International Journal of Health Policy and Management

International Journal of Health Policy and Management

Power in Global Health: A Narrative Review, Relational Framework, and Systems-Based Analysis

Articles in Press

Document Type : Review Article

Authors
Million Tesfaye Eshete 1
Goran Tomson 2
Ole Petter Ottersen 1, 2, 3, 4
Tanja Tomson 5
Rhoda K. Wanyenze 6
Qingyue Meng 7
Eivind Engebretsen 1
1 Sustainable Health Unit, Medical Faculty, University of Oslo, Oslo, Norway
2 Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
3 Oslo New University College, Oslo, Norway
4 Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
5 Department of Health Promoting Science, Sophiahemmet University Stockholm, Sweden
6 Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
7 China Center for Health Development Studies, Peking University, Beijing, China
Abstract
Background
Power is routinely invoked to explain health inequities and governance failures in global health, yet existing work is conceptually fragmented, weakly connected to empirical analysis, and prone to what is referred to as the “power-as-resource fallacy”: the conflation of power bases (what actors possess) with power relationships (how actors influence one another). This narrative review examines how power is conceptualized and operationalized in global health discourse, identifies systematic analytical gaps, and proposes a relational framework to address them.

Methods
We conducted a narrative review of literature that explicitly engages with power in relation to global health, governance, or health systems. We synthesized the included texts thematically and, as a supplementary systems-thinking component, developed a causal loop diagram (CLD) based on a subset of quantitative studies to illustrate how different constellations of power interact with health outcomes over time.

Results
In global health, power is pervasively invoked but rarely operationalized. We organized the reviewed texts into six thematic domains: (1) power as a determinant of health; (2) structural power (class, race, gender, geopolitical hierarchies); (3) power asymmetry; (4) power and governance for health; (5) power and health securitization; and (6) power constellations and health outcomes. Across these domains, we find that discussions of power remain largely qualitative and often stop short of clear operationalization. The CLD translates these insights into interacting feedback loops, illustrating how specific power constellations are associated with particular patterns of policy response and health outcomes, highlighting potential leverage points for governance reform.

Conclusion
This review maps the existing knowledge on power in global health and provides an actionable framework for future research and governance design. It underscores that power is the fundamental thread connecting global political economy to local health inequities.
Keywords
Structural Power
Global Health Governance
Health Inequities
Power Asymmetry
Political Economy of Health
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International Journal of Health Policy and Management

Articles in Press, Accepted Manuscript
Available Online from 02 August 2026

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  • Received Date 23 December 2025
  • Revised Date 23 June 2026
  • Accepted Date 21 July 2026
  • First Published Date 02 August 2026
  • Published Date 02 August 2026