Soft money, hard power: Mapping the material contingencies of change in global health academic structures.

In the proliferating conversations about decolonizing Global Health, a basic assumption has been that global South actors should be the conceptualizers, leaders, and makers of change with global North counterparts thought of as allies or accomplices. This article complicates assumptions about whose responsibility it is to "decolonize" Global Health and how different actors should go about it. We do this through a qualitative anthropological investigation on resource structures and material flows and the ways that global North actors relate to and make sense of them. By outlining the financial structuring at a major American school of public health and faculty experiences within this system, we show how the "soft money" structure reproduces colonial relations, elite dominance, and capture of popularized words connoting change. While acknowledging the necessity of promoting knowledge and discourses from the South, we demonstrate how Global Health academics in this powerful institution hide or overlook their structurally advantageous positions to create change by deploying discourses such as "following the South" or "centering Southern voices." Grappling with how needed material changes fundamentally go against institutional and personal interests of powerful global North institutions and actors, we introduce "ruinous solidarity" as a paradigm of praxis. Ruinous Solidarity is elite actors thinking and acting in ways that embraces the possibilities that emerge in loss of resources and prestige. Ruinous solidarity seeks to move elite actors subjected to funding structures such as those described in this article away from passivity and obscuring the material bases of the imbalance of power in Global Health. Pushing for long term, ethical transfers of wealth and responsibility, ruinous solidarity explicitly reorients the political commitments of those who affiliate with Global Health in imperial cores, and thus offers important considerations in the wake of Trump Administration attacks on the field.