Global Surgery
Each year approximately 17 million people die as a result of surgically treatable conditions.
Each year approximately 17 million people die as a result of surgically treatable conditions. Millions more suffer from surgically preventable disabilities.[1] Currently only 6% of all surgical procedures benefit the poorest third of the world’s population.[1] Lack of access to surgical and anesthesia care perpetuates poverty, inequality, and economic instability.
Surgical conditions represent nearly one-third of global burden of disease and are a leading cause of death and disability.[2] These conditions include maternal health and obstetric conditions; cancer and other noncommunicable diseases (NCDs); injuries; infectious diseases; and congenital issues.
Approximately 5 billion people around the world lack access to safe, timely, and affordable surgical care. Untreated surgical conditions have a devastating economic effect on communities and countries. Without investment in surgical care, estimates show that low- and middle-income countries (LMICs) could lose $12.3 trillion in GDP by 2030.[1]
Improving access to surgical care is a cost-effective investment that advances U.S. global health priorities and assists countries in achieving self-reliant, sustainable health systems. The World Bank identifies essential surgical care as one of the most cost-effective health interventions.[3] For every $1 invested in surgical capacity, an estimated $10 is generated in improved health and productivity.[4]
At least 1 million additional specialists are needed to meet demand for surgical, anesthesia, and obstetric care in LMICs. This shortfall is expected to more than double by 2030. Additional investment in frontline health workers is also needed to safely deliver care provided by surgical teams.[1]
RECOMMENDATIONS FOR CONGRESS
Approve and commit funding for Senate explanatory language on Neglected Surgical Conditions in the 2021 State, Foreign Operations, and Related Programs appropriations bill for the U.S. Agency for International Development (USAID), inclusive of the broad range of surgical conditions, and supporting health system strengthening through development and implementation of national surgical, obstetric, trauma, and anesthesia plans (NSOTAPs).[5]
Hold U.S. government agencies accountable for surgical systems strengthening, integrating surgical care into foreign assistance and global health investments, to achieve progress on health priorities, including preventable maternal and child deaths, HIV/AIDS, nutrition and food security, NCDs, global health security, health systems strengthening, and economic stability.
Affirm the U.S. government’s continued membership in the World Health Organization (WHO) and 2015 commitment to strengthening emergency and essential surgical and anesthesia care in World Health Assembly Resolution 68.15. Support WHO-recommended biannual progress reporting and national and regional data collection; appointment of leadership to WHO technical unit for surgical care, the Global Initiative for Emergency and Essential Surgical Care (GIEESC); and establishment of a coordinated funding mechanism for NSOTAPs in LMICs.[6]
Call for a special advisory committee, bringing together experts from the private and public sectors to integrate surgical care within existing programs at the Department of State, USAID, Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH).
Affirm policies that strengthen health workforces to achieve global health goals as outlined in the Frontline Health Workers brief in the Global Health Briefing Book.
Photo Credit: Jeffery Davis for ReSurge -JonasPostSurgery w Dad
Photo Credit: Jeffery Davis for ReSurge – Bangladesh
WHY THIS INVESTMENT IS IMPORTANT
Surgical care is a public health priority, critical for strengthening health systems, health security, and the global economy; for advancing maternal and child health; and for treating NCDs, trauma, infectious diseases, and congenital issues.
The World Bank identifies essential surgical care as one of the most cost-effective health interventions, and it is achievable without the need for additional research or new technological developments.
The cost of inaction is too great. Without investment in surgical systems, LMICs face dramatically reduced GDP.[1] Every year, as many as 81 million people risk catastrophic health expenditure from seeking life-saving surgery,[3] burdened by out-of-pocket costs and expenses from traveling long distances or missing work. This disparity is not limited to LMICs, with recent data showing 7 out of 10 uninsured trauma patients in the U.S. at risk of catastrophic health expenditure.[7]
Surgery is essential for resilient health systems and primary health care. Health targets for maternal and child health, health workforces, NCDs, and health systems strengthening cannot be achieved without access to safe, timely, and affordable surgical care. Surgical care is a cross-cutting preventive, diagnostic, and curative strategy for nearly all disease causes.[1] Increasing access to surgical care contributes to global health security by bolstering critical care capacity (including adaptive facilities, workforce, processes, and supply chains), stimulating economic growth, and fostering national and regional stability.
