Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Quid Pro Quo? A Critical Perspective on the Global Flow and Spread of Health Innovation 1 4 4802 10.34172/ijhpm.9151 EN Russell Mannion Health Services Management Centre, University of Birmingham, Birmingham, UK 0000-0002-0680-8049 Ewen Speed School of Health and Social Care, University of Essex, Colchester, UK 0000-0002-3850-922X Journal Article 2025 04 14 Over recent decades, the exchange of health innovations between high-income countries (HICs) and low- and middle-income countries (LMICs) has grown significantly. Three main types of cross-border flows characterise this global health innovation ecosystem: (i) trickle-down innovation – where innovations originating in HICs gradually diffuse to LMICs, (ii) reverse innovation, where new solutions originating in LMICs are adopted and adapted in HICs, and (iii) reciprocal innovation – where the focus is on bidirectional exchange and learning between HICs and LMICs. Despite embracing multidirectional flows, the contemporary global health innovation ecosystem is fundamentally shaped by neocolonial power imbalances that prevent LMICs from fully benefiting. These dynamics are further intensified by recent cuts to foreign aid and the rise of philanthrocapitalism, both of which concentrate power and influence in HICs. Viewing health innovation through a neocolonial lens reveals how the current innovation ecosystem reinforces historical patterns of dependency and domination in global health.

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