Ethical Frameworks and Global Health: A Narrative Review of the “Leave No One Behind” Principle

Abstract

The “Leave No One Behind” (LNOB) principle, a fundamental commitment of the United Nations’ Sustainable Development Goals, emphasizes the urgent need to address and reduce global health inequalities. As global health initiatives strive to uphold this principle, they face significant ethical challenges in balancing equity, resource allocation, and diverse health priorities. This narrative review critically examines these ethical dilemmas and their implications for translating LNOB into actionable global health strategies. A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Semantic Scholar, covering publications from January 1990 to April 2024. The review included peer-reviewed articles, gray literature, and official reports that addressed the ethical dimensions of LNOB in global health contexts. A thematic analysis was employed to identify and synthesize recurring ethical issues, dilemmas, and proposed solutions. The thematic analysis identified 4 primary ethical tensions that complicate the operationalization of LNOB: (1) Universalism versus Targeting, where the challenge lies in balancing broad health improvements with targeted interventions for the most disadvantaged; (2) Resource Scarcity versus Equity; highlighting the ethical conflicts between maximizing efficiency and ensuring fairness; (3) Top-down versus Bottom-up Approaches, reflecting the tension between externally driven initiatives and local community needs; and (4) Short-term versus Long-term Sustainability, addressing the balance between immediate health interventions and sustainable systemic changes. To navigate these ethical challenges effectively, global health strategies must adopt a nuanced, context-sensitive approach incorporating structured decision-making processes and authentic community participation. The review advocates for systemic reforms that address the root causes of health disparities, promote equitable collaboration between health practitioners and marginalized communities, and align global health interventions with ethical imperatives. Such an approach is essential to truly operationalize the LNOB principle and foster sustainable health equity.

Keywords

community participation decision making global health health equity health inequities leave no one behind public health resource allocation social justice sustainable development

What do we already know about this topic?

The “Leave No One Behind” (LNOB) principle is a key goal within the United Nations’ Sustainable Development Goals, emphasizing the reduction of health inequalities. However, achieving LNOB in global health has been challenging due to ethical dilemmas, such as balancing equity with resource scarcity and varying capacities of health systems to implement inclusive policies.

How does your research contribute to the field?

This research critically explores the ethical and practical challenges of operationalizing the LNOB principle in global health. It introduces structured decision-making processes and robust community participation as essential strategies to navigate these ethical tensions, advancing health equity and informing more inclusive global health practices.

What are your research’s implications for theory, practice, or policy?

The review underscores the need for a nuanced approach to global health equity, advocating for systemic reforms prioritizing ethical frameworks and meaningful community involvement. These insights can inform the development of participatory methods and policies, influencing future global health initiatives to better address disparities and empower marginalized communities.

Introduction

The United Nations’ 2030 Agenda for Sustainable Development includes a pivotal commitment to “Leave No One Behind” (LNOB), central to Goal 10 of the Sustainable Development Goals (SDGs).¹ This principle emphasizes addressing inequalities marginalizing individuals and communities, particularly those traditionally excluded from progress.² Rather than focusing solely on national averages, LNOB advocates for reaching the “furthest behind first,” highlighting the need for targeted strategies that address intersecting factors like poverty, gender, disability, ethnicity, and geography, contributing to health disparities.³ These principles call for a transformative approach to global health, aiming for both widespread improvement and targeted support for the most vulnerable.

Despite these commitments, achieving global health equity remains fraught with challenges. Marginalized populations continue to experience disproportionate disease burdens and limited access to healthcare.^4,5 Health inequities are particularly acute in conflict zones, where violence disrupts healthcare services, increases preventable illnesses, and undermines access to essential resources like clean water and sanitation.^6,7 Vulnerable groups, including women, children, and the elderly, are especially affected by malnutrition and untreated mental health conditions in these settings.^8-15 Climate change further exacerbates these disparities, with extreme weather events disproportionately impacting marginalized communities by amplifying diseases like malaria and dengue fever and worsening food insecurity.^16-20 The intersection of conflict, migration, and climate change creates a cycle of vulnerability perpetuating health inequities.^21,22

Efforts to address these disparities through global health initiatives often encounter complex ethical dilemmas. Ensuring equitable, effective, and sustainable interventions requires a nuanced understanding of ethical considerations related to equity, resource allocation, community participation, and long-term sustainability.^23-28 Navigating these challenges demands technical expertise and a steadfast commitment to social justice and cultural sensitivity, pushing global health efforts toward more just and inclusive solutions.

This literature review examined 3 critical questions to understand the ethical and practical dimensions of the LNOB approach in global health. First, it explores the inherent tensions between the ethical imperative of the LNOB and the practical realities of implementing international health programs. What are the challenges in ensuring equitable health access and outcomes, and how do existing health systems and policies support or hinder this ethical mandate? Second, this review considers whether a structured decision-making process can facilitate more equitable resource allocation in global health. Can a systematic approach align resource distribution more closely with the LNOB pledge, addressing health access and outcomes disparities? Third, it investigates the role of meaningful participation by marginalized communities in mitigating ethical tensions and ensuring that global health projects adhere to the LNOB principle. How does including these communities in planning and decision-making impact health interventions’ effectiveness and ethics?

Methods

A structured search strategy was conducted to review the literature on the ethical implications of the LNOB principle in global health. Searches were performed across PubMed, Scopus, Web of Science, and Semantic Scholar databases, using keywords and MeSH terms such as “Global Health,” “Ethics,” “ Social Determinants of Health,” “Health Equity,” “ Universal Health Insurance,” and “Sustainable Development.” The search was limited to English-language publications from January 1990 to April 2024.

Articles were included if they discussed ethical challenges, frameworks, or strategies related to LNOB in health and consisted of peer-reviewed articles, gray literature, or official reports. Exclusion criteria were non-English articles, non-health-focused studies, and opinion pieces. Screening involved initial title and abstract checks for relevance, followed by full-text reviews of selected articles. References of included studies were also reviewed to identify additional relevant literature.

The review employed a thematic analysis guided by a theoretical framework of health equity and justice, focusing on aligning global health initiatives with ethical imperatives to leave no one behind.^29-32 This approach involved identifying and synthesizing key themes related to ethical challenges, proposed solutions, and the impact of strategies on marginalized populations.

Operationalizing “Leaving No One Behind”

Universalism Versus Targeting

Operationalizing the LNOB principle requires balancing universal health goals with the specific needs of marginalized groups. Rather than viewing universalism and targeting as opposing strategies, they should be considered complementary tools on a spectrum, adaptable to different contexts to achieve true health equity. A context-specific, community-driven approach, informed by ethical principles, can help global health practitioners navigate these complexities and work toward a world where socioeconomic or demographic circumstances do not determine health outcomes. However, putting these principles into practice reveals a dilemma between universalism and targeting: How can we balance the goal of improving health for everyone with the need to prioritize those who are most disadvantaged?

LNOB challenges policymakers, clinicians, and researchers to move beyond national averages to address disparities in health outcomes for marginalized populations. This creates a tension between universalism—aiming for health improvements for all—and targeting, which prioritizes those most disadvantaged. Universal Health Coverage (UHC) is often viewed as more equitable, reducing stigma and fragmentation compared to targeted programs.^33-35 However, a purely universal approach may overlook the specific barriers faced by marginalized groups, such as social discrimination, geographic isolation, and extreme poverty, potentially conflicting with LNOB’s intent.^36-42 Without targeted interventions, universal programs could inadvertently exacerbate existing disparities.^43-45

Conversely, focusing solely on specific marginalized groups through targeted interventions can lead to inequities among other vulnerable populations who do not receive targeted support. This challenge becomes more pronounced in resource-limited settings where allocation decisions are tough. Over-reliance on targeted programs may also neglect the broader structural changes needed for sustainable improvements in health equity.^46,47

A nuanced approach to resolving this tension is “proportionate universalism,” which combines universal health goals with targeted strategies proportionate to the level of disadvantage experienced. This could involve universal access to essential healthcare services, supplemented by targeted support like transportation vouchers, culturally tailored outreach, or language assistance for those most in need.^48-51 Effective implementation of this approach requires a deep understanding of local contexts. Community-based participatory research (CBPR) can help identify the specific needs of those “furthest behind,” the barriers they face, and the potential unintended consequences of various interventions.⁵² Balancing immediate efforts to alleviate suffering with long-term strategies to address the root causes of health inequities is essential for achieving sustainable health equity.

Resource Scarcity Versus Equity

The aspiration to LNOB faces the stark reality of limited resources in global health, presenting profound ethical dilemmas: How, with finite budgets, personnel, and technology, can we ensure the most marginalized benefit without sacrificing overall health gains for the broader population?

The ethical imperative of equity in healthcare requires that those facing the greatest disadvantages receive the necessary support to reduce health disparities. This often necessitates disproportionate funding for intensive interventions targeting marginalized groups in remote or high-need areas, such as providing antiretroviral therapy for HIV-positive individuals in remote settings.^53-55 Although such measures may not be cost-efficient, they are essential from an equity standpoint. Research supports this approach, emphasizing the importance of targeted funding in areas like reproductive, maternal, and child health and the need to strengthen health systems and digital health services to reduce disparities.^56-59

On the other hand, prioritizing efficiency in healthcare often means focusing on interventions that maximize health benefits for the largest number of people, favoring simpler and less costly initiatives. While this approach may achieve greater short-term returns on investment, it risks neglecting the most marginalized, who require sustained, often more expensive, support, potentially worsening health disparities.^60-66 While strategies like linear programing models and cost-effectiveness thresholds can help optimize resource allocation, they may not always align with equity-focused public preferences, especially in low- and middle-income countries where failing to prioritize high-value healthcare interventions can exacerbate inequities.^67-70

These competing priorities—equity and efficiency—pose significant ethical challenges for global health practitioners. Allocating resources solely based on equity could overwhelm limited programs while focusing only on efficiency risks perpetuating health disparities and denying essential care to those most in need.⁷¹ To navigate this tension, decision-making must be guided by ethical frameworks that consider principles such as fairness, need, and potential benefits to ensure transparency and avoid arbitrary choices.⁷² True efficiency should encompass long-term social and economic benefits, recognizing the broader societal gains from investing in marginalized populations’ health.⁷³

Addressing resource constraints while operationalizing LNOB also requires advocating for increased global health funding. Wealthy nations and institutions are ethically obligated to commit more resources to address the root causes of health disparities. Additionally, innovative approaches like cost-effective technologies, streamlined service delivery models, and new financial instruments, such as AI-driven health policy frameworks and Health Equity Bonds, can help maximize limited resources while prioritizing equity.^74-83

AI-Driven Health Policy Frameworks for Dynamic Adaptation: The development of AI-driven health policy frameworks has been proposed to ensure that global health policies remain adaptive to rapidly changing population health dynamics.^84-88 These frameworks (Figure 1) would utilize real-time data analytics and machine learning algorithms to predict emerging health trends and allocate resources dynamically to areas of greatest need. For instance, predictive models can forecast disease outbreaks in vulnerable regions, allowing for pre-emptive resource deployment and targeted interventions.^81-83

Figure 1.

