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Colonisation and its aftermath: reimagining global surgery.

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Summary
This summary is machine-generated.

Global surgery faces inequities rooted in coloniality, including Western dominance and unequal participation. Addressing these requires inclusive, community-led models for equitable surgical care worldwide.

Keywords:
Health policyHealth systemsObstetricsSurgery

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Area of Science:

  • Global Health
  • Surgical Equity
  • Health Systems Research

Background:

  • Coloniality in global health perpetuates systemic inequalities, benefiting some groups over others.
  • Global surgery, while aiming for equity, inherits existing biases within global health frameworks.
  • Understanding and addressing non-merit-based inequities is crucial for advancing global surgical equity.

Purpose of the Study:

  • To examine and categorize non-merit-based inequities within the field of global surgery.
  • To identify key areas where systemic biases hinder equitable global surgical practices.
  • To propose a framework for shifting global surgery towards more inclusive and equitable models.

Main Methods:

  • A structured, iterative group Delphi consensus-building process was employed.
  • The process integrated existing literature with the lived experiences of diverse global surgery practitioners.
  • Identified inequities were categorized into five distinct areas.

Main Results:

  • Five categories of non-merit inequities were identified: Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power/control.
  • Global surgery is characterized by Western biomedical dominance, a lack of interprofessional collaboration, and exclusion of Indigenous medical systems and socio-cultural contexts.
  • Inequities observed include unidirectional personnel flow (North to South), unequal participation (Global South, female, specific specialties, non-clinicians, patients), and resource/benefit concentration in the Global North.

Conclusions:

  • Shifting global surgery towards equity necessitates building inclusive, pluralist, and polycentric models of care.
  • Models should feature providers representing the community, with resources and governance driven by local communities.
  • Addressing Western-centric dominance and promoting equitable participation are essential for true global surgical equity.