The Lancet Commission on Global Surgery
Modest estimates show that at least 2 billion people worldwide lack access even to basic surgical care. Out of the roughly 250 million operations performed each year, only 3,5% are performed on the poorest 1/3 of the world’s population.
Another low estimate holds that 11-15 % of the world’s disability is due to surgically treatable conditions. Injuries alone cause 5.7 million deaths yearly, much more than the 3.8 million deaths caused by malaria, HIV/AIDS and tuberculosis taken together. Many of these fatal injuries could have been treated by basic surgery, if it were available.
Other prominent conditions that demand surgical treatment are cancer, congenital anomalies such as club foot and cleft lip, cataract and obstetric complications. It is apparent that surgery has a crucial role to play in achieving universal health coverage (including the United Nations Millenium Development Goals, a set of goals set by the UN in 2000 to be fulfilled by 2015). Surgery is essential for good maternal and child health, and lack of treatment puts a significant economic burden on the millions that cannot work or function due to conditions for which the treatment has been known for decades.
Surgical treatment has recently been identified as a cost effective intervention in resource-poor settings, in level with vaccination programs and 10-15 times more so than antiretroviral medication for HIV. This is not to say that surgery is any more important than other types of treatment, but certainly as important as other global health priorities.
Various solutions have been suggested to address the lack of surgery for a vast part of the global population. Training more surgeons and trying to incentivize them to stay in underserved regions – often rural regions of a wide range of countries, from Malawi to Canada – is one method. Surgical missions is another, that has existed for many decades. Recently, however, focus has shifted toward strengthening national health systems, in part through sustainable, global partnerships between surgeons, hospitals and institutions. The goal is to achieve an equitable distribution of treatment options, and to integrate different aspects of health care, from prevention and primary care to antibiotics and surgery. Interest in this endeavor is growing among researchers, clinicians, politicians, trainees and students in all parts of the world.