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Equitable imagery in global health: a qualitative study examining how to create agency, share power and build
Alexandra M Cardoso Pinto1,2, Anastasia Koch3,4,5, Sipho Dlamini6
1School of Public Health, Imperial College London, London, UK alexandra.cardoso-pinto18@imperial.ac.uk.
Objectives:
To 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.
Setting:
International 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.
Participants:
19 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.
Results:
Thematic 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.
Conclusions:
Global 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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