ArticleBMJ global health2026
Equitable imagery in global health: a qualitative study examining how to create agency, share power and build partnership.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo explore how ethical image-making practices in global health are shaped by issues of agency, power and partnership across the planning, creation and dissemination of imagery and to examine stakeholder perspectives on applying a previously published ethical imagery framework.
settingInternational qualitative study involving stakeholders engaged in the commissioning, production and dissemination of Global Health imagery across multiple countries, combined with survey data from young people participating in a photography and ethics programme in Khayelitsha, Cape Town, South Africa.
participants19 stakeholders involved in Global Health imagery participated in semi-structured interviews. Additionally, 18 young people aged 15-17 years participating in an 8-month photography training programme completed a survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was qualitative exploration of stakeholder perspectives on ethical imagery practices across planning and commissioning, image creation and dissemination. Secondary outcomes included survey findings from young people regarding priorities for ethical representation in global health imagery.
resultsThematic analysis identified three interconnected themes: agency and autonomy, power imbalances and inequity and collaborative partnerships. Participants highlighted that ethical concerns arise throughout the image-making process and are shaped by structural inequities including who determines what is photographed, how it is framed and where it is disseminated. Meaningful consent, inclusive representation, community involvement and shared decision-making were identified as central to ethical practice. Participants viewed the framework as a useful tool for ethical reflection but emphasised that its effectiveness depends on training, institutional commitment and accountability mechanisms. Survey findings reinforced the importance of dignity, representation and participant involvement in decisions about imagery.
conclusionsGlobal Health imagery requires approaches that extend beyond technical guidance to address power imbalances and promote meaningful partnership. Frameworks should support dialogue, reflexivity and shared accountability rather than function as prescriptive rulebooks. Institutions, image-makers and communities should work collaboratively to ensure imagery reinforces dignity, agency, equity and solidarity in Global Health.
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