Global Surgery is a rapidly developing field with new discoveries, events and challenges emerging every day. The world is seeing major shifts in population dynamics, through dynamics in levels and trends of fertility, mortality, urbanization and migration. Age structure transitions are reshaping the requirements for investing in health and rights, and a host of related policy measures, and greater longevity presents major challenges in addressing issues related to health care access. In September 2015, the international community came together to agree on the Sustainable Development Goals (SDGs). These 17 goals are part of the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality.[i]
In that context, there is increasing need to acknowledge the linkage between universal delivery of and access to safe and affordable surgical care, global health and development. Critical to the achievement of the SDGs is the global realization of access to safe, affordable surgical and anesthesia care when needed. As a community of researchers, we feel that we have a collective responsibility and opportunity to contribute to global development, making the world more equitable and helping to reduce extreme poverty.
In 2008, Drs. Paul Farmer and Jim Yong Kim, President of the World Bank identified surgery as the "neglected stepchild of global health"[ii] referring to the relative underfunding and lack of priority accorded to surgical care.[iii] [iv] The landmark report by the Lancet Commission on Global Surgery (LCoGS) "Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare and Economic Development" estimated that between 28 and 32 percent of the global burden of disease requires surgical care or anaesthesia management, or both.[v] However, as many as five billion people of a total world population of 7.4 billion lack access to safe, timely, and affordable surgical care, a burden felt most severely in low- and middle-income countries (LMICs). Untreated, these conditions cause premature mortality and are a source of lifetime disability[vi] – surgical conditions claim an estimated 16.9 million lives per year.[vii]
The LCoGS estimates that an additional 143 million surgeries would be necessary every year to save lives and prevent disability from surgical conditions.[viii] Building surgical capacity is not just important for preventing morbidity and mortality—lack of access to surgery impedes human freedoms and impacts global development and economic growth. Without the growth of surgical systems, LMICs are estimated to sacrifice up to 2% of annual gross domestic product (GDP) growth by 2030.[ix] These losses correspond to 12.3 trillion US Dollars (USD) of lost economic output in LMICs alone.[x] Even when surgical care is available, however, it may not be financially accessible to the entire population: 33 million individuals face catastrophic expenditure due to the direct medical costs of surgery and anesthesia each year, with an additional 48 million facing catastrophic expenditure due to nonmedical costs such as travel.[xi] This burden falls most heavily on the poorest people in LMICs.
Surgical, obstetric, trauma, and anesthesia care has a crucial role to play in fulfilling the Sustainable Development Goals, and achieving Universal Health Coverage (UHC). If surgical systems do not provide universal access to surgery, they are incomplete. With the introduction of both a World Health Organization Resolution[xx] recognizing the importance of Surgical Care and Anesthesia as part of UHC and the SDGs, there has never been a more opportune time for members of the research community to join in supporting the integration of surgical care into the global agenda.[xxi]
[i] United Nations. Sustainable Development Goals (SDGs). Secondary Sustainable Development Goals (SDGs) 2015. http://www.undp.org/content/undp/en/home/sustainable-development-goals.html
[ii] Farmer PE, Kim JY. Surgery and global health: a view from beyond the OR. World journal of surgery 2008;32(4):533-6 doi: 10.1007/s00268-008-9525-9
[iii] Huber B. Finding surgery's place on the global health agenda. The Lancet 2015;385(9980):1821-22 doi: 10.1016/s0140-6736(15)60761-9
[iv] Shawar YR, Shiffman J, Spiegel DA. Generation of political priority for global surgery: a qualitative policy analysis. The Lancet Global Health 2015;3(8):e487-e95 doi: 10.1016/s2214-109x(15)00098-4
[v] Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet 2015;386(9993):569-624 doi: 10.1016/s0140 6736(15)60160-x
[vi] Huber B. Finding surgery's place on the global health agenda. The Lancet 2015;385(9980):1821-22 doi: 10.1016/s0140-6736(15)60761-9
[vii] Shrime MG, Bickler SW, Alkire BC, et al. Global burden of surgical disease: an estimation from the provider perspective. The Lancet Global health 2015;3 Suppl 2:S8-9 doi: 10.1016/S2214-109X(14)703845
[viii] Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet 2015;386(9993):569-624 doi: 10.1016/s0140-6736(15)60160-x
[ix] Alkire BC, Shrime MG, Dare AJ, et al. Global economic consequences of selected surgical diseases: a modelling study. The Lancet Global Health 2015;3:S21-S27 doi: 10.1016/s2214-109x(15)70088-4
[x] Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet 2015;386(9993):569-624 doi: 10.1016/s0140-6736(15)60160-x
[xi] Shrime MG, Dare AJ, Alkire BC, et al. Catastrophic expenditure to pay for surgery worldwide: a modelling study. The Lancet Global Health 2015;3:S38-S44 doi: 10.1016/s2214-109x(15)70085-9
[xii] Chao TE, Sharma K, Mandigo M, et al. Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. The Lancet Global Health 2014;2(6):e334-e45 doi:10.1016/s2214-109x(14)70213-x.
[xiii] Mock CN, Donkor P, Gawande A, et al. Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet 2015;385(9983):2209-19 doi: 10.1016/S0140 6736(15)60091-5
[xiv] Daar AS, Singer PA, Persad DL, et al. Grand challenges in chronic non-communicable diseases. Nature 2007;450(7169):494-6 doi: 10.1038/450494a
[xv] Costas-Chavarri A, Gillies R. Surgery for diabetes in low and middle-income countries. The Lancet Diabetes & endocrinology 2014;2(7):534-5 doi: 10.1016/S2213 8587(14)70053-1
[xvi] Munshi A, Gupta S, Anderson B, et al. Guidelines for locoregional therapy in primary breast cancer in developing countries: The results of an expert panel at the 8(th) Annual Women's Cancer Initiative – Tata Memorial Hospital (WCI-TMH) Conference. Indian journal of medical and paediatric oncology: official journal of Indian Society of Medical & Paediatric Oncology 2012;33(2):112-22 doi: 10.4103/0971-5851.99748
[xvii] Semer NB, Sullivan SR, Meara JG. Plastic surgery and global health: how plastic surgery impacts the global burden of surgical disease. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2010;63(8):1244-8 doi: 10.1016/j.bjps.2009.07.028
[xviii] McDonald HD, Vasconez LO. Advances in plastic surgery. The Western journal of medicine 1982;136(1):23-8
[xix] Kouo-Ngamby M, Dissak-Delon FN, Feldhaus I, et al. A cross-sectional survey of emergency and essential surgical care capacity among hospitals with high trauma burden in a Central African country. BMC health services research 2015;15(1):478 doi:10.1186/s12913-015-1147-y
[xx] World Health Organization Resolution http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R15-en.pdf
[xxi] http://www.theg4alliance.org/about-1-1-1-1