Proposed model for an AI-driven health Policy Framework for Dynamic Adaptation in Global Health illustrates a potential AI-driven policy adaptation model that integrates real-time data from various sources—such as epidemiological surveillance, social determinants of health databases, and community feedback platforms. The model demonstrates how AI could dynamically adjust policy priorities and resource allocation based on predictive analytics, making global health interventions more responsive and equitable.

Health Equity Bonds: Financing the Future of Global Health: The concept of “Health Equity Bonds” is a novel financial instrument designed to attract private investment for public health initiatives promoting equity,⁷⁷ Table 1. These bonds would operate similarly to social impact bonds, where returns are linked to achieving specific health outcomes, such as reducing maternal mortality or increasing access to essential health services for underserved populations. Investors would receive dividends based on the social impact achieved, incentivizing them to fund interventions aligned with LNOB objectives.

Table 1.

Health Equity Bonds: Overview Outlining the Structure for Implementing Health Equity Bonds, Including Risk Assessment, Potential Returns, and Success Metrics.

Component	Description
Bond structure	Health Equity Bonds are modeled after social impact bonds, where private investors fund public health initiatives, and returns are based on achieving specific health outcomes.⁸⁰
Target outcomes	Key health outcomes targeted could include reducing maternal and child mortality rates, increasing vaccination coverage, and improving access to essential health services in underserved regions.^78,79
Investor incentives	Investors receive dividends based on the social impact achieved. A tiered return system could be developed, where higher social impact leads to greater returns, promoting investment in high-impact areas.⁷⁷
Risk assessment	Risks could be mitigated by diversifying the portfolio of funded projects across different regions and health issues, creating a balanced investment strategy.⁷⁶
Success metrics	Success would be measured through impact evaluations using indicators such as health outcomes, service coverage, and reductions in health inequities among targeted populations.⁷⁵

Ultimately, balancing equity and efficiency in global health requires a multi-pronged approach, combining ethical advocacy, innovative financial solutions, and a commitment to ensuring that resource constraints do not compromise the goal of leaving no one behind.

Top-Down Versus Bottom-up Approaches

The LNOB principle challenges the traditional top-down approach in global health, where external experts, governments, or industries set priorities and interventions. Instead, LNOB emphasizes identifying and addressing the specific needs of those furthest behind. This shift raises a key question: How can global health initiatives genuinely reflect the voices of marginalized groups and ensure their meaningful participation?

Top-down approaches have been criticized for lacking community engagement and cultural sensitivity, often resulting in poorly adapted and unsustainable interventions. These approaches tend to rely on national-level data, which may overlook regional differences and the lived experiences of marginalized populations. In contrast, bottom-up approaches prioritize local ownership and participation, which are crucial for identifying and addressing the unique needs of the most disadvantaged. However, bottom-up methods can be difficult to scale due to power imbalances and the complexities of integrating diverse community perspectives.^89-92

To address these challenges, global health research must adopt inclusive priority-setting practices that empower marginalized groups, share power, and consider local contexts.^91,93-95 Achieving health equity requires democratizing processes and empowering communities to take an active role in decision-making. However, systemic barriers, such as limited funding, gender disparities, and the effects of globalization, continue to hinder meaningful participation from low- and middle-income countries.^92,96-101

A collaborative model that integrates both top-down and bottom-up approaches is essential to fully realize the LNOB principle. Community-based participatory research (CBPR) is one method that facilitates this integration by fostering knowledge exchange and co-creating solutions between local communities and health experts. This process requires a conscious effort to address power dynamics, maintain continuous reflexivity, and shift decision-making power to local stakeholders.^102-104 Transforming global health further involves decolonizing existing structures, dismantling paternalistic legacies, and ensuring diverse voices are included in decision-making processes. This includes institutional changes, revised funding models, and equitable partnerships that value non-Western knowledge systems.^98,105,106

Ethical considerations are critical in this shift. While community engagement is essential, it must be conducted ethically to avoid exploitation and ensure fair compensation. Moreover, there is a need to proactively address how community participation could exacerbate existing inequalities if not managed carefully. Innovative solutions, such as blockchain-based decentralized health platforms, offer new opportunities for empowering communities by enabling them to manage their own health data and directly influence health priorities.^107-109

Blockchain-Based Decentralized Health Platforms present a transformative approach to global health governance. These platforms allow communities to securely manage their health data, ensuring transparency, reducing data manipulation risks, and promoting trust and equity in health interventions (Figure 2). By decentralizing data governance, communities can have a stronger voice in shaping the health programs that affect them.^107-109

Figure 2.

Decentralized health data platform model where community data is anonymized, securely stored, and transparently shared among stakeholders, including healthcare providers, local governments, and non-governmental organizations (NGOs). This model empowers communities, enhances transparency, and reduces data manipulation risks, promoting trust and equity in global health interventions.

Ultimately, operationalizing the LNOB principle requires moving beyond purely top-down approaches that risk homogenizing diverse needs and perspectives. Shifting power dynamics in global health to center the voices of the most marginalized will involve challenging entrenched practices and building meaningful partnerships between experts and communities. While this is challenging, blending scientific rigor with local knowledge is crucial for designing equitable and sustainable global health interventions.

Short-Term Versus Long-Term Sustainability

The LNOB principle underscores the urgency of addressing the immediate needs of the most disadvantaged, those disproportionately affected by preventable diseases, malnutrition, and inadequate healthcare. However, while rapid responses such as emergency aid and medical care are essential in humanitarian contexts, there is also a need to balance these with long-term strategies for systemic change. The key tension in operationalizing LNOB is: How can global health initiatives sustainably integrate immediate interventions while fostering transformative, systemic change?

Short-term interventions, like emergency aid, temporary housing, and medical care, are critical in saving lives and alleviating suffering, particularly in conflict zones. They are ethical imperatives, providing immediate relief through vaccination campaigns, psychosocial support, and other urgent responses.^110-112 However, these interventions come with challenges, such as the need for targeted planning and managing ethical concerns, including follow-up care and collaboration with local infrastructure.^113-116 Despite these complexities, short-term humanitarian aid remains vital for resilience and recovery, as seen with the role of community health workers in delivering essential services and mitigating disaster impacts.^117-120 Nonetheless, ensuring equitable support requires careful attention to social vulnerabilities during aid allocation.¹²⁰

To achieve lasting health equity, there must be a shift from short-term relief to long-term solutions that address root causes, such as poverty, discrimination, lack of education, and environmental degradation. Strengthening local health systems and focusing on the social determinants of health are crucial for fostering self-reliance and sustainable health outcomes in marginalized communities.^121,122 However, these efforts face obstacles, including macroeconomic policies, governance issues, and resistance from those in power.^123-131 Addressing these requires collaborative action across sectors to dismantle systemic barriers and promote health equity leadership that integrates science, policy, and practice.^127-135

One key challenge for global health initiatives is balancing the need to address immediate needs with fostering long-term sustainability. Overemphasis on short-term projects can undermine local capacities and create dependencies. Ethical frameworks that emphasize collaboration, justice, and autonomy can help mitigate these risks by promoting community empowerment and self-sufficiency, even if they require greater initial investment.^116,136,137 Building local capacity demands investment in infrastructure, education, ongoing support, and mechanisms to share decision-making power with communities to set research and policy priorities.^138-142

Innovative mechanisms are essential to align immediate interventions with long-term sustainability. One such approach is an International Certification Program recognizing nations and regions successfully integrating short-term health responses with long-term Sustainable Development Goals (SDGs).^143-150 This program would incentivize countries to align emergency health interventions, such as pandemic preparedness, with strategies that build long-term health resilience. Certification criteria focus on equitable access, sustainability, community participation, and alignment with ethical frameworks like LNOB. Table 2 outlines the framework for this certification program, including criteria such as ensuring equitable healthcare access, fostering community engagement, and integrating other relevant SDGs (eg, SDG 1: No Poverty, SDG 5: Gender Equality, SDG 13: Climate Action). Monitoring and evaluation processes would include data collection, regular assessments, impact evaluation, and community feedback mechanisms to ensure transparency and accountability. Certified countries would benefit from financial support, global recognition, technical assistance, and preferential access to resources during emergencies. Implementing this program would involve piloting in selected regions, capacity-building workshops, partnership development among key stakeholders, and continuous review to adapt to evolving global health landscapes. To foster continuous improvement, an Annual Global Health Summit could provide a platform for sharing best practices, lessons learned, and innovative solutions.^143-150

Table 2.

Proposal Framework for a Certification Program, Detailing Criteria, Monitoring, Evaluation Processes, and Potential Incentive.^143-150

Certification criteria
Equitable access	Demonstrate progress in ensuring equitable healthcare access across all population groups, focusing on marginalized communities.
Sustainability of health interventions	Ensure long-term viability of health interventions, considering local resources and contexts.
Community participation	Evidence of inclusive community engagement in the design, implementation, and evaluation of health programs, employing participatory approaches like Community-Based Participatory Research (CBPR).
Alignment with ethical frameworks (LNOB)	Integration of global ethical frameworks (eg, LNOB principle) into health policies and interventions.
Integration with other SDGs	Align health responses with other relevant SDGs (eg, SDG 1: No Poverty, SDG 5: Gender Equality, SDG 13: Climate Action) for a holistic development approach.
Monitoring and evaluation (M&E) processes
Data collection and reporting	Standardized mechanisms for data collection and reporting on health equity, program sustainability, community engagement, and ethical compliance indicators.
Periodic assessments	Conduct regular assessments (eg, every 2-3 years) by a multilateral board, including site visits, independent audits, and stakeholder interviews.
Impact evaluation	Evaluate outcomes based on reductions in health inequities, improved service delivery, and strengthened health systems using quantitative and qualitative indicators.
Feedback loops	Continuous feedback from communities, healthcare providers, and other stakeholders through surveys, focus groups, and public consultations to refine certification processes.
Governance structure
Multilateral oversight Board	Composed of representatives from WHO, UNDP, national governments, civil society, and academia, responsible for setting certification standards, overseeing processes, and ensuring transparency and accountability.
Regional committees	Regional committees under the oversight board handle region-specific certification needs, reflecting local contexts and challenges.
Community advisory Panels	Panels comprising community representatives ensure that local voices are integrated into certification standards and assessments.
Potential incentives for certified countries
Financial support	Access to dedicated global health funding pools, low-interest loans, or grants for developing health infrastructure.
Global recognition and diplomatic benefits	Certified countries gain recognition at international forums, enhancing their reputation and opportunities for diplomatic and economic partnerships.
Technical assistance	Priority access to technical assistance from international agencies, NGOs, and academia for building local capacity and resilience.
Preferential access to resources	Priority access to essential resources (eg, vaccines, medical supplies) during emergencies or pandemics for certified countries.
Implementation plan
Pilot program	Launch a pilot in selected regions (eg, sub-Saharan Africa, Southeast Asia) to test the framework and gather insights for scaling up.
Capacity building workshops	Conduct workshops and training sessions for national and local health authorities to build capacity in meeting certification criteria.
Partnership development	Foster partnerships between governments, NGOs, the private sector, and local communities to support successful certification.
Continuous review and adaptation	Regularly review the certification framework to adapt to evolving global health landscapes and emerging challenges, ensuring continued relevance and effectiveness.
Framework for continuous improvement
Annual global health summit	Host an annual summit for certified and aspiring nations to share best practices, lessons learned, and innovative solutions to promote continuous improvement and knowledge exchange.
Research and innovation grants	Provide grants for research and innovation in integrated health and development, encouraging nations to develop novel approaches to align short-term health responses with long-term SDGs.
Community of practice	Establish a global community of practice for certified nations, partners, and experts to collaborate and share insights, fostering a culture of continuous learning and improvement.

