Chapter 49: Global Surgery

KEY POINTS

1. There are five major forces reshaping priorities and strat­egies for the globalization of surgical care:

   1. The epidemiologic transition of diseases

   2. The mobile nature of the world’s populations

   3. Ubiquitous information access

   4. A revolution for equity and human rights

   5. Recognition of the cost-effectiveness of surgical care

2. Understanding and addressing the necessary communication, energy and transportation technologies along with the underlying cultural context represent the foundation critical to implementing sustainable infrastructure necessary for appropriate surgical care.

3. The key components of the global surgery ecosystem include technology, education, community, healthcare, business, and multidisciplinary engagement between a variety of disciplines.

4. There has been a significant shift from communicable, maternal, neonatal, and nutritional causes to noncommunicable causes, many of which require surgical care.

5. Patients and their communities in low-middle income countries (LMICs) bear a much greater share of the burden of cancer than high-income countries.

6. Globally, trauma has become a leading cause of death and disability; 90% of trauma deaths occur in LMICs.

7. The burden of disease is greatest in areas where human resources—physicians, nurses, pharmacists, and other healthcare workers—are the least.

8. Surgery is gaining an increasingly recognized role for improving public health.

9. Surgery has a role in prevention as well as treatment.

10. The cost-effectiveness of various aspects of surgical care has allowed surgical initiatives to be included when prioritizing public health initiatives.

11. Developing advanced surgical capabilities in resource-poor countries has the potential to decrease overall cost and actually develop the infrastructure necessary to entice physicians and other healthcare workers to remain in their own countries.

12. Academic involvement in global surgery provides training for the next generation of surgical leaders.

13. Surgical innovations that consider cost as well as quality and design for challenging energy environments will foster equity in surgical care for LMICs.

INTRODUCTION

Modern surgery can save lives, help expand economies, and offer hope to individuals and communities. Prior to the acceptance and availability of aseptic technique to prevent or decrease infections, and improved anesthesia for controlling pain, surgery as a specialty was held in very low esteem. Over the last 100 years, surgery has developed into an elite discipline that not only provides opportunities for curing certain diseases, but fulfills a special role in preventing and mitigating disability.

Yet, surgery is currently unavailable to most people worldwide. The vast majority—90%—of the world’s population receives only 10% of the surgical care delivered. Said another way, 90% of the world’s surgical resources are consumed by the most privileged 10% of the world’s population. More than 2 billion people lack access to even basic surgical care.¹ Very few surgical procedures occur in countries spending less than US $100/ person on health care per year compared to countries spending greater than U.S. $1000/ person (Fig. 49-1).²