A new paper published in the prestigious Lancet Regional Health–Western Pacific by University of Auckland researchers and Pacific collaborators, including an academic from Samoa, urges a fundamental re-imagining of Global Health in the Pacific region.

Re-imagining Global Health: Perspectives from the Next Generation in the Pacific Region takes a new viewpoint, highlighting the need to dismantle colonial legacies and embed Pacific leadership, knowledge systems and values at the heart of health policy and practice.

The authors, an all-women team of Pacific and non-Pacific researchers, based across the Pacific region and New Zealand, have extensive experience working in health services and research in the Pacific region.

The researchers state that Global Health aims to improve health equity worldwide, but in the Pacific, it has long been shaped by colonial and externally driven approaches that have overshadowed Indigenous knowledge and sidelined local expertise. Pacific researchers and health professionals continue to face the undervaluing of their contributions, from parachute research and limited authorship opportunities to funding models and ethical systems that overlook Pacific priorities.

The paper argues that true progress requires shifting power and leadership to Pacific institutions, valuing Indigenous worldviews alongside Western models, and recognising the vital leadership of Pacific women in shaping more equitable and sustainable health futures.

Authors Dr Sainimere Boladuadua, Dr Fiona Langridge, Dr Rennie Qin, Dr Roannie Ng Shiu, Professor Judith McCool, Jyotishna Mani, Dr Jimaima Kailawadoko and Dr Elizabeth Holt assert that current Global Health structures often perpetuate power imbalances and exclude Indigenous Pacific worldviews.

Lead author Dr Sainimere Boladuadua, from the University of Auckland’s Department of Paediatrics: Child and Youth Health, says there is often an undervaluing of Pacific expertise, demonstrated, for example, by disparities in remuneration between overseas consultants and locally based Pacific experts. This, and other issues, such as extractive practices, limited Pacific leadership and lack of lead and Pacific authorship, perpetuate the status quo. Ensuring Pacific-identified priorities must be addressed to see real health gains across the region and globally.

“Global Health must stop undervaluing Pacific expertise. When overseas consultants are remunerated at a higher rate than local experts, and when research collaborations, for example, extract knowledge without building local capacity, this reinforces colonial patterns.

“Our vision is for Pacific-led, genuine reciprocal partnerships that respect Indigenous knowledge and deliver solutions that are appropriate for the communities we serve.

“A power shift is already happening in Pacific leadership, and our article highlights excellent and positive gains in Global Health in the Pacific region, including the formation of the Fiji Institute of Pacific Health Research, and the recent launch of the Pacific Academy of Sciences in Sāmoa.”

The Pacific region is home to some of the world’s most climate-vulnerable communities and faces disproportionate health burdens, including non-communicable diseases and the impacts of climate change—issues driven by global economic and environmental systems.

Boladuadua says the team of women Pacific health researchers reflects not only a new generation but also demonstrates the available expertise and the growth of the Pacific workforce in Global Health.

“Global Health, at its origins, is about health equity for all, and that means prioritising the most important problems faced by those with the least resources.”