review · PLOS Global Public Health
Interest in global health continues to increase across medical and public health institutions in high-income countries. However, persistent power imbalances, systemic racism, and colonial legacies frequently distort global health scholarship. Projects led by trainees from wealthy nations often worsen these dynamics in low- and middle-income regions. Major structural barriers include high-income-centric institutional structures, limited direct funding for local researchers, an overemphasis on priorities set abroad, linguistic dominance of English, and the exploitation of local research teams. Addressing these inequalities requires grounding research in locally identified solutions, fostering paired institutional partnerships across all training levels, securing equitable funding distributions, and establishing well-defined operational roles. To operationalise these foundational principles across every project phase from conception to dissemination, the Douala Equity Checklist offers a practical twenty-item instrument designed to help collaborating international institutions systematically establish fairer and more ethical research partnerships.
International health partnerships often marginalise the researchers and communities who contribute local data and expertise. When global research agendas favour outside interests, health solutions risk failing local populations. By offering a structured approach to fairness, tools like this checklist help institutions correct funding and power disparities, ensuring research generates meaningful benefits and sustainable capacity in the communities where projects actually take place.
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Interest in "global health" among schools of medicine, public health, and other health disciplines in high-income countries (HIC) continues to rise. Persistent power imbalances, racism, and maintenance of colonialism/neocolonialism plague global health efforts, including global health scholarship. Scholarly projects conducted in low- and middle-income countries (LMIC) by trainees at these schools in HIC often exacerbate these problems. Drawing on published literature and shared experiences, we review key inequalities within each phase of research, from design through implementation and analysis/dissemination, and make concrete and practical recommendations to improve equity at each stage. Key problems facing global health scholarship include HIC-centric nature of global health organizations, paucity of funding directly available for LMIC investigators and trainees, misplaced emphasis on HIC selected issues rather than local solutions to local problems, the dominance of English language in the scientific literature, and exploitation of LMIC team members. Four key principles lie at the foundation of all our recommendations: 1) seek locally derived and relevant solutions to global health issues, 2) create paired collaborations between HIC and LMIC institutions at all levels of training, 3) provide funding for both HIC and LMIC team members, 4) assign clear roles and responsibilities to value, leverage, and share the strengths of all team members. When funding for global health research is predicated upon more ethical and equitable collaborations, the nature of global health collaborations will evolve to be more ethical and equitable. Therefore, we propose the Douala Equity Checklist as a 20-item tool HIC and LMIC institutions can use throughout the conduct of global health projects to ensure more equitable collaborations.
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DOI: 10.1371/journal.pgph.0001418
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