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Colonisation and its aftermath: reimagining global surgery.
Qin, Rennie; Alayande, Barnabas; Okolo, Isioma; Khanyola, Judy; Jumbam, Desmond Tanko; Koea, Jonathan; Boatin, Adeline A; Lugobe, Henry Mark; Bump, Jesse.
Afiliación
  • Qin R; Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
  • Alayande B; Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
  • Okolo I; Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Gasabo, Rwanda.
  • Khanyola J; Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
  • Jumbam DT; Department of Obstetrics and Gynaecology, NHS Slothian, Edinburgh, UK.
  • Koea J; Center for Nursing and Midwifery, University of Global Health Equity, Kigali, Gasabo, Rwanda.
  • Boatin AA; Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA.
  • Lugobe HM; Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
  • Bump J; Department of Obstetrics & Gynecology and Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.
BMJ Glob Health ; 9(1)2024 01 04.
Article en En | MEDLINE | ID: mdl-38176746
ABSTRACT
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Operativos / Salud Global / Colonialismo / Disparidades en Atención de Salud Tipo de estudio: Guideline Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Humans Idioma: En Revista: BMJ Glob Health Año: 2024 Tipo del documento: Article País de afiliación: Nueva Zelanda Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Operativos / Salud Global / Colonialismo / Disparidades en Atención de Salud Tipo de estudio: Guideline Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Humans Idioma: En Revista: BMJ Glob Health Año: 2024 Tipo del documento: Article País de afiliación: Nueva Zelanda Pais de publicación: Reino Unido