“Increased awareness of the place for surgery within global health will not only benefit the surgical community, but will improve health outcomes, strengthen health systems, and reduce health inequities and local and global scale.” – The Lancet (2014)
Global health addresses the needs of a community by evaluating the social, economic, political and environmental factors of each country and allocates resources accordingly. Medicine that falls under the umbrella ranges from infectious diseases, reproductive and maternal health, neonatal and child health.
However, surgery has often been excluded despite large proportion of morbidity and mortality directly resulting from preventable surgical conditions. To not have global surgery as one of the key components of global health has lead global inequity.
So why has global surgery been excluded all this time? To answer this question one has to look into the composition of surgery in general and realize the potential complexities within this field.
Defining global surgery follows the trend of the global health definition. It is not a geographical boundary but rather the scope of a problem, which drives greater insight and emphasis on a solution, which is not limited by political governance. However, it is a global problem and requires global input and shared responsibility and accountability. With this in mind, surgical care is delivered by a multidisciplinary approach, at times may not require the input of surgical intervention and sometimes can be effectively performed in the primary care setting. Examples of surgical issues hospital acquired infections, international organ trafficking, road safety, conflict displacement, natural disasters and post operative morbidity and mortality.
In order to facilitate the development of this new field, it is important to address barriers and outline key factors which fall under social, economical, financial and environmental determinants of health. This may include:
Awareness of surgical conditions among health care providers in developing and developed countries leading to early intervention
- Education to healthcare providers and patients, particularly in developing countries, with means to empower patients to prevent simple surgical conditions
- Resources to infrastructure to prevent accident injuries and deaths
- Safe and time effective management of surgical emergencies in well equipped hospital settings
- Adequate funding for staff and resources, particularly at high-density geographic population
- The inclusions of intensive care and simple post-operative recovery rooms
- Surgical supplies and education to patients for appropriate post operative management
Other areas include surgical primary care and administrative surgery. A belief, which has prevented the inclusion of surgery into global health, is the high cost associated with implementation of such a system. However, studies have shown that common surgical procedures can be delivered in cost-effective ways.
Global surgery is global health. It incorporates anaesthesia, perioperative care, emergency medicine, palliation, rehabilitation and obstetric and neonatal care. It values the involvement of a broad range of clinical experience and relies on collaboration. Defined by The Lancet as ‘an area of study, research, practice, and advocacy that seeks to improve health equity for all people who require surgical care, with a special emphasis on underserved populations and populations at risk’, global surgery is a key and necessary component of global health and greater awareness in required in order to incorporate it into global health.
Until next time.