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Billions lack surgical care; report calls for change

In this country, we take it for granted that we will have access to needed surgeries, whether it's the repair of a broken leg or an operation to remove an infected appendix or a malignant tumor. But for as many as 5 billion people – or two-thirds of the world's population - these basic procedures are out of reach.

A major new report by the Lancet Commission sheds light on this enormous surgery gap and argues that building surgical infrastructure in low- and middle-income countries is critical both from an economic, as well as a human, perspective.

"Surgery hasn’t been part of the dialogue with respect to health system strengthening. It’s been a hugely neglected item,” said Stanford trauma surgeon Thomas Weiser, MD, who contributed to the 58-page report. The commission includes 25 leading experts from the fields of surgery and anesthesia, with contributions from more than 110 countries.

In its report, the commission notes that in 2010, nearly one-third of all deaths (16.9 million) were attributable to conditions readily treated by surgery, such as appendicitis, hernia, fractures, obstructed labor, congenital abnormalities and breast and cervical cancer. That is more than the number of deaths from HIV/AIDS, tuberculosis and malaria combined. And although there have been many gains in global health in the last 25 years, the quality and availability of surgical services in many regions have stagnated or declined, while the demand for surgery continues to rise.

“The global community cannot continue to ignore this problem – millions of people are already dying unnecessarily, and the need for equitable and affordable access to surgical services is projected to increase in the coming decades, as many of the worst affected countries face rising rates of cancer, cardiovascular disease and road accidents,” said Lars Hagander, MD, of Lund University in Sweden and one of the lead authors.

Weiser and his colleagues provide new estimates of the global shortfall, calculating that some 143 million additional surgeries are needed to save lives and prevent disability, with the largest number of neglected patients living in South Asia (57.8 million), East Asia (27.9 million) and southern sub-Saharan Africa (18.9 million).

They argue that investing in surgical services in these regions is cost-effective, saving money over the long haul while contributing to economic growth and development. In countries where access to surgery is weakest, an investment of $420 billion could bring services up to acceptable levels by 2030. Without those resources, low- and middle-income countries will suffer a cumulative loss of more than $12 trillion between 2015 and 2030 due to lost productivity and costs related to health care and long-term disability, they calculate.

Take, for example, the case of the working man whose limb is injured in a traffic accident – an unfortunately common occurrence in the developing world, Weiser notes. In the absence of surgical care, he becomes disabled, losing the income on which many other family members may depend. So instead of being a productive member of society, he becomes an economic burden to his family and to the health care system.

Weiser says he hopes the report will provide a springboard for action by governments in low- and middle-income countries, as well as private organizations, to step up their commitments to building surgical infrastructure.

“I suspect the idea of surgical care will gain increased attention and that will help drive funding for investment,” he said.

Previously: Stanford general surgeon discusses the importance of surgery in global health care, Global health expert: Economic growth provides opportunity to close the "global health gap" and A brief look at the global anesthesia crisis in developing countries
Video from TheLancetTV

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