surgery & global health

7/29/2019 Surgery & Global Health

1/11

Surgery as a Global Health Issue:

General Approach

Antonio Carvajal, MD, SGH.

Chief Executive OfficerCarvajal-Klein Foundation


2/11

Overview

Global health community has recently recognizedthat surgical conditions form a significant burdenof disease and have cost-effective interventions.

A surgical condition is one that requires suture,incision, excision, manipulation, or other invasiveprocedures that usually require anesthesia.

Surgical interventions play a major role in helpingto prevent death and chronic disability.


3/11

Population Disease Burden

Surgery is at the end of thespectrum of the classic curativemedical model and, as such, has notbeen routinely considered as part ofthe traditional public health model.However, no matter how successful

prevention strategies are, surgicalconditions will always account for asignificant portion of a populationsdisease burden, particularly indeveloping countries whereconservative treatment is not readilyavailable, where the incidence oftrauma and obstetrical complicationsis high, and where there is a hugebacklog of untreated surgicaldiseases. (Debas, H. et al. 2010)


4/11

UN Millennium Development Goals

Increasing access to surgery, and improving the quality ofsurgical interventions, may also help to achieve many of the2015 United Nations Millennium Development goals. Reducing child mortality (Goal 4)

Improving maternal health (Goal 5) by treating obstetricalcomplications.

Tackling infectious diseases, including HIV through malecircumcision.

Halving the number of people living in poverty (Goal 1) sincesurgical conditions often put people out of work.

For example, a survey in Pakistan found that blindness, mostcommonly due to cataract, was associated with poverty. (PLoSMedicine Editors, 2010)


5/11

road traffic accidents, falls,

burns, disasters, domestic

violence, pregnancy

related complications,

infections and congenital

defects

Surgical

Services

Basic Human

Rights to Health

Global Burden

(Low and Middle Income

countries)


6/11

Surgical Care, Expensive?

Most organizationspreferentially fund programstargeting infectious diseases,despite increasing evidencethat charts the vast globalburden of surgical conditionsand the fact that relativelysimple, cost-effective andcurative surgical procedurescan avert disability and

premature death from manylife-threatening emergenciesand other conditions.(McQueen et al., 2010)


7/11

Cost of Surgical Burden

For instance, the estimated cost of surgical DALY(disability adjusted life years) gained at a districthospital in Africa ranges from $19 to $102. In

comparison, antiretroviral therapy for HIVinfection is estimated to be $350-$1,494 per DALYaverted. (Luboga, S. 2009)

Existing data suggests that many surgicalinterventions would decrease burden at lowcost.(McQueen et al., 2010)


8/11

WHO: Global Initiative for Emergency

and Essential Surgical Care

In 2005, the WHO established the GIEESC, which strivesto strengthen the capacity to deliver effectiveemergency surgical care, as well as reduce death anddisability from road traffic accidents, trauma, burns,

pregnancy related complications and other disasters.

In 2007, experts in surgery, anesthesia, health policyand epidemiology came together to form the Bellagio

Essential Surgery Group. The group encouragessurgeons to participate in advocacy and education andto partner with public health professionals.


9/11

Partners in Health PIH

In 1996, Partners in Health helped fund and build anoperating room in Haiti, and with the help of Haitiandoctors, the organization has developed a surgical caresystem at their partner hospital, Zanmi Lasante. (PLoSMedicine Editors, 2010)

public health specialists now recognize not only that surgeryhas a preventive role, but also that surgical treatment providedin low-tech community hospitals is cost-effective.(Debas, H.2010)

Public health workers have also recognized that access toessential surgery should exist within the right to health.


10/11

Conclusion

Surgical care has an essential role in global

public health.

Not recognizing its protagonism will ensure

that the morbidity and mortality endured by

millions of people in poor countries unable to

access surgical care will continue to remain

invisible to the rest of the world.


11/11

References

1. Ozgediz, D., Jamison, D., Cherian, M., and McQueen, K. The burden of surgical conditions andaccess to surgical care in low- and middle-income countries. Bulletin of the World HealthOrganization. 86.8 (2008): 577-656. Accessed on 1 November 2010.http://www.who.int/bulletin/volumes/86/8/07-050435/en/

2. PLoS Medicine Editors, A Crucial Role For Surgery in Reaching the UN Millennium DevelopmentGoals. PLoS Medicine. 5.8 (2008): 1165-1167. Accessed on 29 October 2010.

3. Debas, H., Gosselin, R., McCord, C., Thind, A. Surgery. InDisease Control Priorities in DevelopingCountries. (Washington, D.C.: World Bank, 2006). Accessed on 27 October 2010.

surgery & global health

Documents