Funding agencies' complicity in advancing or impeding equity in and through global health research

Abstract Background In Global Health Research (GHR), funding policies inform how health research is approached and structured, serving to distribute power and resources in ways that can either reinforce or take action on inequities. In essence, these policies incentivize the focus of GHR and are therefore among the political/structural determinants of health. Despite broad recognition of the need for equity in GHR, the role of funders receives relatively little scrutiny. We sought to better understand the place of equity across the international landscape of GHR funders. Methods Publicly accessible, current strategic (those that set the vision, mission and goals of funding) and operational (those that set the implementation rules and compliance requirements for funded research) policies were harvested from 23 purposely selected Global North and philanthropic funding agencies. Content and discourse analysis were used to examine the portrayal of GHR in inequitable contexts, declarations of equity intentions, and to assess alignment to the six CCGHR equity-centred principles. Results Funding agencies across the Global North made clear declarations on the importance of equity in GHR; however, operationalization was largely absent or incompatible with the best scientific evidence on advancing health equity. Most philanthropic funding agencies failed to make policies public meaning equity action remains unclear. Alignment with equity-centred principles presented in different forms from varying agencies, though no single agency demonstrated good alignment to all six principles. Conclusions Funder discourses suggest equity is a central priority in GHR. Given that funder policies are themselves determinants of equity, stronger alignment between strategic policies, intentions, and action on inequity (e.g., investing in interventional research that acts on upstream determinants) are critically needed for funders of GHR, specifically, and public health research, broadly. Key messages • Funding policy can determine equity possibilities, both in research processes and outcomes. • Coherence between strategic intentions and operational policies is possible, and would promote more equity-advancing research.