Editing Surgery (section)

==Global surgery==
Global surgery has been defined as 'the [[multidisciplinary]] enterprise of providing improved and equitable surgical care to the world's population, with its core belief as the issues of need, access and quality".<ref>{{cite journal | vauthors = Bath M, Bashford T, Fitzgerald JE | title = What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health | journal = BMJ Global Health | volume = 4 | issue = 5 | pages = e001808 | year = 2019 | pmid = 31749997 | pmc = 6830053 | doi = 10.1136/bmjgh-2019-001808 }}</ref> [[Halfdan T. Mahler]], the 3rd Director-General of [[World Health Organization|the World Health Organization (WHO)]], first brought attention to the disparities in surgery and surgical care in 1980 when he stated in his address to the World Congress of the International College of Surgeons, "'the vast majority of the world's population has no access whatsoever to skilled surgical care and little is being done to find a solution.As such, surgical care globally has been described as the 'neglected stepchild of global health,' a term coined by [[Paul Farmer]] to highlight the urgent need for further work in this area.<ref>{{cite journal | vauthors = Farmer PE, Kim JY | title = Surgery and global health: a view from beyond the OR | journal = World Journal of Surgery | volume = 32 | issue = 4 | pages = 533–536 | date = April 2008 | pmid = 18311574 | pmc = 2267857 | doi = 10.1007/s00268-008-9525-9 }}</ref> Furthermore, [[Jim Yong Kim|Jim Young Kim]], the former President of the [[World Bank]], proclaimed in 2014 that "surgery is an indivisible, indispensable part of health care and of progress towards universal health coverage."<ref>{{cite journal | vauthors = Dare AJ, Grimes CE, Gillies R, Greenberg SL, Hagander L, Meara JG, Leather AJ | title = Global surgery: defining an emerging global health field | journal = Lancet | volume = 384 | issue = 9961 | pages = 2245–2247 | date = December 2014 | pmid = 24853601 | doi = 10.1016/S0140-6736(14)60237-3 | s2cid = 37349469 }}</ref>

In 2015, the Lancet Commission on Global Surgery (LCoGS) published the landmark report titled "Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development", describing the large, pre-existing burden of surgical diseases in low- and middle-income countries (LMICs) and future directions for increasing universal access to safe surgery by the year 2030.<ref name=":2">{{cite journal | vauthors = Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W | title = Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development | journal = Lancet | volume = 386 | issue = 9993 | pages = 569–624 | date = August 2015 | pmid = 25924834 | doi = 10.1016/S0140-6736(15)60160-X | s2cid = 2048403 | doi-access = free }}</ref> The Commission highlighted that about 5 billion people lack access to safe and affordable surgical and anesthesia care and 143 million additional procedures were needed every year to prevent further [[morbidity]] and [[Mortality rate|mortality]] from treatable surgical conditions as well as a $12.3 trillion loss in economic productivity by the year 2030.<ref name=":2" /> This was especially true in the poorest countries, which account for over one-third of the population but only 3.5% of all surgeries that occur worldwide.<ref>{{cite journal | vauthors = Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA | title = An estimation of the global volume of surgery: a modelling strategy based on available data | language = English | journal = Lancet | volume = 372 | issue = 9633 | pages = 139–144 | date = July 2008 | pmid = 18582931 | doi = 10.1016/S0140-6736(08)60878-8 | s2cid = 17918156 }}</ref> It emphasized the need to significantly improve the capacity for Bellwether procedures – [[laparotomy]], [[caesarean section]], [[Open fracture|open fracture care]] – which are considered a minimum level of care that first-level hospitals should be able to provide in order to capture the most basic emergency surgical care.<ref name=":2" /><ref>{{cite journal | vauthors = O'Neill KM, Greenberg SL, Cherian M, Gillies RD, Daniels KM, Roy N, Raykar NP, Riesel JN, Spiegel D, Watters DA, Gruen RL | title = Bellwether Procedures for Monitoring and Planning Essential Surgical Care in Low- and Middle-Income Countries: Caesarean Delivery, Laparotomy, and Treatment of Open Fractures | journal = World Journal of Surgery | volume = 40 | issue = 11 | pages = 2611–2619 | date = November 2016 | pmid = 27351714 | doi = 10.1007/s00268-016-3614-y | publisher = Springer Science and Business Media LLC | s2cid = 12830913 }}</ref> In terms of the financial impact on the patients, the lack of adequate surgical and anesthesia care has resulted in 33 million individuals every year facing catastrophic health expenditure – the out-of-pocket healthcare cost exceeding 40% of a given household's income.<ref name=":2" /><ref>{{cite journal | vauthors = Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ | title = Household catastrophic health expenditure: a multicountry analysis | journal = Lancet | volume = 362 | issue = 9378 | pages = 111–117 | date = July 2003 | pmid = 12867110 | doi = 10.1016/S0140-6736(03)13861-5 | s2cid = 2052830 }}</ref>

