Although full provision of essential surgical procedures would avert about 1.5 million deaths a year, or about 6 to 7 percent of all avertable deaths in low- and middle-income countries, as Paul Farmer said in a recent blog for The World Bank, “For far too long, the global health movement has failed to count surgery as an integral part of public health. Prevailing wisdom dictated that the surgical disease burden was too low, surgical expenses too high, and delivery of care too complicated.”
That thought has been turned on its head with the launch of the essential surgery chapter of the new Disease Control Priorities, Volume 3, released this March at the Consortium of Universities from Global Health (CUGH) conference in Boston.
The Disease Control Priorities Network (DCP) was funded in 2009 by the Bill & Melinda Gates Foundation as an ongoing project that aims to determine priorities for disease control across the world, in an effort to relieve health disparities worldwide. DCP is a seven-year project managed by the University of Washington’s Department of Global Health (UW-DGH) and the Institute of Health Metrics and Evaluation (IHME). UW-DGH leads and coordinates two key components to promote and support the use of economic evaluation for priority setting at both global and national levels.
The DCP has produced two editions (1993 and 2006) published for The World Bank by Oxford University Press, and this first chapter of a third edition is now available. The chapter on surgery was edited by a stellar group of international names including Haile Debas, Peter Donkor, Atul Gawande, Dean Jamison, Margaret Kruk, and Charles Mock.
This paradigm-shift decision to include surgery in a disease priorities volume helps to dispel the myth about surgery’s role in global health. Often thought of as not only non-essential, but a luxury, the cost of minor surgery has never been figured into basic health care costs and has not been part of the scheme in provision of universal health care packages. Studies have now documented the very large health burden from conditions that are primarily or extensively treatable by surgery and show that surgical procedures rank among the most cost-effective of all health interventions.
At the launch, Atul Gawande posited that one of the basic needs of feeling secure is to have a well-equipped, functioning surgical center at least accessible. He pointed out that although this may not be a conscious thought, it is a main consideration, nonetheless. This brings the global situation local—possibly a rural U.S. area without proper facilities. Simple treatment at the point of injury can prove essential in controlling costs and preventing larger health burdens down the road.
Paul Farmer has been quoted as saying global surgery is one of the most exciting frontiers in the quest for global health equity. Certainly, this chapter headed up by UC San Francisco’s Global Health Sciences’ founding director, Haile Debas, will help to put this issue at the forefront of consideration in looking at health care costs and potential ways to increase savings and efficiency.
Investing in health now for our future generations is the easiest and most cost-efficient way to build strong communities and promote health equity for all.
Robert Mansfield is the communications coordinator and social media manager for Global Health Sciences (GHS) at the University of California, San Francisco. GHS has been at the forefront of global health activities for the past 10 years, incubating the Consortium of Universities for Global Health (CUGH) and establishing the UC system-wide Global Health Institute, bringing together the power of the 10 campuses of the University of California to improve health and reduce the burden of disease in the world’s most vulnerable populations. Robert has a BA in Urban Studies from San Francisco State University and a Master of Science in Health Communication from Boston University.