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The Viewpoint by Isha Ray and Kirk Smith (March, 2021)1 makes a welcome critique of interventions to provide safe drinking water and clean cooking in poor communities, arguing that household-level interventions have been mostly unsuccessful because they do not appropriately account for the lived realities of people who are poor, and proposes utility-scale interventions as an alternative. However, the Viewpoint unintentionally reveals an endemic barrier to the success of global health interventions led by institutions in high-income countries. Namely, a vast disparity in life-worlds between elites (ie, well-remunerated, high-status professionals in positions of prestige) who conduct public health and development research and the people living in poor communities they target. This disparity forms the greatest obstacle to the success of global health and poverty alleviation. For example, Ray and Smith surmise that people who are poor face challenging and uncertain tradeoffs for how to spend meagre income, and that people who are poor “worry about their children, the onset of a health emergency, and…about their tenuous access to water and sanitation.”1 These statements and others in these passages are remarkable for their obviousness, and suggest that the commonplace austerities, complexities, and challenges of poverty are largely opaque concepts to thought leaders in global health and development. Global health interventions conceived across widely differing life-worlds will fall short of stated objectives if elites implicitly hold that poverty is the result of underdevelopment rather than being a systemically manufactured phenomenon. Embedded in the Viewpoint is the predominant implicit assumption that communities must be lifted out of poverty by modernisation, development, and research. In reality, neoliberal globalisation, growth-oriented economics, Western imperialism and militarism, and even much of what occurs under the aegis of sustainable development are principal causes of global poverty.2 Poverty cannot be fixed through technocratic policies and interventions devised by elites, whose affluence and privilege depend on the exploitation and diminution of the global poor regardless of whether efforts are made to incorporate elements of their lived experience into global health research.3 As much as we agree that service-based models are important, interventions pursued under a fundamentally unjust political–economic framework will fail regardless of the mode of delivery. What is needed is a paradigm shift away from elite institutions as the loci of technocratic solutions to poverty. Instead, we global health and sustainable development professionals must embrace direct solidarity with people who are poor under circumstances wherein they invite us to function as consultants and accompagnateurs. We must relinquish our belief in the primacy of externally defined research agendas to change people's lives and instead work in service alongside people who are poor, following their lead. We declare no competing interests.