Achieving lasting health equity requires a balanced approach, integrating short-term interventions with strategies that build resilient communities and systems. Prioritizing local capacities, community-led advocacy, and self-reliant solutions is critical to addressing immediate suffering while tackling systemic inequities. Transitioning from short-term responses to sustainable, community-driven approaches is essential for dismantling social and structural barriers and achieving the goals of the LNOB principle.

Potential Solutions and Frameworks

Can Structured Decision-Making Ensure Equity?

The LNOB principle requires a strategic and ethically sound approach to designing and implementing global health interventions. Structured decision-making processes, supported by ethical frameworks and practical tools, can help ensure equity. However, their effectiveness in addressing the complex realities of global health requires careful assessment.

Ethical frameworks provide a systematic approach to addressing equity concerns by analyzing interventions, identifying biases, and centering the needs of marginalized groups. Frameworks based on human rights, social justice, and decolonial ethics align well with LNOB’s core principles.^151-153 Tools such as checklists, scoring matrices, and ethical analysis templates can help apply these frameworks consistently throughout the project lifecycle, enhancing transparency and accountability.^154,155

Structured decision-making helps counteract the pitfalls of intuitive or urgency-driven decision-making by introducing objectivity and clarity in addressing ethical dilemmas in LNOB initiatives. Setting criteria, assigning weights, and evaluating trade-offs ensure that marginalized groups are explicitly considered alongside traditional effectiveness and efficiency measures.^156-159

However, it is essential to acknowledge the limitations of such frameworks. Over-reliance on rigid quantification and objectivity can overlook social disadvantages’ complex, multifaceted nature. Ethical frameworks should complement—rather than replace—in-depth contextual analyses, community engagement, and ongoing reflection. Their true value lies in fostering dialog, revealing biases, and supporting continuous adaptation throughout a project’s lifecycle.^116,160-162 Practitioners must use flexible, participatory methods to adapt these frameworks to new information and ensure that the “furthest behind” definitions reflect local realities and community priorities.

Research emphasizes incorporating local knowledge and social values when applying frameworks in specific contexts, particularly when addressing stigmas, disparities, and vulnerable groups’ agency in public health research.^116,160-166 A culturally sensitive and balanced approach is essential, especially in mental health interventions and health inequities, where political and ethical complexities are prevalent.^167-172

For ethical frameworks to be effective, systemic financing, power sharing, and knowledge production reforms are essential to create an environment conducive to equitable decision-making. These reforms empower marginalized communities, granting them greater autonomy and influence over their health outcomes. A shared ethical framework in global health governance should prioritize values like solidarity, innovation, and commitment to action, ensuring consistent application of ethical principles in health financing and policy decisions.^{30,71,173-175}

Equitable research partnerships and funding practices are critical to advancing global health equity. This includes involving communities in decision-making, promoting equitable funding, and using ethical toolkits for priority setting. Addressing epistemic injustice in funding and overcoming challenges in evidence-based prioritization and culturally adaptive governance, particularly in indigenous health research, are vital steps toward empowering marginalized communities.^{92,142,176-178} Initiatives like logic models for locally led solutions in universal health coverage further highlight the need for systemic changes that enhance decision-making power and autonomy for these communities.¹³⁷

While structured decision-making and ethical frameworks have the potential to guide global health initiatives toward greater equity, their true value lies in promoting critical reflection, transparency, and flexibility rather than enforcing rigid formulas. When combined with meaningful community engagement and a commitment to systemic change, these frameworks can be powerful tools for advancing a more just and equitable global health landscape.

Community Participation as a Solution

The LNOB principle calls for a shift from “doing for” to “doing with” marginalized communities, emphasizing genuine participation and empowerment in shaping health outcomes.^179,180 This requires overcoming barriers to participation faced by marginalized groups and using models like community development to reach those often excluded or hard to reach.^181,182 Effective partnerships among governments, NGOs, healthcare providers, and communities are crucial for enhancing sustainability and ensuring culturally appropriate interventions.^183-185

To facilitate genuine community engagement, it is vital to use participatory methods such as visual tools, capacity-building initiatives, and technology integration.^186-189 Engaging communities in managing their health environments and using participatory research can help build more sustainable and healthier societies.^190-193 However, authentic participation goes beyond tokenism and involves dismantling traditional power hierarchies in global health. Key strategies for achieving meaningful community participation include:

Global health practitioners must reflect on their biases, assumptions, and power dynamics. Recognizing and addressing unconscious paternalism is essential for building authentic partnerships based on trust and shared decision-making.

Redirecting funding to support community-based organizations directly fosters local ownership and self-determination. Investing in local leadership develops long-term capacity and promotes sustainable impact.

Challenging traditional research hierarchies involves valuing local knowledge and co-creating research that benefits academic institutions and communities.

While community participation is essential for equitable research and development (R&D), it must be carefully managed to avoid harm and exploitation. This involves ensuring fair representation of diverse voices within communities, avoiding manipulation or coercion, and providing fair compensation for community members’ time and expertise.^194,195 Respecting community autonomy is critical, allowing individuals the right to refuse or withdraw participation without repercussions.

Special consideration is needed in research involving indigenous communities, where historical contexts and power dynamics are particularly significant. However, there is still a need for a more critical examination of how concepts like “community” and “participation” are applied in practice.^196-198 Integrating community perspectives into research ethics reviews can help address the protection-inclusion dilemma, ensuring that vulnerable groups are protected and included meaningfully.¹²

Community participation is not a quick solution; it requires time, resources, and a willingness from global health actors to share control. Power imbalances are deeply rooted and may resist change, demanding ongoing dialog, humility, and a commitment to structural reform. Embracing community participation is an ethical imperative under the LNOB principle and a practical necessity for achieving sustainable health equity. By employing participatory methods and actively shifting power dynamics, global health initiatives can better address unique community needs, enhance cultural appropriateness, and foster long-term improvements in health outcomes. While challenging, prioritizing community participation moves beyond mere good intentions to genuine collaboration, empowering those traditionally excluded and paving the way for a more just global health landscape.

Participation, Decolonization, and Shifting Power in Global Health Practice

The LNOB principle demands a fundamental re-examination of global health power dynamics, emphasizing marginalized communities’ voices and agency. Achieving ethical and effective interventions requires a practical focus on meaningful participation and critically examining colonial legacies. Community-based participatory research (CBPR) empowers communities as co-investigators, aligning research questions, methods, and interventions with local needs and priorities.^184,199-203 Collaborative partnerships with community-based organizations should prioritize hiring local staff, investing in leadership development, and granting communities decision-making authority to promote self-sufficiency and resilience. Participatory evaluation tools like storytelling and community-led scorecards enable communities to define success beyond standard health metrics, ensuring culturally relevant and effective interventions.¹⁹⁹

Addressing power imbalances requires centering marginalized voices and sharing decision-making power.^{5,23-25,28,30,90,91,104,117,124,128,156,157,179,188,190,204} Tools and frameworks are available to tackle inequitable dynamics within CBPR, ensuring genuine participation and representation of marginalized groups in healthcare decision-making.^205-208 These approaches underscore the need for both practical strategies and critical reflection on power imbalances to achieve LNOB’s goals.

The legacy of colonialism continues to shape global health, often manifesting in paternalistic attitudes and unequal power relationships between Western institutions and the Global South.^15,56,104 Decolonizing global health requires critical reflexivity by practitioners and researchers to interrogate their biases, positionality, and power dynamics.^102,104 Valuing local and indigenous knowledge equally and emphasizing co-creation are essential for developing holistic solutions. Transforming institutions through diversified leadership, revised funding models, and equitable partnerships is crucial for addressing structural power imbalances.^102,209

This transformation involves moving away from charity models to true partnerships centered on capacity-building. Understanding global health in a globalized world from a systems perspective is vital to this shift.^210-212 Decolonization is necessary to dismantle mechanisms perpetuating health inequities, and educational institutions play a key role by integrating colonial history into curricula and fostering equitable collaborations.^213-215 Redistributing power is a complex process that may face resistance, especially from those accustomed to traditional structures. Challenges include navigating internal power dynamics within communities, avoiding tokenism, and ensuring equitable representation. Nonetheless, these are ethical imperatives in pursuing genuine LNOB implementation. Practical steps to operationalize LNOB by shifting power and control over resources include:

Allocating more funding directly to community-based organizations in the Global South fosters local autonomy and reduces reliance on external intermediaries.

Engaging marginalized communities in resource allocation ensures that funding aligns with local priorities and that the LNOB commitment is reflected on the ground.

Long-term investment in local research, leadership, and advocacy skills is essential to build sustainable local capacity and reduce dependence on external expertise.

Ethical guidelines and contractual agreements must ensure fair compensation, shared ownership of data, and recognition of traditional knowledge systems in global health partnerships.

The transformative potential of LNOB lies in embracing community participation and dismantling the colonial legacies entrenched in global health. Adopting methods involving communities at all stages, critical reflexivity, and institutional changes that redistribute power can create a more just and equitable global health landscape. This approach prioritizes co-creation over top-down solutions, respects local knowledge and priorities, and focuses on long-term capacity-building rather than short-term outcomes.

