Challenges for breaking down the old colonial order in global health research: the role of research funding
Authors: Larissa Fortunato Araújo, Flávia B Pilecco, Francisco Gustavo Silveira Correia, Marcelo José Monteiro Ferreira
Journal: The Lancet Global Health (2021)

In an Editorial,1The Lancet Global HealthGlobal health 2021: who tells the story?.Lancet Glob Health. 2021; 9: e99Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar published this year, The Lancet Global Health drew attention to the importance of decolonising global health. The current austerity policies in Brazil are making the academic role of researchers unfeasible. In the past few years underfunding for research in Brazil has intensified, especially after the enactment of the Constitutional Amendment 95/2016, imposing strict limits on public expenditures and preventing the expansion of investments for 20 years in areas such as health and education.2Massuda A Hone T Leles FAG de Castro MC Atun R The Brazilian health system at crossroads: progress, crisis and resilience.BMJ Glob Health. 2018; 3e000829Crossref PubMed Scopus (148) Google Scholar This austerity policy has already had an impact on the underfunding of population surveys such as the Brazilian National Health Survey (NHS), coordinated by the Brazilian Institute of Geography and Statistics and the Brazilian Ministry of Health. The Brazilian NHS was the only national survey that followed the three steps recommended by WHO3WHOThe STEPS instrument and support materials.https://www.who.int/ncds/surveillance/steps/instrument/en/Date accessed: February 28, 2021Google Scholar for the investigation of non-communicable diseases—questionnaire (step one), physical measurements (step two), and biochemical measurements (step three)—with a representative sample of all social strata from the population including people from 18 to 109 years. In 2013,4Szwarcwald CL Malta DC Pereira CA et al.Pesquisa Nacional de Saúde no Brasil: concepção e metodologia de aplicação.Cien saude colet. 2014; 19: 333-342Crossref PubMed Scopus (173) Google Scholar physical measurements were taken from a sample of residents (n=60 202). Biological material was collected from a subsample of 8952 individuals. In the 2019 edition,5Stopa SR Szwarcwald CL de Oliveira MM et al.Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas.Epidemiol Serv Saude. 2020; 29e2020315Crossref PubMed Google Scholar in addition to not collecting biological material, physical measurements, such as waist circumference and blood pressure were also not assessed. Weight and height were collected through self-report (n=89 954) and through in-person appoinments in a small sample (n=6730). Thus, the 2019 Brazilian NHS contemplated step one only, failing to reach step two due to the absence of data on waist circumference and blood pressure. The underfunding of the Brazilian NHS 2019 has deteriorated the accuracy of the information on risk factors, directly impacting epidemiological surveillance and planning of health actions for the prevention and control of non-communicable diseases. This loss in quality of fundamental surveys, such as the Brazilian NHS, due to underfunding, ends up impacting the reliability of Brazilian research, further deepening the production gap between researchers from high-income countries and those in low-income and middle-income countries (LMICs) and contributing to a colonialist vision of global health. For this reason, if the aim is to decolonise global health, there is an urgent need to better appreciate the science produced in LMICs. Public and private institutions that fund research locally and globally must guarantee the maintenance and even expand the funding of research done in and led by scientists from LMICs. We declare no competing interests. LFA and FBP contributed equally. Global health 2021: who tells the story?In an Art of Medicine essay published in The Lancet in November, 2020, Seye Abimbola and Madhukar Pai set out a vision for the future of academic global health. In their promised land they imagine, among other changes, a transformation of journals—"No longer exclusive, high-impact western journals now exist among a multitude of go-to places, most of which are now based in the Global South"—and imbalances in authorship within high-income country and low-income or middle-income country (LMIC) collaborations are "a thing of the past". Full-Text PDF Open Access