This commentary on the special issue of Global Public Health on structural competency in global perspective asks: what is specific to the U.S. about structural competency, and what is its utility beyond the U.S., especially in the 'global south'? Why are biomedical practitioners the focus of U.S. structural competency? And what can U.S. structural competency advocates learn from the deep and rich social medicine traditions of Latin America? And is there anything that Latin American and other non-U.S. social medicine traditions might learn from U.S. structural competency? The commentary identifies the crucial insights from international comparisons include that racial justice movements are Social Medicine innovators in the U.S., that cultivating allies within biomedicine can enhance the impact of community health movements, and that cross-fertilising U.S. Structural Competency and social medicine traditions across regions should be a priority for the fields.