Advocacy for Increased Resources

The LNOB principle embodies a bold vision for achieving health equity globally. However, realizing this vision is challenged by resource scarcity in global health. While limited resources are a reality, increasing funding and support is desirable and ethically essential to transform LNOB from aspirational rhetoric into meaningful action for marginalized populations. The call for increased resources is grounded in the ethical principle of justice. Health is a fundamental human right recognized in the Universal Declaration of Human Rights.²¹⁶ Inadequate investment in the health of marginalized populations constitutes discrimination and perpetuates inequities.²¹⁷ The stark disparities in health outcomes between the Global North and South are a profound moral failure, exacerbated by significant gaps in funding that hinder low- and middle-income countries’ ability to implement effective interventions and build robust healthcare systems.^218,219

Resource scarcity poses a dilemma for global health practitioners: maximizing efficiency with limited funds can perpetuate neglect of those with the most complex health challenges. Conversely, failing to allocate sufficient resources denies life-saving treatment to those in greatest need.^72,220 Therefore, advocating for increased resources is both a practical necessity and a moral obligation. However, increased funding must be paired with transparency and accountability to ensure resources are used effectively. Concerns about donor fatigue and corruption make robust monitoring and evaluation mechanisms essential. Investments should focus on strengthening local health systems, fostering local ownership, and ensuring sustainable impact.²²¹

Several strategies can address resource scarcity in global health:

High-income countries must raise their Official Development Assistance contributions to meet internationally agreed targets, providing crucial support for global health initiatives.²²²

Public-private partnerships, social impact bonds, and other innovative financial instruments can unlock additional funds for global health.^223,224

Coordinated funding and collaboration are vital for addressing complex global health threats like pandemics or antimicrobial resistance.^224,225

Improving governance and addressing global tax evasion can release significant resources for health, especially in resource-constrained settings.^92,226

Wealthier countries have an ethical responsibility to reassess their spending priorities and allocate resources proportionate to the scale of global health inequities.^92,224

While advocating for increased resources is crucial, ensuring their effective allocation and utilization is equally important. Investments in research and development, alongside efforts to improve access to essential medicines and technologies, can help maximize limited resources and enhance health outcomes. Transparent and equitable allocation mechanisms guided by distributive justice principles should be used to prioritize resource-constrained decisions.²²⁷ Strengthening health research capacity and promoting the co-production of health research in low- and middle-income countries are also vital for sustainable progress.²²⁸

Advocating for increased resources and ensuring their strategic and just allocation is fundamental to achieving LNOB’s goals. By aligning funding with equity, justice, and sustainability principles, global health initiatives can better address the needs of those furthest behind and make significant strides toward a more equitable world.

Context-Specific Innovations and Ethical Frontiers in LNOB Implementation

While existing LNOB frameworks offer valuable guidance, they often lack specificity for different socio-economic and cultural contexts. To be effective, LNOB strategies must be adapted to local realities through context-specific innovations that address unique challenges and ethical considerations.

In regions affected by conflict, mistrust in external interventions can undermine global health efforts. Integrating local conflict-resolution practices into health programs can help build community trust and facilitate participation. This requires partnerships with local leaders and community-based organizations to co-develop health interventions that resonate with the region’s socio-political dynamics. Aligning health initiatives with culturally accepted conflict-resolution norms can promote local ownership and the sustainability of intervention.²²⁹

In settings with limited internet connectivity, offline-capable mHealth solutions can ensure that marginalized populations are included in digital health advancements. These solutions could offer essential health education, remote consultations, and access to digital health records without requiring continuous Internet access. Ethical considerations must address data privacy, digital literacy, and the risk of excluding digitally illiterate individuals. Developing these solutions should be driven by local needs assessments and user feedback to ensure they are relevant and effective.²³⁰

While digital health tools have great potential to expand access to care, especially in under-resourced settings, they also present ethical challenges related to privacy, equity, and data governance. Robust ethical guidelines tailored to these contexts are urgently needed to address issues like informed consent, data security, and equitable access to technology. These guidelines must be adaptable to different cultural norms and values, ensuring digital health tools do not exacerbate existing inequities or create new forms of discrimination.^231,232

Integrating technologies such as AI and blockchain into LNOB strategies brings new ethical dilemmas, including algorithmic bias, digital exclusion, and privacy breaches. A forward-looking framework that anticipates and mitigates these risks is essential for LNOB implementation. This framework must be dynamic, evolving with technological advancements and the changing needs of global health, to ensure ethical considerations keep pace with innovation.²³³

Developing context-specific innovations that address these ethical frontiers is critical for effectively operationalizing LNOB. By tailoring frameworks to local realities and anticipating ethical challenges, global health initiatives can ensure they are both inclusive and effective, truly leaving no one behind.

Conclusion—A Call for Action and Continued Reflection

The LNOB principle, central to the Sustainable Development Goals, represents a significant ethical commitment to global health, demanding a shift from focusing on national averages to prioritizing those marginalized by poverty, discrimination, conflict, or lack of access to essential resources. However, operationalizing LNOB has exposed existing approaches’ inherent tensions and limitations.

Addressing these challenges requires more than technical solutions; it involves ethical commitments. Balancing universalism with targeted interventions, navigating resource scarcity while ensuring equity, and combining top-down and bottom-up approaches reflect deeper questions about how the global community values the well-being of those furthest behind. Progress depends on adopting ethical frameworks, enhancing community participation, advocating for increased resources, and challenging colonial legacies within global health systems.

This transformative process demands humility and continuous adaptation. There are no simple or one-size-fits-all solutions. LNOB offers a roadmap toward a world where health is a universal right, not a privilege defined by circumstances. However, achieving this vision requires ongoing critical analysis, flexibility, and responsiveness to evolving contexts, Table 3.

Table 3.

Approaches to Address Ethical Tensions in Global Health Initiatives.

Ethical tension	Main challenges	Proposed solutions	Potential impacts on policy and practice
Universalism versus targeting	Balancing broad health goals with specific needs of marginalized groups	Implement dynamic policies that use real-time health data analytics to balance universal and targeted needs.	AI-driven frameworks that adapt to changing health dynamics can ensure inclusive and effective health policies (Figure 1).^84-88
Resource scarcity versus equity	Limited resources risk deepening disparities.	Create a global health equity fund supported by taxes on international financial transactions.	“Health Equity Bonds” could finance interventions with social impact dividends, encouraging investment in equity-focused health initiatives (Table 1).^234,235
Top-down versus bottom-up approaches	Lack of local nuance in top-down methods; scalability issues in bottom-up approaches.	Use blockchain to democratize health data, enabling community control and localized health solutions.	Decentralized platforms driven by community health data can prioritize local needs and empower communities in health governance (Figure 2).¹⁰⁷
Short-term versus long-term sustainability	Immediate interventions may conflict with sustainable development goals.	Link emergency health aid to sustainable development credits that incentivize long-term planning and infrastructure.	An international certification program for aligning short-term responses with sustainable goals can enhance global health security and resilience (Table 2).^236-238

Turning this vision into reality requires embracing the ethical complexities of global health interventions, recognizing the limitations of current frameworks, and committing to ongoing dialog and collaboration. Achieving global health equity is a shared responsibility, calling for sustained efforts to prioritize the needs of the most marginalized. Continued research is essential to refine ethical decision-making, develop context-specific strategies, and identify best practices that ensure no one is left behind.

Footnotes

Author Contributions

DO was the principal author and initiator of the article and was responsible for its conception, drafting, and writing. PG contributed to the article by reviewing and revising it critically for important intellectual content. Both authors have read and approved the final version of the manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Daniela Oehring

Poorna Gunasekera

References

United Nations. 70/1. Transforming our world: the 2030 Agenda for Sustainable Development. In: Assembly TG, editor. 2015.

Janczukowicz

Goreux

To leave no one behind in complex systems of health and education. Med Teach. 2023;45(9):933-936. doi:10.1080/0142159X.2023.2231136

Health CoSDo. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health: Final Report of the Commission on Social Determinants of Health. World Health Organization; 2008.

Simpson

Kelly

Morgan

Defining principles for good practice: using case studies to inform health systems action on health inequalities. Eval Program Plann. 2013;36(1):191-197. doi:10.1016/j.evalprogplan.2012.03.007

McCartney

Popham

McMaster

Cumbers

Defining health and health inequalities. Public Health. 2019;172:22-30. doi:10.1016/j.puhe.2019.03.023

Sundaram

Filion

Akaribo

Stephens

PR.

Footprint of war: integrating armed conflicts in disease ecology. Trends Parasitol. 2023;39(4):238-241. doi:10.1016/j.pt.2023.01.007

Martineau

McPake

Theobald

, et al. Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states. BMJ Glob Health. 2017;2(2):e000327. doi:10.1136/bmjgh-2017-000327

Majuru

Michael Mokoena

Jagals

Hunter

PR.

Health impact of small-community water supply reliability. Int J Hyg Environ Health. 2011;214(2):162-166. doi:10.1016/j.ijheh.2010.10.005

Hunter

MacDonald

Carter

RC.

Water supply and health. PLoS Med. 2010;7(11):e1000361. doi:10.1371/journal.pmed.1000361

10.

Fitzpatrick

JJ.

Mental health and war, and its aftermath. Arch Psychiatr Nurs. 2017;31(1):1. doi:10.1016/j.apnu.2016.12.004

11.

Dissanayake

Jabir

Shepherd

, et al. The aftermath of war; mental health, substance use and their correlates with social support and resilience among adolescents in a post-conflict region of Sri Lanka. Child Adolesc Psychiatry Ment Health. 2023;17(1):101. doi:10.1186/s13034-023-00648-1

12.

Disease as an aftermath of war. JAMA. 2023;330(22):2221. doi:10.1001/jama.2022.16152

13.

Folayan

Schroth

Ayouni

, et al. A scoping review linking early childhood caries to violence, neglect, internally displaced, migrant and refugee status. BMC Oral Health. 2023;23(1):747. doi:10.1186/s12903-023-03459-0

14.

Murthy

Lakshminarayana

Mental health consequences of war: a brief review of research findings. World Psychiatry. 2006;5(1):25-30.

15.

Ahmad

Shaheen

Hussain

Internal displacement: relationship of mental health and education of children in Swat, Pakistan. Pak J Med Sci. 2020;36(5):909-913. doi:10.12669/pjms.36.5.1847

16.

Baugh

Kemen

Messervy

Biddinger

Beyond the hazard vulnerability analysis: preparing health systems for climate change. R I Med J. 2021;104(9):55-59.

17.

Robinson

WA.

Climate change and extreme weather: a review focusing on the continental United States. J Air Waste Manag Assoc. 2021;71(10):1186-1209. doi:10.1080/10962247.2021.1942319

18.

Ebi

Hess

Watkiss

. Health risks and costs of climate variability and change. In: Mock

Nugent

Kobusingye

Smith

, eds. Injury Prevention and Environmental Health. 3rd ed. World Bank Group; 2017:153-169.

19.

Weilnhammer

Schmid

Mittermeier

, et al. Extreme weather events in europe and their health consequences - a systematic review. Int J Hyg Environ Health. 2021;233:113688. doi:10.1016/j.ijheh.2021.113688

20.

Ebi

Vanos

Baldwin

, et al. Extreme weather and climate change: population health and health system implications. Annu Rev Public Health. 2021;42:293-315. doi:10.1146/annurev-publhealth-012420-105026

21.

Berry

Enright

Shumake-Guillemot

Villalobos Prats

Campbell-Lendrum

Assessing health vulnerabilities and adaptation to climate change: a review of international progress. Int J Environ Res Public Health. 2018;15(12):1-25. doi:10.3390/ijerph15122626

22.

