a vital component of the research roadmap. Given their low prevalence, these disorders frequently suffer from limited clinical expertise and scarce therapeutic options. EndoCompass advocates for increased collaborative networks to harmonize diagnostic criteria, foster translational research, and expedite clinical trials, thereby enhancing patient care for these neglected populations. The roadmap further stresses the importance of endocrine laboratory medicine to underpin diagnostic precision and support the validation of innovative biomarkers.

The development of EndoCompass as a living, practical resource aims to empower the endocrine community to collectively advocate for policy-driven funding commitments while facilitating cross-national research partnerships. By outlining clear strategic priorities and fostering an ecosystem of collaboration and innovation, the initiative hopes to catalyze a paradigm shift in how hormone health challenges are approached scientifically and clinically. This paradigm shift is particularly vital in addressing pervasive conditions like obesity and infertility, which have historically been underrepresented in public health discourse despite their substantial societal impact.

Leading figures in the endocrine field emphasize the roadmap’s potential to unify disparate research efforts and foster a coherent European strategy. Professor Martine Cools, ESPE Co-Chair of the EndoCompass Steering Group, articulates the underlying vision: elevating the field by inspiring researchers to tackle the most pressing questions whilst increasing endocrinology’s profile with policymakers and the broader public. Professor Martin Fassnacht, ESE Co-Chair, concurs, underscoring the collaborative nature of the project and its objective to transform endocrine science into a more visible, better funded, and patient-centered discipline.

The comprehensive supplement contains 14 dedicated chapters addressing diverse aspects of endocrinology—from funding analyses, specialized subfield roadmaps, environmental effects, to the integration of cutting-edge artificial intelligence applications. Each chapter, authored by domain experts, provides detailed insights into prevailing knowledge gaps and research opportunities. The availability of these chapters as open-access materials furthers the initiative’s commitment to transparency and broad dissemination within the scientific community and beyond.

In conclusion, the release of the EndoCompass Research Roadmap represents a pivotal moment for European endocrine science. By articulating a shared vision and strategic framework for the next decade, it sets the stage for impactful research, innovative clinical practices, and informed policy decisions aimed at alleviating the burden of endocrine diseases. Through coordinated investment and multidisciplinary collaboration, the endocrine field is poised to make transformative advances that will improve hormone-related health outcomes for millions, marking a new era of discovery and patient care.

For the full EndoCompass Research Roadmap and detailed chapters, readers can access the supplement in the European Journal of Endocrinology online.

Subject of Research: Not applicable
News Publication Date: October 17, 2025
Web References: https://academic.oup.com/ejendo/issue/193/Supplement_2, http://www.ese-hormones.org/endocompass
References: See individual chapter DOIs provided within the supplement
Image Credits: European Society of Endocrinology
Keywords: Endocrine research, hormone health, endocrinology roadmap, European Society for Endocrinology, endocrine funding, diabetes, thyroid disorders, endocrine oncology, obesity, reproductive endocrinology, artificial intelligence in endocrinology, health disparities, environmental endocrinology

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