Colonisation and its aftermath

Reimagining global surgery

Bibliographic Data

ID21879868
AuthorsRennie Xinrui Qin (0000-0003-2167-1500, Harvard University), Barnabas Tobi Alayande (0000-0002-1326-6452, University of Global Health Equity), Barnabas Alayande (University of Global Health Equity), Isioma Okolo (0000-0002-2748-0302, NHS Lothian), Judy Khanyola (University of Global Health Equity), Desmond T Jumbam (0000-0002-3062-2519, Operation PAR), Jonathan Koea (0000-0001-8833-5603, University of Auckland), Adeline A Boatin (0000-0003-3420-7846, Massachusetts General Hospital), Henry Mark Lugobe (0000-0001-8177-8786, Mbarara University of Science and Technology, corresponding author), Jesse B Bump (0000-0003-1014-0456, Harvard Global Health Institute)
Year2024
Volume9
Issue1
Pagese014173
Publication date2024-01-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2023-014173
PMID38176746
OpenAlexW4390631741
LanguageEN
Citations received2
References cited76

Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession (‘non-specialists’, non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting

Business · Economic growth · Economics · Global health · Global strategy · Health care · Health equity · Indigenous · Inequality · Political science · Public relations · Sociology · Diversity and Career in Medicine · Global Health and Surgery · Global Health Workforce Issues · Law · Medicine

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