Despite the stated intentions of major public research funding organisations to address health inequalities and engage underserved communities, significant obstacles remain deeply embedded in the current research ecosystem. At Mabadiliko CIC, we’ve work to identify how traditional research models continue to fail marginalised communities and why transformative change is essential.

The Persistent Problem of Health Inequalities

Health inequalities in the UK persist at the intersection of socioeconomic deprivation and racial disparities, affecting outcomes throughout the life course. For instance, adults in deprived areas face higher mortality rates from heart disease, while Black women are nearly three times more likely to die in childbirth than white women. People from racially minoritised groups and those living in deprived areas experience higher rates of chronic diseases and face barriers in accessing healthcare. These stark disparities aren’t simply a matter of fate—they reflect systemic failures in how we research, design, and deliver healthcare.

Where Traditional Models Fall Short

Traditional research approaches are failing marginalised communities in several critical ways:

• Cultural and Attitudinal Barriers: Many researchers lack cultural humility and sensitivity awareness, potentially holding unconscious biases that impede genuine community engagement. This creates significant potential for harm in diverse communities.
• Power Imbalances: Existing structures perpetuate unequal power dynamics between researchers and communities, hindering true co-production of knowledge. Researchers often hold disproportionate control over funding, resources, and the framing of research questions.
• Time and Resource Limitations: The pressure to publish, secure grants, and meet institutional demands leaves little room for the time-intensive work of community engagement. Building trust and establishing genuine partnerships with communities is a long-term process.
• Lack of Diversity: The underrepresentation of individuals from marginalised communities in research leadership roles perpetuates biased perspectives and approaches. This lack of diversity results in research questions, methodologies, and interpretations that fail to capture the full complexity of health issues.
• Institutional Inertia: Research institutions often prioritise and reinforce traditional hierarchies, processes, and outputs over community engagement. They fail to support, recognise, and reward researchers for equitable practices.

The Financial Framework Problem

Current funding models often fail to adequately support equitable partnerships with Voluntary and Community Sector Organisations (VCSOs) or compensate community members for their expertise and time. This is particularly challenging in areas with a high cost of living, where many VSCOs operate on limited budgets. Short-term, project-based funding models and inadequate resources for equitable partnership with VCSOs and communities jeopardise long-term relationships with community partners and impede the development of trust. This affects the continuity of engagement with communities.

The Community Perspective

Communities themselves tell us they have concerns about research conducted “into us, by others,” citing a lack of cultural sensitivity, inadequate attention to trauma, and fear of extraction. They identify trusted, grassroots VCS organisations as providing an interface that would increase their likelihood of engagement and transparency. When the VCS sector is engaged by the health ecosystem, there are perpetual illustrations of inequitable practice built on historical power imbalances, including procurement processes and the short-term, transactional nature of relationships. 

The Way Forward

Addressing these systemic barriers requires a comprehensive approach that involves:

• Reimagining funding structures to support long-term, community-engaged research
• Fostering cultural competence and humility among researchers and institutions
• Challenging institutional norms that perpetuate power imbalances
• Allocating appropriate resources for meaningful community engagement
• Redistributing power to enable genuine co-creation of knowledge
• Ensuring sustainable, long-term support for community partnerships

The case for change is clear. Traditional research models are failing the very communities who experience the greatest health inequalities. By transforming how we conduct research—moving from research “on” communities to research “with” and “by” communities—we can create knowledge that leads to more effective, equitable, and sustainable health solutions. Only by tackling these obstacles holistically can we hope to achieve truly transformative and equitable health research that benefits all members of society, particularly those who have been historically marginalised and underserved.