Van de Vuurst

Escobar

LE.

Climate change and infectious disease: a review of evidence and research trends. Infect Dis Poverty. 2023;12(1):51. doi:10.1186/s40249-023-01102-2

23.

Venkatapuram

Global health without justice or ethics. Public Health. 2021;43(1):178-179. doi:10.1093/pubmed/fdaa001

24.

Drame

Connor

Abrons

Chen

AMH

. The importance of equity, ethics, and rigor in global health research. Res Social Adm Pharm. 2020;16(11):1509-1512. doi:10.1016/j.sapharm.2020.08.024

25.

Kontoghiorghes

GJ.

Ethics in medicines: Exposing unethical practices and corruption in all sectors of medicines is essential for improving global public health and saving patients’ lives. Medicines. 2021;8(9):1-4. doi:10.3390/medicines8090054

26.

Mac-Seing

Ringuette

Zinszer

Godard

Zarowsky

How to navigate the application of ethics norms in global health research: reflections based on qualitative research conducted with people with disabilities in Uganda. BMC Med Ethics. 2021;22(1):140. doi:10.1186/s12910-021-00710-7

27.

Tangwa

GB.

Root causes of epistemic (in)justice for the global south in health ethics and bioethics. J Med Ethics. 2023;49(5):343-344. doi:10.1136/jme-2023-109093

28.

Chattopadhyay

de Kok

Making research ethics work for global health: towards a more agile and collaborative approach. BMJ Glob Health. 2023;8(7):1-8. doi:10.1136/bmjgh-2022-011415

29.

Pratt

Research for Health Justice: an ethical framework linking global health research to health equity. BMJ Glob Health. 2021;6(2):1-15. doi:10.1136/bmjgh-2020-002921

30.

Ruger

JP.

Ethics and governance of global health inequalities. J Epidemiol Community Health. 2006;60(11):998-1003. doi:10.1136/jech.2005.041947

31.

Pratt

Hyder

AA.

Global justice and health systems research in low- and middle-income countries. J Law Med Ethics. 2015;43(1):143-161. doi:10.1111/jlme.12202

32.

Pratt

Loff

A framework to link international clinical research to the promotion of justice in global health. Bioethics. 2014;28(8):387-396. doi:10.1111/bioe.12009

33.

WHO. SDG Target 3.8. Achieve universal health coverage (UHC). 2024. https://www.who.int/data/gho/data/themes/theme-details/GHO/universal-health-coverage

34.

Verrecchia

Thompson

Yates

Universal Health Coverage and public health: a truly sustainable approach. Lancet Public Health. 2019;4(1):e10-e11. doi:10.1016/S2468-2667(18)30264-0

35.

Macdonald

Verster

Seale

Baggaley

Ball

Universal health coverage and key populations. Curr Opin HIV AIDS. 2019;14(5):433-438. doi:10.1097/COH.0000000000000570

36.

Debie

Nigusie

Gedle

Khatri

Assefa

Building a resilient health system for universal health coverage and health security: a systematic review. Glob Health Res Policy. 2024;9(1):2. doi:10.1186/s41256-023-00340-z

37.

Becerril-Montekio

Meneses-Navarro

Pelcastre-Villafuerte

Serván-Mori

Segmentation and fragmentation of health systems and the quest for universal health coverage: conceptual clarifications from the Mexican case. J Public Health Policy. 2024;45(1):164-174. doi:10.1057/s41271-024-00470-9

38.

Bertram

Aylward

Bosio

, et al. Confronting the elephants in the room: reigniting momentum for universal health coverage. Lancet. 2024;403(10437):1611-1613. doi:10.1016/S0140-6736(24)00365-9

39.

Watkins

Jamison

Mills

, et al. Universal health coverage and essential packages of care. In: Jamison

Gelband

Horton

eds. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd ed. The International Bank for Reconstruction and Development/The World Bank; 2017.

40.

Collaborators

GS.

Measuring the health-related sustainable development goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1813-1850. doi:10.1016/S0140-6736(16)31467-2

41.

Okamoto

Sata

Rosenberg

, et al. Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare. Health Econ Rev. 2024;14(1):8. doi:10.1186/s13561-023-00475-2

42.

Hogan

Stevens

Hosseinpoor

Boerma

Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. Lancet Glob Health. 2018;6(2):e152-e168. doi:10.1016/S2214-109X(17)30472-2

43.

Khalid

Skead

Wong

The politics of universal health coverage. Lancet. 2022;399(10340):2066-2074. doi:10.1016/S0140-6736(22)00585-2

44.

Sachs

JD.

Achieving universal health coverage in low-income settings. Lancet. 2012;380(9845):944-947. doi:10.1016/S0140-6736(12)61149-0

45.

Louart

Bonnet

Ridde

Is patient navigation a solution to the problem of “leaving no one behind”? A scoping review of evidence from low-income countries. Health Policy Plan. 2021;36(1):101-116. doi:10.1093/heapol/czaa093

46.

Veinot

Ancker

Cole-Lewis

, et al. Leveling up: on the potential of upstream health informatics interventions to enhance health equity. Med Care. 2019;57(Suppl 2):S108-S114. doi:10.1097/MLR.0000000000001032

47.

Hui

Latif

Hinsliff-Smith

Chen

Exploring the impacts of organisational structure, policy and practice on the health inequalities of marginalised communities: Illustrative cases from the UK healthcare system. Health Policy. 2020;124(3):298-302. doi:10.1016/j.healthpol.2020.01.003

48.

Marmot

Friel

Bell

Houweling

Taylor

Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661-1669. doi:10.1016/S0140-6736(08)61690-6

49.

Carey

Crammond

De Leeuw

Towards health equity: a framework for the application of proportionate universalism. Int J Equity Health. 2015;14:81. doi:10.1186/s12939-015-0207-6

50.

Whitehead

The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429-445. doi:10.2190/986L-LHQ6-2VTE-YRRN

51.

Dewidar

Al-Zubaidi

Bondok

, et al. Reporting of equity in observational epidemiology: A methodological review. J Glob Health. 2024;14:04046. doi:10.7189/jogh.14.04046

52.

Israel

Schulz

Parker

, et al. Critical issues in developing and following CBPR principles. In: Community-Based Participatory Research for Health: Advancing Social and Health Equity, Vol. 3. Jossey-Bass and Pfeiffer Imprints, Wiley; 2017;32-35.

53.

Taha

M-K

Martinon-Torres

Köllges

, et al. Equity in vaccination policies to overcome social deprivation as a risk factor for invasive meningococcal disease. Expert Rev Vaccines. 2022;21(5):659-674.

54.

Martinez-Alvarez

Federspiel

Singh

, et al. Equity of resource flows for reproductive, maternal, newborn, and child health: are those most in need being left behind? BMJ. 2020;368:m305.

55.

Friedman

Chandler

Adams

, et al. Toward a New Framework for Equity in Epidemic Allocations: Implications of HIV-Prevention–Allocation Misalignment. American Public Health Association; 2021:12-14.

56.

Richardson

Lawrence

Schoenthaler

Mann

A framework for digital health equity. NPJ Digit Med. 2022;5(1):119. doi:10.1038/s41746-022-00663-0

57.

Lau

Knudsen

Reducing disparities in telemedicine: an equity-focused, public health approach: perspective examines ways to reduce disparities in telemedicine. Health Aff. 2022;41(5):647-650.

58.

Westby

Nissly

Gieseker

Timmins

Justesen

Achieving equity in telehealth: “Centering at the margins” in access, provision, and reimbursement. J Am Board Fam Med. 2021;34:S29-S32.

59.

Jensen

Kelly

Avendano

Health equity and health system strengthening – time for a WHO re-think. Glob Public Health. 2022;17(3):377-390.

60.

Ostermann

Brown

de Bekker-Grob

Mühlbacher

Reed

SD.

Preferences for Health Interventions: improving uptake, adherence, and efficiency. Patient. 2017;10(4):511-514. doi:10.1007/s40271-017-0251-y

61.

Barroy

Cylus

Patcharanarumol

Novignon

Evetovits

Gupta

Do efficiency gains really translate into more budget for health? An assessment framework and country applications. Health Policy Plan. 2021;36(8):1307-1315.

62.

Platt

Keyes

Galea

Efficiency or equity? Simulating the impact of high-risk and population intervention strategies for the prevention of disease. SSM Popul Health. 2017;3:1-8. doi:10.1016/j.ssmph.2016.11.002

63.

Flessa

Where efficiency saves lives: a linear programme for the optimal allocation of health care resources in developing countries. Health Care Manag Sci. 2000;3(3):249-267. doi:10.1023/a:1019053710258

64.

Remme

Martinez-Alvarez

Vassall

Cost-effectiveness thresholds in global health: taking a multisectoral perspective. Value Health. 2017;20(4):699-704. doi:10.1016/j.jval.2016.11.009

65.

Leech

Kim

Cohen

Neumann

PJ.

Are low and middle-income countries prioritising high-value healthcare interventions?

BMJ Glob Health. 2020;5(2):e001850. doi:10.1136/bmjgh-2019-001850

66.

Jain

Chandrashekar

Implementing a targeted approach to social determinants of health interventions. Am J Manag Care. 2020;26(12):502-504. doi:10.37765/ajmc.2020.88537

67.

Wang

Gilmour

Tao

Zhuang

Does scale and efficiency of government health expenditure promote development of the health industry?

Int J Environ Res Public Health. 2020;17(15):5529.

68.

Jordi

Pley

Jowett

Abou Jaoude

Haghparast-Bidgoli

Assessing the efficiency of countries in making progress towards universal health coverage: a data envelopment analysis of 172 countries. BMJ Glob Health. 2020;5(10):e002992. doi:10.1136/bmjgh-2020-002992

69.

Zeng

Yao

Barroy

Cylus

Improving fiscal space for health from the perspective of efficiency in low- and middle-income countries: what is the evidence?

J Glob Health. 2020;10(2):020421.

70.

Wright

Paulden

Payne

Implementing interventions with varying marginal cost-effectiveness: an application in precision medicine. Med Decis Making. 2020;40(7):924-938. doi:10.1177/0272989X20954391

71.

Daniels

Just health: replies and further thoughts. J Med Ethics. 2009;35(1):36-41.

72.

Moon

Sridhar

Pate

, et al. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the global response to Ebola. Lancet. 2015;386(10009):2204-2221.

73.

Meara

Leather

Hagander

, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624.

74.

Chomilo

Can capitalism drive health equity? Considering the benefits and risks of social drivers of health bonds. Health Aff. 2023;42(3):392-394. doi:10.1377/hlthaff.2022.01689

75.

Arredondo

Orozco

Equity, governance and financing after health care reform: lessons from Mexico. Int J Health Plann Manage. 2008;23(1):37-49. doi:10.1002/hpm.913

76.

