BACKGROUND:
Healthcare interventions such as drugs and therapies exist because researchers transform ideas into practical solutions. Nevertheless, these processes rely on funders whose financial decisions determine which innovations materialize. I argue that in public health, persistent inequities in access to innovative drugs and therapies render funders’ understandings of justice particularly essential. Hence, this study examines how health research funders conceive and interpret justice and how their perceptions shape equity, inclusion, and global health sustainability.

METHODS:
Using constructivist grounded theory, I conducted a semi-structured interviewed with nine senior decision makers from six health research funding organizations across three countries/continents. Interviews explored participants’ perceptions of justice, its relevance to their decision-making processes, and its role in shaping organizational priorities. The data were coded and categorized following the constructivist grounded theory guidelines.

RESULTS:
Although funders demonstrated numerous similarities in how they perceived and conceptualized justice, there were equally conflicting interpretations of the concept. While some viewed justice as peripheral to funding decisions, others regarded it as a core and often implicit organizational value. Furthermore, participants differed in whether they perceived justice instrumentally: to achieve better outcomes, or intrinsically: as a moral principle guiding responsible investment. These conceptual differences influenced how decision makers understood their obligations to address inequities, including those that cross national borders.

CONCLUSIONS:
Funders’ interpretations of justice shape the priorities and processes that guide support for initial health research. In understanding the conceptual foundations behind justice related decision-making, this study highlights why efforts to achieve equity in access to innovative drugs and therapies, require clearer, and justice sensitive frameworks for research funding. Understanding how funders think about justice before acting is essential for building more equitable, inclusive, and sustainable global health innovation systems for just outcomes.