In an editorial in this week's PLoS Medicine, the journal's editors outline five key reasons why providing basic surgical services universally should be considered a global public health priority:
- Surgical conditions—defined as conditions that require suture, incision, excision, manipulation or other invasive procedures, usually under anesthesia—make up a substantial proportion of the world's burden of disease (11% according to one estimate).
- The developing world suffers from a shortage of surgeons and surgical services, even though it suffers more surgical disease.
- Providing surgery can be remarkably cost effective when compared with interventions that are considered the "building blocks" of global public health (e.g. childhood vaccination).
- Building surgical services, which requires infrastructure, supplies, and human resources, may in turn help to build health systems and to strengthen primary care.
- Despite considerable hurdles, particularly the human resources crisis in sub-Saharan Africa, it is feasible to deliver surgical services even in the most resource-constrained settings.
The editors are encouraged by the fact that surgeons and public health professionals are now coming together to build a movement to promote surgery as a crucial tool in improving global public health.
"How can this movement now bring donors on board," they ask "given that they have so far shown little willingness to fund programs outside the traditional purview of public health?" One strategy that might help to persuade donors, they say, is to argue that surgery could play an essential role in meeting many of the 2015 United Nations Millennium Development Goals (http://www.un.org/millenniumgoals/), a development blueprint agreed to by all the world's countries and all the leading development institutions.
For example, trauma care, obstetric surgery, and general surgical services are essential components in reaching goal 4 (reducing child mortality) and goal 5 (improving maternal health). Surgery can even play a role in tackling infectious diseases (goal 6), since male circumcision can reduce the risk of men acquiring HIV through heterosexual sex by 60%.
- The PLoS Medicine Editors. A Crucial Role for Surgery in Reaching the UN Millennium Development Goals. PLoS Medicine, 2008; 5(8): e182 DOI: 10.1371/journal.pmed.0050182
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