Global surgery: An integral and indivisible component of global health
Global surgery is a newly emerging field of global health which aims to provide safe and affordable surgical and anaesthesia care. Global surgery has been defined by Dare et al. as “an area of study, research, practice, and advocacy that seeks to improve health outcomes and achieve health equity for all people who need surgical and anaesthesia care, with a special emphasis on underserved populations and populations in crisis. It uses collaborative, cross-sectoral, and transnational approaches and is a synthesis of population-based strategies with individual surgical and anaesthesia care.” 
The global burden of disease which is amenable to surgical intervention, such as trauma, cancer, and complications from childbirth, is substantial and growing. Despite this, there remain gross disparities in access to safe surgical care worldwide and the concept of global surgery is still alien to many underserved countries with limited resources, especially those in austere environments and war zones. Surgery is an integral, indivisible component of a properly functioning healthcare system, and we have a collective responsibility to ensure people have access to safe, high-quality surgical and anaesthesia care, with financial protection if required .
Public awareness of the principles of global surgery has dramatically changed in the last few years, with recent attention on efforts to meet the global need for surgical care. In 2013, a group of healthcare professionals approached editors at The Lancet to discuss the neglected role of surgery in public health. The response was the establishment of The Lancet Commission on Global Surgery, commissioned to develop and assemble the best evidence on the state of surgery worldwide, to study the economics of surgical and anaesthesia care delivery and to develop strategies for improving access . The Commission is engaging experts across the global health community to define the best strategies for the provision of surgical care with a focus on low-income and middle-income health systems, while also recognising the major issues related to equitable delivery of high-quality surgical care in areas of conflict, disaster and in high-income settings .
In 2015, the Commission reported that 5 billion people worldwide lack access to safe, affordable surgical and anaesthesia care when they need it. This report estimated that a minimum of 143 million additional surgical procedures are needed each year to save lives and prevent disability. The global gap between surgical need and the equitable provision of safe surgical care is substantial. Low- and middle-income countries have the greatest burden of untreated surgical disease . The Commission has a plan to close the gap in global surgery provision between high-income countries and low to middle-income countries by delivering 5000 operations per 100,000 population by the year 2030. Significant progress has been made in global health in the last 25 years, but progress has not been uniform. Mortality and morbidity from common conditions requiring surgical intervention have grown in the world’s poorest regions. At the same time, development of safe, essential, life-saving surgical and anaesthesia care in low-income and middle-income countries has stagnated or regressed .
To learn more and become involved in global surgery please see the following resources (modified from Faith Robertson’s blog on the Association of Women Surgeons) :
- The Lancet Commission on Global Surgery: http://www.lancetglobalsurgery.org/ Twitter: @GSCommission
- Oxford Global Surgery Group (offers weekly seminars on global surgery and an annual course in global surgery): http://www.globalsurgery.ox.ac.uk/ Twitter: @Oxglobalsurg
- Harvard Global Surgery Group (Program in Global Surgery and Social Change) Twitter: @HarvardPGSSC
- InciSioN (A global surgery social networking group for students and trainees): http://www.incisionetwork.org/ Twitter: @StudentSurgNet
- Global Alliance for Surgical, Obstetric, Trauma, & Anaesthesia Care http://www.theg4alliance.org/ Twitter: @TheG4Alliance
- Lifebox (A start-up company working to ensure safer surgery through pulse-oximeters): http://www.lifebox.org/
- GlobalSurg (one of the largest research collaborative evaluating global surgery outcomes worldwide): http://globalsurg.org/ Twitter: @GlobalSurg
- Global PaedSurg (the largest collaborative research looking at surgical outcomes of congenital anomalies repair worldwide): http://globalpaedsurg.com/ Twitter: @GlobalPaedSurg
- Global Neurotrauma Outcomes Study (GNOS) (a collaborative research evaluating the surgical outcomes following traumatic brain injury worldwide) https://globalneurotrauma.com/ Twitter: @Global_neuro
- King’s College London, which offers a MSc in Global Health (with a specific track in Global Surgery): https://www.kcl.ac.uk/lsm/research/divisions/global-health/surgery/index.aspx
- The Global Surgical Frontiers conference by the Royal College of Surgeons of England (RCSEng):https://www.rcseng.ac.uk/about-the-rcs/international-affairs/gsf/
- Royal Society of Medicine – Global Surgery Summer School (two days condensed course is targeted at UK and international trainees and students) https://www.rcseng.ac.uk/news-and-events/events/calendar/global-surgery-summer-school/
- Royal College of Surgeons of Edinburg (RCSEd) Global Surgery Symposium:https://www.rcsed.ac.uk/professional-support-development-resources/learning-resources/video-lectures-and-resources/rcsed-global-surgery-symposium
- ASiT Global Surgery Award (An award for surgical trainees in the UK who are involved in global surgery): https://www.asit.org/resources/asit-global-surgery-award/res1158
- DCP3 – Disease Control Priorities, World Bank: http://dcp-3.org/surgery
About the Author
Dr. Osaid H. Alser is currently a Master by Research (MRes) student at the University of Oxford. He grew up and completed medical school and his internship in Gaza, Palestine. He is currently leading GlobalSurg II and III and Global PaedSurg international global research collaborative research projects in Palestine, evaluating the surgical outcomes worldwide. As a student, he conducted elective courses and clinical attachments in Oxford, Boston (Harvard University) and Minnesota. He aims to specialise in plastic and reconstructive surgery followed by a fellowship in trauma and acute care surgery, with the long-term aim of delivering safe and affordable surgery both in his country of Palestine and other war zones and austere environment.
- Dare AJ, Grimes CE, Gillies R, Greenberg SLM, Hagander L, Meara JG, et al. Global surgery: defining an emerging global health field. The Lancet. 2014;384(9961):2245-7.
- The Lancet Commission on Global Surgery [Internet]. Thelancet.com. 2018 [cited 1 November 2018]. Available from: http://www.thelancet.com/commissions/global-surgery
- Lancet Commission on Global Surgery [Internet]. Lancet Commission on Global Surgery. 2018 [cited 1November 2018]. Available from: http://www.lancetglobalsurgery.org/background
- Meara JG, Hagander L, Leather AJM. Surgery and global health: a <em>Lancet</em> Commission. The Lancet.383(9911):12-3.
- Farmer, P, Kim, J, and Basilico, M. Reimagining global health. An introduction. University of California Press, Berkeley; 2013
- Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet.386(9993):569-624.
- Association of Women Surgeons » Blog Archive » Global Surgery: An indivisible, indispensable part of health care [Internet]. Blog.womensurgeons.org. 2018 [cited 1 November 2018]. Available from: http://blog.womensurgeons.org/uncategorized/global-surgery/
Image Credit: Boston Children’s Hospital