A Global Health Revolution: Expanding Access to Basic Care

SOCAP Global August 22, 2014

A Global Health Revolution: Expanding Access to Basic Care, Pt. 1–
The need for essential surgery to ensure healthy and vibrant communities worldwide

By: Myra Donnelley; @EniwareMyra
Company: Eniware; @Eniware

“Surgery is the neglected stepchild of global health.” ¹
 – Paul Farmer, Chairman of the Harvard Medical School Department of Global Health and Social Medicine and co-founder of Partners in Health
Essential Surgery

What is “essential surgery”?
Essential surgery refers to simple procedures that produce a big “bang for the buck” in regards to the death and disability that can be avoided without a large drain on limited resources. Generally, four basic types of surgeries are considered “essential”: 4
(a) injury care for lacerations/cuts, burns and broken bones to save lives and prevent disability
(b) emergency childbirth care including C-sections and repair of birth-related injuries to preserve maternal health and reduce maternal/neonatal mortality
(c) treatment of life-threatening abdominal conditions such as hernias and appendicitis
(d) procedures to correct or prevent disability including repair of birth defects such as cleft palate and clubfoot, removal of tumors and growths, and simple eye and ear surgeries to prevent blindness and deafness²
Surgery as a global public health “solution”
Access to basic surgical care is a human right and an economic necessity. Somewhere between 11 and 25% of the global burden of disease– more than twice the burden of HIV/Aids, Malaria and TB combined – is addressable by these simple, essential procedures. Likewise, “estimates of the disease burden addressable by vaccination are coincidentally similar to current estimates for surgery.”⁴ But while billions of dollars have been spent and laudable gains have been made in the field of global disease prevention through vaccination efforts, global support for surgical treatment of injury and disease has lagged far behind. Now, largely because of successful public health interventions, the global burden of infectious disease is shrinking and the burden of non-communicable disease (NCD) is growing. With surgical conditions comprising a significant proportion of NCDs and the global burden of NCDs growing year by year, access to basic surgical care is now more urgently “essential” than ever.
Access to essential surgery is Extremely Far Behind
In the 2008 Lancet article, “An Estimation of the Global Volume of Surgery”, the authors estimated that 234 million surgeries were performed annually. Of these 73.6% (more than 172 million procedures) were performed for the benefit of the richest third of the world’s population. Only 3.5% were estimated to benefit the poorest third of the world’s people. ³
But isn’t surgery expensive?
Recent studies have helped explode the widely-held, but mistaken belief that surgery is too expensive to be an effective global health strategy. A 2014 review of 26 studies measuring cost-effectiveness for seven categories of basic surgical interventions found that, “nearly all studies showed the same result: surgical interventions are cost-effective or very cost-effective.” For example, the cost-effectiveness of surgical circumcision (for HIV prevention) was similar to that of standard vaccinations and of bed-nets for malaria prevention, both widely regarded as low-cost, high return interventions. Likewise, the C-sections were found to be more cost-effective than multi-drug anti-retroviral treatment of HIV, a similarly well-regarded, public health intervention seen as money well-spent. The article concludes that “data from these studies lend support to the conclusion that a subset of surgical interventions compares very favourably (sic) to accepted health interventions in low-income and middle-income settings.”⁶
How can we make essential surgery more widely available?
Thank you for asking. We will answer that question in Part 2 of our blog under the SOCAP community discussion “Healthcare Innovators”: see “Eniware’s portable, power-free sterilization for medical instruments and other disruptive healthcare solutions igniting healthy and vibrant communities worldwide”

1.http://news.harvard.edu/gazette/story/2010/11/where-surgery-is-lacking/
2.http://www.ncbi.nlm.nih.gov/books/NBK11719/ Debas, Haile T. , Richard Gosselin, Colin McCord, and Amardeep Thindin, “Chapter 67 – Surgery”, Disease Control Priorities in Developing Countries. 2nd edition, Jamison DT, Breman JG, Measham AR, et al., editors. Washington (DC): World Bank; 2006.
3.http://www.thelancet.com/journals/lancet/article/PIIS0140673608608788/abstract Although published in 2008, global surgery figures are for 2004. In 2013, The Centers for Disease Control reported that 51.4 million inpatient surgeries were performed in the US alone. http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm This does not include outpatient, or ambulatory, surgeries; in 2006, the most recent statistical year available, there were reported to be 24.7 million of these outpatient procedures in the US. http://www.cdc.gov/media/pressrel/2009/r090128.htm
4.http://www.who.int/bulletin/volumes/86/8/07-050435/en/ Other experts estimate the global burden of disease treatable by surgery to be as high as 25%, making surgical conditions more than twice as economically and medically impactful globally as HIV/Aids, Malaria and TB combined. (see citation #6)
5.http://www.givewell.org/international/charities/vaccination-organizations
6.http://www.globalsurgery.info/wp-content/uploads/2014/01/Cost-Effectiveness.pdf
 

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