GENEVA, Switzerland—The past 25 years are full of great achievements in global health, but some global health experts are asking why surgery has not been utilized more as an intervention.
Last August, the medical journal The Lancet reported that progress in global health has not been uniform, with death and illness in the world’s poorest countries increasing for common conditions needing surgery.
“At the same time, development of safe, essential, life-saving surgical and anaesthesia care in low-income and middle-income countries (LMICs) has stagnated or regressed,” the journal article states. “In the absence of surgical care, case-fatality rates are high for common, easily treatable conditions including appendicitis, hernia, fractures, obstructed labour, congenital anomalies, and breast and cervical cancer.”
The World Health Organization (WHO) says that the problem may lie with the rhetoric surrounding surgery. Below is a list of the four most common myths about surgery identified by WHO, followed by the reality of the situation.
- Myth: Surgery’s ability to lessen the global disease burden (GDB) is negligible.
Fact: Recent studies show that surgery can be used to treat up to one-third of the GDB. While many people believe surgery is limited by disease type or severity, WHO’s 2010 GDB study, showed surgery was prevalent in every single disease sub-category.
- Myth: The world simply does not have the capability to implement surgery as a viable solution.
Fact: While it is true that about 2 billion people worldwide do not have access to basic surgical care, programs implemented in the most impoverished regions of the world, such as Haiti and Mongolia, have successfully grown with minimal resources.
- Myth: Surgery is too expensive.
Fact: WHO figures show that surgical care in Africa is about the same price as measles inoculation. Furthermore, if the conditions that require surgery go untreated, the potential loss of output due to death and incapacitation is $20.7 trillion over the next 15 years. This loss significantly outweighs the cost of global scale-up, estimated to be $300 billion in the same time period.
- Myth: Surgery requires advanced health care systems.
Fact: Surgery can actually be the catalyst to improving health systems. Surgical infrastructure, anesthesia and a workforce are the building blocks to creating a long-lasting health care service.
Currently, the poorest third of the global population undergoes only 3.5 percent of the surgeries conducted each year. This is largely due to the fact that there is no single global funding organization that is dedicated solely to funding surgical implementation. Major donors also shy away from surgery because they do not see it as a major issue in global health.
While small-scale missions have been implemented on the ground, these are only short-term solutions. These missions typically only focus on immediate crisis relief, which is estimated at only 2 percent of the GDB for surgery.
Investment in health systems in low- and middle-income countries is needed to build long-lasting solutions. WHO and other international organizations recognize the need to work together with policy-makers and health care providers to give surgery the international attention it deserves. “Surgery can and should be recognized as an important global health intervention, ” a World Health Organization bulletin states. “To achieve this goal, it is critical to improve the local surgical capacity in low- and middle-income countries.”
Sources: The Lancet Global Health Journal 1, The Lancet Global Health Journal 2, The Lancet Global Health Journal 3, The Lancet Global Health Journal 4, The New York Times, Public Library of Science ONE, World Health Organization 1, World Health Organization 2
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