Surgical interventions have transformative impacts for families and communities. With surgical care, a traffic-accident victim can return to work; a child with a repaired cleft can attend school; and a woman can survive complicated childbirth. Integrating surgical care into health systems is a proven, cost-effective strategy that will save millions of lives each year, contribute to economic growth, equality, and poverty alleviation, and bridge the care gap for the poorest billion.[8]
GLOBAL SURGERY AND COVID-19
In May 2020, it was estimated that 28 million surgeries would be postponed around the world during the peak of the COVID-19 pandemic. These estimates included 38 percent of cancer surgeries and 25 percent of elective caesarean sections.[9]
Yet, surgical systems have proven to be essential for the COVID-19 response.[10] Operating rooms, anesthesia equipment, supplies and protocols for infection control, and provider skills have been repurposed for critical care, especially in LMICs.[11] The versatility of surgical systems allows for investment in surgical care capacity to serve simultaneously as investment in health security for future crisis response.
RESOURCES
- The Lancet Commission on Global Surgery http://bit.ly/2QYNQae
- Disease Control Priorities Third Edition: Essential Surgery http://bit.ly/2zwndmE
- Resources for National Surgical Systems Strengthening, The G4 Alliance http://bit.ly/2IgdDXv
CONTRIBUTORS
Natalie Sheneman, G4 Alliance, natalie.sheneman@theg4alliance.org
Matt Hey, G4 Alliance, Herbert Wertheim College of Medicine, mhey001@med.fiu.edu
Laura Hoemeke, G4 Alliance, laura@hoemeke-global.com
HEADER PHOTO CREDIT Jeffery Davis for ReSurge- Bangladesh
[1] Meara, John and Andrew Leather, et al. “Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development,” The Lancet. August 2015; 386(9993):569-624. http://bit.ly/2KhdxQx.
[2] Shrime, Mark and Stephen Bickler, et al. “Global burden of surgical disease: an estimation from the provider perspective,” The Lancet Global Health, April 2015; 3(2):S8-S9. http://bit.ly/2DvTkFi.
[3] Mock, Charles and Peter Donkor, et al. “Essential surgery: key messages from Disease Control Priorities, 3rd edition,” The Lancet, February 2015; 385(9983):2209-2219. http://bit.ly/2OSjdB6.
[4] “A New Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development,” United Nations, 2013. http://bit.ly/2KhTrWv.
[5] Explanatory Statement for Department of State, Foreign Operations, and Related Programs Appropriations Bill, 2021, 116th Cong (2021). https://bit.ly/2KstM1e.
[6] Haider, Adil and John Scott, et al. “Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance),” World Journal of Surgery, October 2017; 41(10):2426-2434. http://bit.ly/2Dv2Ubv.
[7] Scott JW, Raykar NP, Rose JA, et al. Cured into Destitution: Catastrophic Health Expenditure Risk Among Uninsured Trauma Patients in the United States. Ann Surg. 2018;267(6):1093-1099. doi:10.1097/SLA.0000000000002254
[8] Bukhman G, Mocumbi AO, Atun R, et al. The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion. Lancet. 2020;396(10256):991-1044. doi:10.1016/S0140-6736(20)31907-3
[9] COVIDSurg Collaborative. “Elective surgery cancellations due to the COVID‐19 pandemic: global predictive modelling to inform surgical recovery plans.” British Journal of Surgery, May 2020; 107(11):1440-1449. https://bit.ly/3dhRuaY.
[10] Park, Kee. To Prepare for Pandemics, Invest in Surgical Care. globalhealthnow.org. https://www.globalhealthnow.org/2020-09/prepare-pandemics-invest-surgical-care?utm_source=Global+Health+NOW+Main+List&utm_campaign=86213f94b0-EMAIL_CAMPAIGN_2020_09_11_02_03&utm_medium=email&utm_term=0_8d0d062dbd-86213f94b0-2813813. Published September 14, 2020. Accessed October 12, 2020. https://bit.ly/30YWdsZ.
[11] Singhal, Shubham and Finn, Patrick, et al. Critical care capacity: The number to watch during the battle of COVID-19. McKinsey & Company. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/critical-care-capacity-the-number-to-watch-during-the-battle-of-covid-19# Published March 30, 2020. Accessed October 12, 2020. https://mck.co/3jTCD9c.