Available online 9 February 2026, 151587

Author links open overlay panelIan Stevens a bShow moreAbstract

This article argues that evaluating surgical innovations’ normative and scientific integrity requires that their merits must also be contextualized by their social, cultural, and environmental determinants. This article draws on examples of surgical innovations developed in the Global South that have or have not found their way to the lucrative health care marketplaces of the Global North. While interrogating what ought to count as “innovative,” these examples will also act as a foundation for better understanding the asymmetric power dynamics at play in global health initiatives and how dismantling them will require returning credit and ownership to those who bore the risks of the innovation in the first place.

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Access through your organizationSection snippetsGlobal surgery

The practice of global surgery has been on an upswing over the past few decades with major milestones including its description as “[t]he neglected stepchild of global health” in 2008.1 The Lancet Commission for Global Surgery reiterated the need for global access to surgical care, reporting that “5 billion people lack[ed] access to safe, affordable surgical and anaesthesia care when needed” in 2015.2 While the field has since outgrown its “neglected stepchild” label,3 global surgery, as an

Social context and surgical innovation

The general practice of innovating can be understood “as a socially and territorially embedded, interactive process, which cannot be separated from its institutional and cultural contexts.”30 As such, the broader cultural influences on surgical innovation can be seen well in those innovations developed in the GS, or in what have been described as “frugal innovations” that allow health care practitioners to do better than expected in settings of low resource levels.3,31, 32, 33 An important

Colonial forces in global surgery

The push for global surgery is mainly based on agendas set by countries in the GN7 and follows the trends of neocolonialism in being “unlike “naked colonialism,” insofar as influential actions strive to be “covert, because … acts of conquest are intentionally disguised.”54 Baked within such a dynamic is the “continued advantaging of the former colonizing nation at the expense of the formerly colonized nation.”54 These types of power dynamics can be quite encompassing, given that, despite the

Dismantling colonial trends

While adding sociocultural complexities to the evaluation of surgical innovations does provide a humbler understanding of them than the value-neutral methods of the GN, it’s incorrect to assume that this approach alone would garner trust from those in the GS. Action toward not only dismantling inequalities in global surgery but “advancing the political, economic, cultural and epistemic sovereignty of communities over their own care”5 will be paramount to gaining this trust. (I am intentionally

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

I respect that by writing this article I am responsible for contributing to the biased knowledge production of the GS from a privileged position in the GN.65 With this in mind, my goal in producing this article is to heed the advice of Qin et al. in that addressing inequities in global surgery “requires those in the Global North to be allies in dismantling power asymmetries.”5 That said, I strongly recommend that those from the GS be consulted for nuances that my article is inherently in need

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