While specific definitions of empowerment varied, the idea that empowerment includes a shift in power structures was a central concept that underwrote almost all talk. Interviewees related empowerment agendas to relations of power in multiple domains. At the highest levels, participants referred to global power inequities among and between HICs and LMICs (low middle income countries) that resulted in a lack of appetite and ability to do empowerment work in LMICs, as well as an arrogance that neutered acknowledgment that Southern countries could provide innovative solutions to health problems, even ones that could be taken up in the global North.