Chen

Palmer

Improving equity in health care financing in China during the progression towards Universal Health Coverage. BMC Health Serv Res. 2017;17(1):852. doi:10.1186/s12913-017-2798-7

77.

Eschliman

Pham

Navathe

Dale

Harris

The role of payment and financing in achieving health equity. Health Serv Res. 2023;58(Suppl 3):311-317. doi:10.1111/1475-6773.14219

78.

Chen

Zhao

New evidence on financing equity in China's health care reform–a case study on Gansu province, China. BMC Health Serv Res. 2012;12(1):466. doi:10.1186/1472-6963-12-466

79.

Zhou

Chen

Equity in health-care financing in China during the progression toward universal health coverage. China Econ Rev. 2020;61:101427. doi:10.1016/j.chieco.2020.101427

80.

Asante

Price

Hayen

Jan

Wiseman

Equity in health care financing in low- and middle-income countries: a systematic review of evidence from studies using benefit and financing incidence analyses. PLoS One. 2016;11(4):e0152866. doi:10.1371/journal.pone.0152866

81.

Kobres

Chretien

Johansson

, et al. A systematic review and evaluation of Zika virus forecasting and prediction research during a public health emergency of international concern. PLoS Negl Trop Dis. 2019;13(10):e0007451. doi:10.1371/journal.pntd.0007451

82.

Desai

Kraemer

MUG

Bhatia

, et al. Real-time epidemic forecasting: challenges and opportunities. Health Secur. 2019;17(4):268-275. doi:10.1089/hs.2019.0022

83.

Martin-Moreno

Alegre-Martinez

Martin-Gorgojo

Alfonso-Sanchez

Torres

Pallares-Carratala

Predictive models for forecasting public health scenarios: practical experiences applied during the first wave of the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(9):1-16. doi:10.3390/ijerph19095546

84.

Obermeyer

Powers

Vogeli

Mullainathan

Dissecting racial bias in an algorithm used to manage the health of populations. Science. 2019;366(6464):447-453. doi:10.1126/science.aax2342

85.

Wang

Artificial intelligence empowering public health education: prospects and challenges. Front Public Health. 2024;12:1389026. doi:10.3389/fpubh.2024.1389026

86.

Tanui

Ndembi

Kebede

Tessema

SK.

Artificial intelligence to transform public health in Africa. Lancet Infect Dis. 2024;24(9):e542. doi:10.1016/S1473-3099(24)00435-3

87.

Dankwa-Mullan

Health equity and ethical considerations in using artificial intelligence in public health and medicine. Prev Chronic Dis. 2024;21:E64. doi:10.5888/pcd21.240245

88.

da Silva

Jr Lima

Haddad

, et al. From national and regional commitments to global impact: artificial intelligence for equitable public health at the G20. Rev Panam Salud Publica. 2024;48:e73. doi:10.26633/RPSP.2024.73

89.

Stuart

Soulsby

Reducing global health inequalities. Part 2: myriad challenges. J R Soc Med. 2011;104(10):401-404. doi:10.1258/jrsm.2011.100394

90.

Laaser

Dorey

Nurse

A plea for global health action bottom-up. Front Public Health. 2016;4:241. doi:10.3389/fpubh.2016.00241

91.

Pratt

Inclusion of marginalized groups and communities in global health research priority-setting. J Empir Res Hum Res Ethics. 2019;14(2):169-181. doi:10.1177/1556264619833858

92.

Hayman

DTS

Barraclough

Muglia

, et al. Addressing the challenges of implementing evidence-based prioritisation in global health. BMJ Glob Health. 2023;8(6):e012450. doi:10.1136/bmjgh-2023-012450

93.

Whiteford

Manderson

Global Health Policy, Local Realities: The Fallacy of the Level Playing Field. Lynne Rienner Publishers; 2000.

94.

Sridhar

Craig

Introduction: Analysing global health assistance: the reach for ethnographic, institutional and political economic scope. Soc Sci Med. 2011;72(12):1915-1920. doi:10.1016/j.socscimed.2011.05.002

95.

Ruano

Sánchez

Jerez

Flores

Making the post-MDG global health goals relevant for highly inequitable societies: findings from a consultation with marginalized populations in Guatemala. Int J Equity Health. 2014;13:57. doi:10.1186/1475-9276-13-57

96.

Shawar

Shiffman

Political challenges to prioritizing gender in global health organisations. J Glob Health. 2020;10(1):010702. doi:10.7189/jogh.10.010702

97.

Reynolds

CF.

Optimizing personalized management of depression: the importance of real-world contexts and the need for a new convergence paradigm in mental health. World Psychiatry. 2020;19(3):266-268. doi:10.1002/wps.20770

98.

Kulesa

Brantuo

NA.

Barriers to decolonising educational partnerships in global health. BMJ Glob Health. 2021;6(11):e006964. doi:10.1136/bmjgh-2021-006964

99.

Schaefer

Kümpers

Cook

[Involving the seldom heard in participatory health research: challenges and strategies]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2021;64(2):163-170. doi:10.1007/s00103-020-03269-7

100.

Shumba

Lusambili

AM.

Not enough traction: barriers that aspiring researchers from low- and middle-income countries face in global health research. J Glob Heal Econ Policy. 2021;1(1):0-0.

101.

Schrecker

Globalization and health: political grand challenges. Rev Int Polit Econ. 2020;27(1):26-47.

102.

Finkel

Temmermann

Suleman

, et al. What do global health practitioners think about decolonizing global health? Ann Global Health. 2022;88(1):61.

103.

Tembo

Hickey

Montenegro

, et al. Effective engagement and involvement with community stakeholders in the co-production of global health research. BMJ. 2021;372:n178. doi:10.1136/bmj.n178

104.

Eichbaum

Adams

Evert

Semali

van Schalkwyk

SC.

Decolonizing global health education: rethinking institutional partnerships and approaches. Acad Med. 2021;96(3):329-335. doi:10.1097/ACM.0000000000003473

105.

Abimbola

Pai

Will global health survive its decolonisation?

Lancet. 2020;396(10263):1627-1628. doi:10.1016/S0140-6736(20)32417-X

106.

Zarowsky

Global health research, partnership, and equity: no more business-as-usual. BMC Int Health Hum Rights. 2011;11(Suppl 2):S1.

107.

Vazirani

O'Donoghue

Brindley

Meinert

Implementing blockchains for efficient health care: systematic review. J Med Internet Res. 2019;21(2):e12439. doi:10.2196/12439

108.

Hölbl

Kompara

Kamišalić

Nemec Zlatolas

A systematic review of the use of blockchain in healthcare. Symmetry. 2018;10(10):470.

109.

Hasselgren

Kralevska

Gligoroski

Pedersen

Faxvaag

Blockchain in healthcare and health sciences-a scoping review. Int J Med Inform. 2020;134:104040. doi:10.1016/j.ijmedinf.2019.104040

110.

Yanoov

Chetkow

Short-term intervention: a model of emergency services for times of crisis. Ment Health Soc. 1976;3(1-2):33-52.

111.

Moodley

Hardie

Selgelid

, et al. Ethical considerations for vaccination programmes in acute humanitarian emergencies. Bull World Health Organ. 2013;91(4):290-297. doi:10.2471/BLT.12.113480

112.

Wessells

MG.

Do no harm: toward contextually appropriate psychosocial support in international emergencies. Am Psychol. 2009;64(8):842-854.

113.

Walsh

DS.

A framework for short-term humanitarian health care projects. Int Nurs Rev. 2004;51(1):23-26. doi:10.1111/j.1466-7657.2003.00203.x

114.

Arroyo

Lundahl

Butters

Vanderloo

Wood

DS.

Short-term interventions for survivors of intimate partner violence: a systematic review and meta-analysis. Trauma Violence Abuse. 2017;18(2):155-171. doi:10.1177/1524838015602736

115.

Szilágyi

Humanitarian action to empower the most vulnerable social groups in disasters and complex emergencies. Biztonságtudományi Szemle. 2020;2(3):61-75.

116.

Penney

Ethical considerations for short-term global health projects. J Midwifery Womens Health. 2020;65(6):767-776. doi:10.1111/jmwh.13162

117.

Lova Herizo

Claudia

RFT

Mamy Alfa

Tiana

AM.

The scope of humanitarian actions in resilience towards A sustainable development of the urban population. Int J Appl Sci

Eng. 2022;03(01):01-19.

118.

Miller

Richards

Marx

Checchi

Kozuki

Assessing community health worker service delivery in humanitarian settings. J Glob Health. 2020;10(1):010307. doi:10.7189/jogh.10.010307

119.

Sáfár

The Role of Humanitarian Assistance in Resilience Development – An Innovative Research Area. University of Northumbria at Newcastle; 2020.

120.

Drakes

Tate

Rainey

Brody

Social vulnerability and short-term disaster assistance in the United States. Int J Disaster Risk Reduct. 2021;53:102010.

121.

Woolf

SH.

Progress in achieving health equity requires attention to root causes. Health Aff. 2017;36(6):984-991. doi:10.1377/hlthaff.2017.0197

122.

Jarris

Savage-Narva

Lupi

MV.

Promoting health equity and optimal health for all. J Public Health Manag Pract. 2016;22(Suppl 1):S5-S7.

123.

Sanders

Chopra

Key challenges to achieving health for all in an inequitable society: the case of South Africa. Am J Public Health. 2006;96(1):73-78.

124.

Eliassen

The usefulness of health disparity: stumbling blocks in the path to social equity. J Community Posit Pr. 2013;13(3):3-25.

125.

Baum

Bégin

Houweling

TAJ

Taylor

Changes not for the fainthearted: reorienting health care systems toward health equity through action on the social determinants of health. Am J Public Health. 2009;99(11):1967-1974.

126.

Popay

Whitehead

Hunter

DJ.

Injustice is killing people on a large scale–but what is to be done about it?

J Public Health. 2010;32(2):148-149.

127.

Koh

Nowinski

JM.

Health equity and public health leadership. Am J Public Health. 2010;100(S1):S9-S11. doi:10.2105/AJPH.2010.191379

128.

Lyles

Wachter

Sarkar

Focusing on digital health equity. JAMA. 2021;326(18):1795-1796. doi:10.1001/jama.2021.18459

129.

Fichtenberg

Delva

Minyard

Gottlieb

LM.

Health and human services integration: generating sustained health and equity improvements. Health Aff. 2020;39(4):567-573. doi:10.1377/hlthaff.2019.01594

130.

Hudson

Achieving Health Equity by addressing legacies of racial violence in public health practice. Ann Am Acad Pol Soc Sci. 2021;694(1):59-66.

131.

Loder

Progress against health inequities is slow and obstacles are numerous. BMJ. 2022;376:o470.

132.

Brewer

Fortuna

Jones

, et al. Back to the future: achieving health equity through health informatics and digital health. JMIR Mhealth Uhealth. 2020;8(1):e14512.

