Three Dimensions of Compounding Neglect: How Biobanks, Clinical Trials, and Scientific Literature Systematically Exclude the Global South

Abstract Global health inequities are widely documented in outcomes. However, the research systems that generate knowledge, trials, and discovery have rarely been evaluated as an integrated structure. We introduce the Health Equity Informative Metrics (HEIM) framework, a three-dimensional audit of discovery (biobank output), translation (clinical trial activity), and knowledge (semantic organisation of the scientific literature). Analysing 70 international biobanks, 563,725 registered clinical trials, 13.1 million PubMed abstracts, and 175 Global Burden of Disease categories, we demonstrate that exclusion compounds systematically for diseases that primarily burden the Global South. No WHO-classified neglected tropical disease has generated a publication from these 70 biobanks. Clinical trial sites concentrate 2.5-fold in high-income countries relative to disease burden. Diseases disproportionately affecting low-and middle-income regions are 44% more semantically isolated from mainstream biomedical research than other conditions (P < 0.0001, Cohen’s d = 1.80), limiting cross-disciplinary integration. Nine of the ten most neglected diseases across all dimensions disproportionately affect the Global South, and these disparities show no improvement over 26 years. By contrast, the trajectory of HIV/AIDS demonstrates that sustained, coordinated investment can reverse semantic isolation and integrate a once-marginalised disease into mainstream biomedical networks. HEIM reframes research inequity as a measurable, multi-stage enterprise and establishes a framework for health data accountability.