Global advocacy in neurosurgery has emerged as a critical driver for improving access to safe, timely and affordable surgical care worldwide. Neurosurgical conditions, including trauma, congenital anomalies and neurological diseases, contribute substantially to global morbidity and mortality, particularly in the 75 low- and middle-income countries (LMIC) and low-income countries (LIC), as defined by the World Bank [1]. Despite this high burden, neurosurgical care remains unequally distributed, with stark disparities in workforce density, training opportunities, infrastructure and research capacity [ref]. In this context, global advocacy serves as both a moral imperative and a strategic mechanism for advancing health equity (SDG 3 – Good Health and Well-being) [3] and strengthening systems for innovation and infrastructure (SDG 9 – Industry, Innovation, and Infrastructure) [4].
Advocacy in neurosurgery takes many forms, spanning institutional, national and international levels. At its core, effective advocacy aims to raise awareness of neurosurgical disparities, mobilize resources, inform policy and foster sustainable partnerships. U.S.-affiliated institutions, for example, have increasingly contributed to global neurosurgery scholarship, generating evidence that highlights gaps in access, workforce distribution and infrastructure. Our recent work in bibliometric analyses demonstrate that U.S.-authored publications in global neurosurgery have grown steadily over the past decade, reflecting broader engagement in advocacy-oriented research, education and capacity-building initiatives. These outputs not only quantify disparities but also provide actionable insights for strategic investment and collaboration, informing both local stakeholders and international policy makers.
A key dimension of advocacy is addressing geographic inequities. Data indicates that scholarly engagement remains concentrated in a limited number of LMIC and LIC settings, with countries only a handful of the 75 LMIC/LIC countries represented. While focused partnerships enable deep collaboration and long-term capacity building, underrepresented regions risk being overlooked. Advocacy efforts, therefore, must highlight these inequities, encourage a more diversified distribution of partnerships and support the development of sustainable neurosurgical systems in underserved areas. Mechanisms for achieving this include consortia-based collaborations, targeted mentorship programs and initiatives that explicitly map and address gaps in geographic representation.
Thematic and subspecialty focus represents another critical advocacy lever. Pediatric neurosurgery and traumatic brain injury (TBI) dominate the global neurosurgery literature, reflecting both the high disease burden and philanthropic attention these areas attract. While these focus areas are justified by their immediate health impact, broader advocacy is needed to ensure other neurosurgical domains—such as cerebrovascular, functional and epilepsy surgery—receive attention and resources. Highlighting underrepresented subspecialties is essential for guiding policy, directing funding and building comprehensive neurosurgical capacity, thereby ensuring that advocacy promotes equitable health outcomes across the full spectrum of neurological disease.
Institutional leadership and research capacity are equally central to global advocacy. Analyses reveal that a small number of academic centers produce a disproportionate share of publications, often benefiting from established networks, dedicated global health divisions and access to funding streams. Advocacy at this level involves promoting cross-institutional collaboration, sharing mentorship resources and expanding funding opportunities for emerging programs. Such measures not only democratize scholarly engagement but also enhance research infrastructure, innovation and the translation of evidence into practice, aligning closely with SDG 9. Virtual platforms and networks have already demonstrated success in broadening participation, connecting institutions and amplifying collective advocacy efforts.
A further dimension of global neurosurgical advocacy lies in policy engagement and guideline development. Publications that quantify disparities, evaluate workforce distribution and assess system-level needs provide the evidence base for high-level advocacy targeting ministries of health, professional societies and international organizations. By presenting data on both needs and impact, neurosurgical advocacy can influence national surgical planning, resource allocation and the integration of neurosurgical services into broader health systems. These efforts are particularly crucial in LMIC and LIC, where policy guidance, funding and infrastructure investments are often limited.
Finally, global advocacy in neurosurgery is strengthened through reciprocal and cross-national collaborations. Partnerships with high-income countries, while not driven by capacity-building imperatives, contribute to knowledge exchange, multicenter research and the dissemination of best practices. Such collaborations enhance the scientific rigor of global neurosurgical research, accelerate innovation and inform policy and clinical guidelines worldwide. Advocacy that emphasizes these bidirectional benefits encourages HIC institutions to take a proactive, responsible role in supporting equitable neurosurgical development globally.
In essence, global advocacy in neurosurgery is multifaceted, spanning research, policy, education and partnership development. Effective advocacy leverages data to highlight disparities, mobilize resources, guide investments and build sustainable capacity. By strategically addressing geographic inequities, thematic gaps and institutional imbalances, neurosurgeons can advance health equity, strengthen research and infrastructure and promote a more resilient and inclusive global neurosurgical ecosystem. Furthermore, frameworks developed through U.S.-affiliated scholarship and other high-income countries can serve as models to assess the existing engagement, identify opportunities and contribute meaningfully to collaboration across the globe. Ultimately, sustained, evidence-based advocacy is essential for realizing the vision of universal access to safe, timely and affordable neurosurgical care.
References
- https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed December 19, 2025
- Neurosurgery and Global Health. Germano IM (Editor), Springer Nature 2022
Isabelle M. Germano, MD, MBA, FAANS, is a tenured professor of Neurosurgery, Neurology Oncological Sciences and Global health at the Icahn School of Medicine at Mount Sinai in New York City. She serves as director of the Comprehensive Brain Tumor Program at The Mount Sinai Hospital in New York City and Chair of the AANS Global Neurosurgery Committee (2023-2027) and immediate past-chair of the AANS/CNS Section on Tumor Chair (2022-2024).