133.

Webb Hooper

Pérez-Stable

. Health equity is not possible without addressing disparities. Health Psychol. 2023;42(9):625-627.

134.

Weil

AR.

Tackling social determinants of health around the globe. Health Aff. 2020;39(7):1118-1121. doi:10.1377/hlthaff.2020.00691

135.

Peek

Gottlieb

Doubeni

, et al. Advancing health equity through social care interventions. Health Serv Res. 2023;58(Suppl 3):318-326.

136.

Prasad

Aldrink

Compton

, et al. Global health partnerships and the brocher declaration: principles for ethical short-term engagements in global health. Ann Global Health. 2022;88(1):31. doi:10.5334/aogh.3577

137.

Kiendrébéogo

Thoumi

Mangam

, et al. Reinforcing locally led solutions for universal health coverage: a logic model with applications in Benin, Namibia and Uganda. BMJ Glob Health. 2021;6(2):1-7. doi:10.1136/bmjgh-2020-004273

138.

Ponka

Coffman

Fraser-Barclay

, et al. Fostering global primary care research: a capacity-building approach. BMJ Glob Health. 2020;5(7):1-7. doi:10.1136/bmjgh-2020-002470

139.

Egan

Abba

Barnes

, et al. Building collective control and improving health through a place-based community empowerment initiative: qualitative evidence from communities seeking agency over their built environment. Crit Public Health. 2021;31(3):268-279.

140.

Pratt

Developing a toolkit for engagement practice: sharing power with communities in priority-setting for global health research projects. BMC Med Ethics. 2020;21(1):21. doi:10.1186/s12910-020-0462-y

141.

Pratt

Seshadri

Srinivas

PN.

Overcoming structural barriers to sharing power with communities in global health research priority-setting: lessons from the participation for Local Action project in Karnataka, India. Glob Public Health. 2022;17(12):3334-3352. doi:10.1080/17441692.2022.2058048

142.

Charani

Abimbola

Pai

, et al. Funders: the missing link in equitable global health research? PLoS Glob Public Heal. 2022;2(6):e0000583. doi:10.1371/journal.pgph.0000583

143.

Pettigrew

De Maeseneer

Anderson

Essuman

Kidd

Haines

Primary health care and the sustainable development goals. Lancet. 2015;386(10009):2119-2121. doi:10.1016/S0140-6736(15)00949-6

144.

Chotchoungchatchai

Marshall

Witthayapipopsakul

Panichkriangkrai

Patcharanarumol

Tangcharoensathien

Primary health care and sustainable development goals. Bull World Health Organ. 2020;98(11):792-800. doi:10.2471/BLT.19.245613

145.

Allen

Metternicht

Wiedmann

Initial progress in implementing the Sustainable Development Goals (SDGs): a review of evidence from countries. Sustain Sci. 2018;13(5):1453-1467. doi:10.1007/s11625-018-0572-3

146.

Cerf

ME.

Sustainable development goal integration, interdependence, and implementation: the environment-economic-health nexus and universal health coverage. Glob Chall. 2019;3(9):1900021. doi:10.1002/gch2.201900021

147.

Aftab

Siddiqui

Tasic

Perveen

Siddiqi

Bhutta

ZA.

Implementation of health and health-related sustainable development goals: progress, challenges and opportunities - a systematic literature review. BMJ Glob Health. 2020;5(8):1-10. doi:10.1136/bmjgh-2019-002273

148.

Morton

Pencheon

Bickler

The sustainable development goals provide an important framework for addressing dangerous climate change and achieving wider public health benefits. Public Health. 2019;174:65-68. doi:10.1016/j.puhe.2019.05.018

149.

Suthar

Khalifa

Joos

, et al. National health information systems for achieving the Sustainable Development Goals. BMJ Open. 2019;9(5):e027689. doi:10.1136/bmjopen-2018-027689

150.

Nunes

Lee

O'Riordan

. The importance of an integrating framework for achieving the Sustainable Development Goals: the example of health and well-being. BMJ Glob Health. 2016;1(3):e000068. doi:10.1136/bmjgh-2016-000068

151.

Tasioulas

Vayena

Getting human rights right in global health policy. Lancet. 2015;385(9978):e42-e44. doi:10.1016/S0140-6736(14)61418-5

152.

Braveman

Gruskin

Defining equity in health. J Epidemiol Community Health. 2003;57(4):254-258. doi:10.1136/jech.57.4.254

153.

Muhammad

Wallerstein

Sussman

Avila

Belone

Duran

Reflections on researcher identity and power: the impact of positionality on community based participatory research (CBPR) processes and outcomes. Crit Sociol. 2015;41(7-8):1045-1063. doi:10.1177/0896920513516025

154.

Resnik

The environment, ethics, and health. In: Benatar

Brock

, eds. Global Health: Ethical Challenges. Cambridge University Press; 2021;269.

155.

Hyder

Rattani

Krubiner

Bachani

Tran

NT.

Ethical review of health systems research in low- and middle-income countries: a conceptual exploration. Am J Bioeth. 2014;14(2):28-37.

156.

Norheim

OF.

Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services. BMC Med. 2016;14:75. doi:10.1186/s12916-016-0624-4

157.

Pratt

Towards inclusive priority-setting for global health research projects: recommendations for sharing power with communities. Health Policy Plan. 2019;34(5):346-357. doi:10.1093/heapol/czz041

158.

Bloom

Cadarette

Dayalu

Sullivan

Introduction: priority setting in global health. Cost Eff Resour Alloc. 2018;16(Suppl 1):49. doi:10.1186/s12962-018-0115-x

159.

Pratt

Sheehan

Barsdorf

Hyder

AA.

Exploring the ethics of global health research priority-setting. BMC Med Ethics. 2018;19(1):94. doi:10.1186/s12910-018-0333-y

160.

Montesanti

Abelson

Lavis

Dunn

JR.

The value of frameworks as knowledge translation mechanisms to guide community participation practice in Ontario CHCs. Soc Sci Med. 2015;142:223-231. doi:10.1016/j.socscimed.2015.08.024

161.

Kara

Arvidson

To what extent can evaluation frameworks help NGOs to address health inequalities caused by social exclusion?

Perspect Public Health. 2015;135(4):191-196. doi:10.1177/1757913914536155

162.

Themessl-Huber

Lazenbatt

Taylor

Overcoming health inequalities: a participative evaluation framework fit for the task. J R Soc Promot Health. 2008;128(3):117-122. doi:10.1177/1466424008089798

163.

Stangl

Earnshaw

Logie

, et al. The Health Stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17(1):31. doi:10.1186/s12916-019-1271-3

164.

Krieger

Gruskin

Frameworks matter: ecosocial and health and human rights perspectives on disparities in women's health–the case of tuberculosis. J Am Med Womens Assoc. 2001;56(4):137-142.

165.

Hoffman

Røttingen

Dark sides of the proposed framework convention on global health's man y virtues: a systematic review and critical analysis. Heal Hum Rights An Int J. 2013;15(1):E117-E134.

166.

London

Ethical oversight of public health research: can rules and IRBs make a difference in developing countries?

Am J Public Health. 2002;92(7):1079-1084. doi:10.2105/ajph.92.7.1079

167.

Sayeed

Taylor

Institutionalising global health: a call for ethical reflection. BMJ Glob Health. 2020;5(9):e003353. doi:10.1136/bmjgh-2020-003353

168.

Suzuki

Webb

Small

Competing frames in global health governance: an analysis of stakeholder influence on the political declaration on non-communicable diseases. Int J Health Policy Manag. 2022;11(7):1078-1089. doi:10.34172/ijhpm.2020.257

169.

Maaløe

Ørtved

AMR

Sørensen

, et al. The injustice of unfit clinical practice guidelines in low-resource realities. Lancet Glob Health. 2021;9(6):e875-e879. doi:10.1016/S2214-109X(21)00059-0

170.

Loewenson

Villar

Baru

Marten

Engaging globally with how to achieve healthy societies: insights from India, Latin America and East and Southern Africa. BMJ Glob Health. 2021;6(4):e005257. doi:10.1136/bmjgh-2021-005257

171.

Cash-Gibson

Harris

Guerra

Benach

A novel conceptual model and heuristic tool to strengthen understanding and capacities for health inequalities research. Health Res Policy Syst. 2020;18(1):42. doi:10.1186/s12961-020-00559-z

172.

Woodland

Blignault

O'Callaghan

Harris-Roxas

A framework for preferred practices in conducting culturally competent health research in a multicultural society. Health Res Policy Syst. 2021;19(1):1-11. doi:10.1186/s12961-020-00657-y

173.

Ruger

JP.

Ethics in American health 2: an ethical framework for health system reform. Am J Public Health. 2008;98(10):1756-1763. doi:10.2105/AJPH.2007.121350

174.

Ijsselmuiden

Kass

Sewankambo

Lavery

JV.

Evolving values in ethics and global health research. Glob Public Health. 2010;5(2):154-163. doi:10.1080/17441690903436599

175.

Pratt

Sharing power in global health research: an ethical toolkit for designing priority-setting processes that meaningfully include communities. Int J Equity Health. 2021;20(1):127. doi:10.1186/s12939-021-01453-y

176.

Hodson

Etoundi

Parikh

Boum

Striving towards true equity in global health: a checklist for bilateral research partnerships. PLoS Glob Public Heal. 2023;3(1):e0001418. doi:10.1371/journal.pgph.0001418

177.

Koum Besson

. How to identify epistemic injustice in global health research funding practices: a decolonial guide. BMJ Glob Health. 2022;7(4):e008950. doi:10.1136/bmjgh-2022-008950

178.

Duke

DLM

Prictor

Ekinci

Hachem

Burchill

. Culturally adaptive governance-building a new framework for equity in aboriginal and Torres Strait Islander health research: theoretical basis, ethics, attributes and evaluation. Int J Environ Res Public Health. 2021;18(15):7943. doi:10.3390/ijerph18157943

179.

Larson

Schlundt

Patel

Goldzweig

Hargreaves

Community participation in health initiatives for marginalized populations. J Ambul Care Manag. 2009;32(4):264-270. doi:10.1097/JAC.0b013e3181ba6f74

180.

George

. Governance and diversity: encouraging and enabling participation from marginalised and minority community groups. Just Policy: J Australian Soc Policy. 2008;(49):90-93.

181.

Montesanti

Abelson

Lavis

Dunn

JR.

Enabling the participation of marginalized populations: case studies from a health service organization in Ontario, Canada. Health Promot Int. 2017;32(4):636-649. doi:10.1093/heapro/dav118

182.

O'Keefe

Hogg

. Public participation and marginalized groups: the community development model. Health Expect. 1999;2(4):245-254. doi:10.1046/j.1369-6513.1999.00058.x

183.

Cornwall

Lucas

Pasteur

Introduction: Accountability through participation: developing workable partnership models in the health sector. IDS Bull. 2000;31(1):1-13. doi:10.1111/j.1759-5436.2000.mp31001001.x

184.

