Global health can be defined as an area for study, research and practice that places a priority on improving health and achieving health equity for everyone worldwide1. Bioengineers can thus have a crucial role in improving global health by designing diagnostics and treatment technologies that require minimal expertise to operate, are robust and endurable, cost little to manufacture and perform outside controlled laboratory settings. All with the noble aim to eventually increase the accessibility and global deployment of biomedical technologies.

However, this access agenda in global health-related research and development, focusing on the unequal distribution of biomedical technologies, may overlook wider structural inequalities in the production of global health knowledge, as Alice Street et al. discuss in this issue. One cannot remove health and illness — and accordingly, technologies aimed at monitoring health or addressing illness — from local contexts. Indeed, these contexts need to be understood and provide the foundation of the global health innovation ecosystem.

Yet, key resources — human, infrastructural and financial — that underpin the generation of global health-related knowledge and ultimately drive innovation, are concentrated in high-income countries2, thereby framing global health-related research in the context of coloniality (keeping in mind that the entire field of global health was birthed in colonialism3). Common practices in academic global health — such as research partnerships, research framing, authorship practices, conceptualization, and the design and conduct of research — keep upholding colonialist structures3.

This framework of global health as a colonial project underlies the call for decolonization, with the goal “to critically reflect on (global health’s) history, identify hierarchies and culturally Eurocentric conceptions, and overcome the global inequities that such structures perpetuate”4. In particular, knowledge decolonization is long overdue in global health — that is, to put an end to hierarchical assumptions and disregard of local knowledge and contributions5.

Knowledge decolonization may be achieved by striving for equitable innovation, which requires the establishment of equitable relationships (and prioritization of local capacity building, which should also be reflected on a funding and priority setting level). Specifically, Street et al. call for improved representation and recognition of scientists and engineers working in low- and middle-income countries. The role of scientists from these countries is often limited to providing samples or doing fieldwork, and they may be excluded from contributing scientifically or from making scientific and conceptual contributions in collaborative projects, which is also reflected in authorship practices (‘stuck-in-the-middle patterns’)6,7.

“innovation through equitable relationships will prevent the development of designs that fail to meet the needs of users”

Importantly, innovation through equitable relationships will prevent the development of designs that fail to meet the needs of users. If biomedical technologies are designed in research laboratories that are far from the point of use, and without knowledge of the local contexts and logistics, they may never be deployed, applied and trusted8. Therefore, inclusive and equitable research and development may considerably improve the global effects of biomedical technologies to achieve health equity for all people worldwide — as per the definition of global health.