Global Surgery 2030: An introduction

Editor’s note: This introduction is based on the foreword to the report published in Surgery and The Lancet Global Health. This report is the second in a series of articles that The Lancet Commission on Global Surgery has submitted regarding its efforts. A progress report on the commission’s activities was published in the April issue of the Bulletin.

Following is an Executive Summary of The Lancet Commission on Global Surgery (LCoGS) report on global health care disparities. LCoGS’ vision is “universal access to safe, affordable surgical and anesthesia care when needed.”¹ At present, 5 billion people are unable to receive surgical interventions that could save lives or prevent disability.² In an era in which we discuss the dawn of personalized medicine and genetic engineering with frequency and familiarity, how can more than half the world’s population live in a health care time warp, trapping them centuries in the past without access to quality care?

As the Executive Summary reveals, disparities in global surgical care are due to inaccurate assumptions, competing priorities, and a lack of resolve. For years the public health community assumed that surgery was too costly and too complex, leading public health intelligentsia to concentrate on ostensibly more cost-effective interventions, including vaccines and infectious disease treatments—all of which are necessary but no more cost-effective than surgery.³ In addition, the surgical and anesthesia community lacked a cohesive resolve to reverse the marginalization of surgery.

Integration of surgery and anesthesia care is critical to achieving the emerging global health care goals of sustainable development and universal health coverage. Without immediate attention and scale-up, lack of surgical care will not only continue to result in preventable death and disability but will also lead to an estimated reduction of the gross domestic product of low- and middle-income countries by as much as 2 percent by 2030.⁴ This decrease will be crippling for fragile economies struggling to emerge from poverty and instability.

In January 2014, World Bank president Jim Yong Kim, MD, PhD, addressed these realities at the first Assembly of the LCoGS, stating that “surgery is an indivisible, indispensable part of health care.”⁵ Fortunately, Dr. Kim’s words landed on fertile ground, prepared by the hard work and dedication of numerous groups and individuals, including the thousands of frontline providers in LMICs. The year 2014 and early 2015 saw several worldwide events unfold that complemented and catalyzed the work of LCoGS. A World Health Assembly Resolution on essential surgery gained momentum with multi-country support; in January it was passed by the World Health Organization Executive Board and at press time was scheduled to go for a final vote in May.⁶ At the same time, 2015 has thus far marked a transition to a collection of health and development targets aimed broadly at poverty reduction, universal health care, and equity.

The initial LCoGS launch took place in London on April 27 and 28, in collaboration with the Royal Society of Medicine. The second launch followed shortly afterwards in Boston, MA, in May. These launches represent the culmination of more than two years of work by hundreds of people in more than 110 countries, four international meetings, and multiple regional events—all of which represents a broad, purposeful, and critical outreach effort.

The launch events in London and Boston signified the beginning of LCoGS’ education and advocacy efforts to highlight the pivotal role of surgical care in strengthening global health care systems. The formal commission report is only one part of the initial commission product. A dozen open-access, business-style teaching cases have been published to provide an educational framework focused on global surgery topics. In addition, 61 abstracts were presented at the launch in London and published in The Lancet. Numerous full-length articles are being published in The Lancet and in multiple other journals, highlighting the importance of international collaboration in combating surgery’s marginalization.

The following Executive Summary of LCoGS’ report on Global Surgery 2030 encapsulates the commission’s findings regarding the state of global surgical care and strategies for reversing decades of neglect. The authors maintain that the delivery of surgery and anesthesia care must be included by health care providers, policymakers, and funders as a central component of global health system improvement at the local level by local leaders with support from global partners. Only in this way will we be able to achieve health, welfare, and economic development for all.

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References

1. Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015. [Epub ahead of print.]
2. Raykar N, Alkire BC, Shrime MG, et al. Global access to surgical care: A modeling exercise. Lancet Glob Health. 2015. [Epub ahead of print.]
3. Chao TE, Sharma K, Mandigo M, et al. Cost-effectiveness of surgery and its policy implications for global health: A systematic review and analysis. Lancet Glob Health. 2014;2(6):e334-e345.
4. Alkire BC, Shrime MG, Dare AJ, Vincent JR, Meara JG. Global economic consequences of selected surgical diseases: A modelling study. Lancet Glob Health. 2015. [Epub ahead of print.]
5. Kim JY. Opening address at the inaugural meeting of The Lancet Commission on Global Surgery. First Meeting of The Lancet Commission on Global Surgery. January 17, 2014; Boston, MA. Available at: www.globalsurgery.info/video/. Accessed April 16, 2015.
6. World Health Organization. Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage. Report by the secretariat. November 28, 2014. Available at: http://apps.who.int/gb/ebwha/pdf_files/EB136/B136_27-en.pdf. Accessed April 16, 2015.