Sule

Community participation in health and development. Niger J Med. 2004;13(3):276-281.

185.

Jones

Sidell

Partnerships and collaborations: the promise of participation. In: Jones L, Sidell M, eds. The Challenge of Promoting Health. Macmillan Education UK; 1997;37-54, Chapter 3.

186.

Black

Sykes

Steps toward engagement integrity: learning from participatory visual methods in marginalized South African communities. Front Public Health. 2022;10:794905. doi:10.3389/fpubh.2022.794905

187.

Kamruzzaman

Exploring the nexus between participation and empowerment. J Dev Policy Pract. 2020;5(1):32-53. doi:10.1177/2455133320909926

188.

Rwebugisa

Usinger

Empowerment through genuine participation: giving voice to the neglected majority. J Dev Policy Pract. 2021;6(2):144-167. doi:10.1177/24551333211035181

189.

Mamokhere

Meyer

DF.

A review of mechanisms used to improve community participation in the integrated development planning process in South Africa: an empirical review. Soc Sci. 2022;11(10):448. doi:10.3390/socsci11100448

190.

Fors

Hagemann

Sang

ÅO

Randrup

TB.

Striving for inclusion—a systematic review of long-term participation in strategic management of urban green spaces. Front Sustain Cities. 2021;3:3. doi:10.3389/frsc.2021.572423

191.

Peters

LER

Shannon

Kelman

Meriläinen

. Toward resourcefulness: pathways for community positive health. Glob Health Promot. 2022;29(3):5-13. doi:10.1177/17579759211051370

192.

Brear

Hammarberg

Fisher

Community participation in health research: an ethnography from rural Swaziland. Health Promot Int. 2020;35(1):e59-e69. doi:10.1093/heapro/day121

193.

Taliep

Ismail

Bulbulia

Louw

. Data from: Stimulating and building compassionate and humanising networks for pro moting sustainable safer and healthier communities: Researcher reflexi vity on the Local Network of Care (LNOC).1.0. doi:10.1285/I24212113V7I1P54

194.

Pelletier

Pousette

Ward

Fox

Exploring the perspectives of community members as research partners in rural and remote areas. Res Involvement Engagem. 2020;6(1):3. doi:10.1186/s40900-020-0179-6

195.

Farhana

MS.

Community participation in preventing child trafficking. In Proceedings of the International Conference on Community Development (ICCD 2020). Atlantis Press; 2020.

196.

Mosurska

Ford

JD.

Unpacking community participation in research: a systematic literature review of community-based and participatory research in Alaska. ARCTIC. 2020;73(3):347-367. doi:10.14430/arctic71080

197.

Katz

Brownell

Ensuring indigenous participation in research on the health and well-being of Indigenous Peoples. CMAJ. 2019;191(25):E714. doi:10.1503/cmaj.72120

198.

Rass

Lokot

Brown

, et al. Participation by conflict-affected and forcibly displaced communities in humanitarian healthcare responses: a systematic review. J Migr Heal. 2020;1-2:100026. doi:10.1016/j.jmh.2020.100026

199.

Kohrt

Asher

Bhardwaj

, et al. The role of communities in mental health care in low- and middle-income countries: a meta-review of components and competencies. Int J Environ Res Public Health. 2018;15(6):1279. doi:10.3390/ijerph15061279

200.

Horowitz

Robinson

Seifer

Community-based participatory research from the margin to the mainstream: are researchers prepared?

Circulation. 2009;119(19):2633-2642. doi:10.1161/CIRCULATIONAHA.107.729863

201.

Bennett

Moberg

Participatory Research in Development of Public Health Interventions. Population Health Insitute, University of Wisconsin-Madison; 2006.

202.

Corcega

. Participatory research: getting the community involved in health development. Int Nurs Rev. 1992;39(6):185-188.

203.

Minkler

Community-based research partnerships: challenges and opportunities. Urban Health. 2005;82(2 Suppl 2):ii3-12. doi:10.1093/jurban/jti034

204.

Keikelame

Swartz

Decolonising research methodologies: lessons from a qualitative research project, Cape Town, South Africa. Glob Health Action. 2019;12(1):1561175. doi:10.1080/16549716.2018.1561175

205.

Wallerstein

Muhammad

Sanchez-Youngman

, et al. Power Dynamics in community-based participatory research: A multiple-case study analysis of partnering contexts, histories, and practices. Health Educ Behav. 2019;46(1_suppl):19S-32S. doi:10.1177/1090198119852998

206.

Andress

Hall

Davis

Levine

Cripps

Guinn

Addressing power dynamics in community-engaged research partnerships. J Patient Rep Outcomes. 2020;4(1):24. doi:10.1186/s41687-020-00191-z

207.

Heap

Jennings

Mathias

, et al. Participatory mental health interventions in low-income and middle-income countries: a realist review protocol. BMJ Open. 2022;12(4):e057530. doi:10.1136/bmjopen-2021-057530

208.

De Abreu Lourenço

Devlin

Howard

, et al. Giving a voice to marginalised groups for health care decision making. Patient. 2021;14(1):5-10. doi:10.1007/s40271-020-00456-1

209.

Keshri

Bhaumik

The feudal structure of global health and its implications for decolonisation. BMJ Glob Health. 2022;7(9):e010603. doi:10.1136/bmjgh-2022-010603

210.

Adams

Wagner

Nutt

Binagwaho

The future of global health education: training for equity in global health. BMC Med Educ. 2016;16(1):296. doi:10.1186/s12909-016-0820-0

211.

Swanson

Cattaneo

Bradley

, et al. Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy Plan. 2012;27(Suppl 4):iv54-iv61. doi:10.1093/heapol/czs090

212.

Walt

Globalisation of international health. Lancet. 1998;351(9100):434-437. doi:10.1016/S0140-6736(97)05546-3

213.

Chandanabhumma

Narasimhan

Towards health equity and social justice: an applied framework of decolonization in health promotion. Health Promot Int. 2020;35(4):831-840. doi:10.1093/heapro/daz053

214.

Garba

Stankey

Jayaram

Hedt-Gauthier

BL.

How do we decolonize global health in medical education? Ann

Global Health. 2021;87(1):29. doi:10.5334/aogh.3220

215.

Perez Ramos

Garriga-Lopez

Rodriguez-Diaz

CE.

How is colonialism a sociostructural determinant of health in Puerto Rico?

AMA J Ethics. 2022;24(4):E305-E312. doi:10.1001/amajethics.2022.305

216.

Assembly

Universal declaration of human rights. UN Gen Assem. 1948;302(2):14-25.

217.

Braveman

Defining Equity in Health. J Epidemiol Community Health. 2004;57(4):254-258.

218.

Ottersen

Dasgupta

Blouin

, et al. The political origins of health inequity: prospects for change. Lancet. 2014;383(9917):630-667. doi:10.1016/S0140-6736(13)62407-1

219.

Health WCoSDo, World Health Organization. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health: Commission on Social Determinants of Health Final Report. World Health Organization; 2008.

220.

Persad

Wertheimer

Emanuel

EJ.

Principles for allocation of scarce medical interventions. Lancet. 2009;373(9661):423-431. doi:10.1016/S0140-6736(09)60137-9

221.

World Health Organization. A Vision for Primary Health Care in the 21st Century: Towards Universal Health Coverage and the Sustainable Development Goals. World Health Organization; 2018.

222.

Carey

Desai

Maximising Official Development Assistance. OECD Publishing; 2023.

223.

Forman

Brolan

Kenyon

KH.

Global health, human rights, and the law. Lancet. 2019;394(10213):1987. doi:10.1016/S0140-6736(19)32604-2

224.

Ekström

Tomson

Wanyenze

, et al. Addressing production gaps for vaccines in African countries. Bull World Health Organ. 2021;99(12):910-912. doi:10.2471/BLT.21.287381

225.

Shafiq

Pandey

Malhotra

, et al. Shortage of essential antimicrobials: a major challenge to global health security. BMJ Glob Health. 2021;6(11):e006961. doi:10.1136/bmjgh-2021-006961

226.

Waldron

Coyne

. You can’t develop what you don’t know: the realities and limitations of foreign aid missions. In: Moonshots and the New Industrial Policy. International Studies in Entrepreneurship, vol 56. Springer; 2024:191-212.

227.

Yuk-Chiu Yip

. Healthcare resource allocation in the COVID-19 pandemic: Ethical considerations from the perspective of distributive justice within public health. Public Heal Pr. 2021;2:100111. doi:10.1016/j.puhip.2021.100111

228.

Agyepong

Godt

Sombie

Binka

Okine

Ingabire

MG.

Strengthening capacities and resource allocation for co-production of health research in low and middle income countries. BMJ. 2021;372:n166. doi:10.1136/bmj.n166

229.

Bruynseels

Santoni

Sio

van den Hoven

Digital twins in health care: ethical implications of an emerging engineering paradigm. Front Genet. 2018;9:31. doi:10.3389/fgene.2018.00031

230.

Jacobson

Bentley

Walton

, et al. Ethical dilemmas posed by mobile health and machine learning in psychiatry research. Bull World Health Organ. 2020;98(4):270-276. doi:10.2471/BLT.19.237107

231.

Prodan

Deimel

Ahlqvist

, et al. Success factors for scaling up the adoption of digital therapeutics towards the realization of P5 medicine. Front Med. 2022;9:854665.

232.

Fürstenau

Gersch

Schreiter

Digital therapeutics (DTx). Bus Inf Syst Eng. 2023;65(3):349-360.

233.

Basu

Sharma

Under-recognised ethical dilemmas of diabetes care in resource-poor settings. Indian J Med Ethics. 2018;III(4):324-326. doi:10.20529/IJME.2018.048

234.

Nabyonga-Orem

Christmals

Addai

, et al. The nature and contribution of innovative health financing mechanisms in the World Health Organization African region: a scoping review. J Glob Health. 2023;13:04153. doi:10.7189/jogh.13.04153

235.

Iovan

Lantz

PM.

Social impact bonds: a promising public–private partnership model for public health. Am J Public Health. 2018;108(8):e6. doi:10.2105/AJPH.2018.304548

236.

Raub

Heymann

Progress in national policies supporting the sustainable development goals: policies that matter to income and its impact on health. Annu Rev Public Health. 2021;42:423-437. doi:10.1146/annurev-publhealth-040119-094151

237.

Nazir

Vervoort

Environmentally sustainable surgical health systems: an analysis of policies, tools, and guidelines. Lancet Planet Heal. 2023;7(7):e538-e539. doi:10.1016/S2542-5196(23)00124-9

238.

Mauti

Gautier

Agbozo

, et al. Addressing policy coherence between health in all policies approach and the sustainable development goals implementation: insights from Kenya. Int J Health Policy Manag. 2022;11(6):757-767. doi:10.34172/ijhpm.2020.212