In alignment with the LCoGS call for action, the [[World Health Assembly]] adopted the resolution WHA68.15 in 2015 that stated, "Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage."<ref name="World Health Assembly Resolution WH">{{cite journal | vauthors = Price R, Makasa E, Hollands M | title = World Health Assembly Resolution WHA68.15: "Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage"—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services | journal = World Journal of Surgery | volume = 39 | issue = 9 | pages = 2115–2125 | date = September 2015 | pmid = 26239773 | doi = 10.1007/s00268-015-3153-y | s2cid = 13027859 }}</ref> This not only mandated the [[World Health Organization|WHO]] to prioritize strengthening the surgical and anesthesia care globally, but also led to governments of the member states recognizing the urgent need for increasing capacity in surgery and anesthesia. Additionally, the third edition of [[Disease Control Priorities Project|Disease Control Priorities]] (DCP3), published in 2015 by the [[World Bank]], declared surgery as essential and featured an entire volume dedicated to building surgical capacity.<ref>{{Cite book | vauthors = Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN |editor-first1=Haile T. |editor-first2=Peter |editor-first3=Atul |editor-first4=Dean T. |editor-first5=Margaret E. |editor-first6=Charles N. |editor-last1=Debas |editor-last2=Donkor |editor-last3=Gawande |editor-last4=Jamison |editor-last5=Kruk |editor-last6=Mock |date=2015-03-24 |title=Disease Control Priorities | edition = Third | volume = 1 Essential Surgery |doi=10.1596/978-1-4648-0346-8 |pmid=26740991 |hdl=10986/21568 |isbn=978-1-4648-0346-8 |url=https://openknowledge.worldbank.org/handle/10986/21568 |language=en-US}}</ref>

Data from WHO and the World Bank indicate that scaling up infrastructure to enable access to surgical care in regions where it is currently limited or is non-existent is a low-cost measure relative to the significant morbidity and mortality caused by lack of surgical treatment.<ref name=":3">{{cite journal | vauthors = McQueen KA, Ozgediz D, Riviello R, Hsia RY, Jayaraman S, Sullivan SR, Meara JG | title = Essential surgery: Integral to the right to health | journal = Health and Human Rights | volume = 12 | issue = 1 | pages = 137–152 | date = June 2010 | pmid = 20930260 | url = https://www.hhrjournal.org/2013/08/essential-surgery-integral-to-the-right-to-health/ }}</ref> In fact, a systematic review found that the [[Cost-effectiveness|cost-effectiveness ratio]] – dollars spent per DALYs averted – for surgical interventions is on par or exceeds those of major public health interventions such as [[oral rehydration therapy]], [[breastfeeding promotion]], and even [[Management of HIV/AIDS|HIV/AIDS antiretroviral therapy]].<ref>{{cite journal | vauthors = Chao TE, Sharma K, Mandigo M, Hagander L, Resch SC, Weiser TG, Meara JG | title = Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis | language = English | journal = The Lancet. Global Health | volume = 2 | issue = 6 | pages = e334–e345 | date = June 2014 | pmid = 25103302 | doi = 10.1016/S2214-109X(14)70213-X | doi-access = free }}</ref> This finding challenged the common misconception that surgical care is financially prohibitive endeavor not worth pursuing in LMICs.

A key policy framework that arose from this renewed global commitment towards surgical care worldwide is the National Surgical Obstetric and Anesthesia Plan (NSOAP).<ref name=":4">{{cite journal | vauthors = Truché P, Shoman H, Reddy CL, Jumbam DT, Ashby J, Mazhiqi A, Wurdeman T, Ameh EA, Smith M, Lugazia E, Makasa E, Park KB, Meara JG | title = Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery | journal = Globalization and Health | volume = 16 | issue = 1 | pages = 1 | date = January 2020 | pmid = 31898532 | pmc = 6941290 | doi = 10.1186/s12992-019-0531-5 | doi-access = free }}</ref> NSOAP focuses on policy-to-action capacity building for surgical care with tangible steps as follows: (1) analysis of baseline indicators, (2) partnership with local champions, (3) broad stakeholder engagement, (4) consensus building and synthesis of ideas, (5) language refinement, (6) costing, (7) dissemination, and (8) implementation. This approach has been widely adopted and has served as guiding principles between international collaborators and local institutions and governments. Successful implementations have allowed for sustainability in terms of longterm monitoring, quality improvement, and continued political and financial support.<ref name=":4" />