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

The concept of Gender-Based Analysis Plus (GBA+) is rooted in the recognition that policies do not affect all individuals equally. GBA+ seeks to consider gender alongside other intersecting identity factors such as race, ethnicity, age, disability, and socioeconomic status when formulating public policies. Its goal is to enhance equity by identifying how diverse groups are differently impacted by government programs and legislation. In Canada, GBA+ is a mandated process within federal departments; however, this new scholarly work reveals that, during an unprecedented crisis, the implementation mechanisms faltered substantially.

According to the study, while there was strong rhetorical commitment to applying a gender and intersectional equity lens during the pandemic response, actual application in health and social policies often remained superficial or symbolic. The authors utilize extensive qualitative and quantitative data, including interviews with policymakers and frontline workers, to reveal significant discrepancies between policy declarations and delivery outcomes. One of the critical technical issues identified involved inconsistent data collection methodologies that failed to capture nuanced demographic information, rendering targeted interventions ineffective.

This failure in data granularity and accuracy worsened the visibility of marginalized groups who suffered disproportionately from COVID-19’s impact. The researchers highlight that Indigenous communities, racialized populations, women in precarious employment, and persons with disabilities often fell through the cracks due to inadequate disaggregated data, which is essential for precise GBA+ analysis. Despite the existence of frameworks for collecting intersectional data, operationalizing these in real-time emergency response settings proved near impossible, revealing structural limitations in both capacity and mandate clarity.

Another key dimension explored in the study is the strain on institutional capacity, which was widely documented during the pandemic. Government departments responsible for GBA+ implementation experienced significant resource diversion to urgent pandemic measures, causing expertise and infrastructure dedicated to inclusive policy analysis to be sidelined. The report underscores that crisis-driven policymaking tends to prioritize speed and uniformity over complexity and nuance, directly undermining the careful consideration needed for effective GBA+ integration.

The authors also navigate the politics surrounding GBA+, noting that ideological resistance and bureaucratic inertia played nontrivial roles in delaying or weakening its uptake. While GBA+ has supporters within federal agencies and activist circles, it has encountered skepticism and pushback from factions perceiving it as bureaucratic red tape or politically contentious. This polarized environment hampered cooperative governance and diluted coordinated efforts essential for intersectional equity, especially in swiftly evolving pandemic contexts.

In addition to policy ecosystems, the study investigates how GBA+ gaps manifested in frontline health and social services during COVID-19. The pandemic’s disproportionate economic and health burdens on women, particularly those in caregiving and essential worker roles, were well-documented globally. However, the researchers stress that Canadian policies often failed to provide adequate targeted support, partly due to a lack of nuanced needs assessments grounded in GBA+. For example, shortfalls in childcare provisions, mental health resources, and workplace protections disproportionately impacted these groups, exacerbating existing inequities.

The research sheds light on notable examples where GBA+ principles were underutilized or absent in pandemic responses. The analysis of financial aid distribution reveals that many relief programs did not account for intersecting vulnerabilities such as income precarity combined with racial discrimination. Similarly, vaccination campaign strategies often lacked culturally and linguistically appropriate outreach modalities, marginalizing racialized communities and limiting equitable access. These shortcomings underline the operational disconnect between policy frameworks and real-world inclusivity.

Methodologically, the study employed a mixed methods approach, triangulating policy analysis, detailed stakeholder interviews, and demographic data reviews. This comprehensive strategy allowed the researchers to parse complex dynamics shaping GBA+ implementation throughout the pandemic lifecycle—from early crisis management to the recovery phases. Their findings offer critical insight into how emergency governance contexts present unique challenges for embedding equity-centered approaches without compromising responsiveness.

The implications of these findings extend well beyond the Canadian context. As other nations grapple with similar equity concerns amid ongoing and future health crises, the study provides a cautionary tale and guidepost. Efficient and meaningful intersectional analysis requires robust institutional frameworks, ample resourcing, and political commitment that endures beyond symbolic gestures. It calls for a reimagining of emergency policy design to integrate equity proactively, rather than retroactively.

Critically, the research also highlights the necessity of refined data infrastructures. Governments must develop and maintain systems capable of capturing intersectional demographic indicators rapidly and accurately. Without this, comprehensive analysis remains aspirational rather than actionable. The authors advocate for investment in capacity building at multiple levels, emphasizing that equity is not a luxury add-on but a fundamental component of effective crisis management.

Moreover, fostering inclusive and participatory policy design processes emerged as a pivotal recommendation. Engaging community representatives, particularly from historically marginalized groups, throughout policy formulation and implementation can enhance relevance and responsiveness. The study indicates that such collaboration remains limited and calls for deliberate efforts to institutionalize consultative mechanisms.

The research invites reflection on how bureaucratic culture and political will intersect to shape equity outcomes. It stresses the importance of leadership endorsing and normalizing GBA+ as a fundamental analytical tool, not merely a procedural checkbox. Embedding equity-oriented thinking into the organizational DNA of public institutions may mitigate resistance and enable more agile adaptations to evolving crises.

In conclusion, the study by Tiwana, Hollmann, and Smith exposes a paradox deeply entrenched in the Canadian pandemic response: a desire for equity stymied by systemic barriers. Their work challenges policymakers, researchers, and advocates to move beyond well-intentioned but insufficiently executed commitments. To truly achieve intersectional equity during public health emergencies, GBA+ must be equipped with adequate resources, political support, and institutional integration. As the world confronts ongoing and future health shocks, these lessons resonate universally, underscoring the urgent imperative to transform equity from aspiration to reality.

Subject of Research: Gender-Based Analysis Plus (GBA+) implementation and gaps during the COVID-19 pandemic in Canada

Article Title: “They wanted to, but they just couldn’t get there”: GBA + implementation and gaps during the COVID-19 pandemic in Canada

Article References:
Tiwana, M.H., Hollmann, L. & Smith, J. “They wanted to, but they just couldn’t get there”: GBA + implementation and gaps during the COVID-19 pandemic in Canada. Int J Equity Health 24, 152 (2025). https://doi.org/10.1186/s12939-025-02522-2

Image Credits: AI Generated