Authors: John G Meara, Andrew J M Leather, Lars Hagander
Remarkable gains have been made in global health in the past 25 years, but progress has not been uniform. Mortality and morbidity from common conditions needing surgery have grown in the world’s poorest regions, both in real terms and relative to other health gains. 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. 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 Commission’s key findings show that the human and economic consequences of untreated surgical conditions in LMICs are large and for many years have gone unrecognised. During the past two decades, global health has focused on individual diseases. The development of integrated health services and health systems has been somewhat neglected. As such, surgical care has been afforded low priority in the world’s poorest regions. Our report presents a clear challenge to this approach. As a new era of global health begins in 2015, the focus should be on the development of broad-based health-systems solutions, and resources should be allocated accordingly. Surgical care has an incontrovertible, cross-cutting role in achievement of local and global health challenges. It is an important part of the solution to many diseases—for both old threats and new challenges—and a crucial component of a functional, responsive, and resilient health system. The health gains from scaling up surgical care in LMICs are great and the economic benefits substantial. They accrue across all disease-cause categories and at all stages of life, but especially benefit our youth and young adult populations. The provision of safe and affordable surgical and anaesthesia care when needed not only reduces premature death and disability, but also boosts welfare, economic productivity, capacity, and freedoms, contributing to long-term development. Our six core surgical indicators should be tracked and reported by all countries and global health organisations, such as the World Bank through the World Development Indicators, WHO through the Global Reference List of 100 Core Health Indicators, and entities tracking the SDGs.