you think of public health efforts in developing countries, you probably think
of childhood vaccinations, programs for clean water, malaria and TB eradication
campaigns. Surgery is rarely considered as a tool for improving the health of
the world's poorest people. Prompted by an article in their on-line journal
suggesting that it should be, the editors of PLoS Medicine have added
their voice to the discussion. Faith Lapidus reports.
Yamey says he and the other editors at PLoS Medicine wanted to make the
case that providing surgical services should be thought of as a global health
priority. "We absolutely have to consider [surgery] as a building block of
global public health," he says, pointing to evidence that surgery–even in
the world's poorest countries–is feasible and cost-effective. "It can help
to lift people out of poverty," he adds.
The first reason for raising surgery's
profile, Yamey says, is that medical conditions requiring surgery make up a
substantial proportion of the world's burden of disease. He also points out
that even though the developing world accounts for most of the demand for
surgical care, it receives the least. Providing that surgical care would boost
national health systems and primary care in general, he says, recalling a
conversation he had with a surgeon who once worked in Africa. "When you
provide surgical services at a district general hospital in rural Africa, his
experience is that it raises the overall quality of care at that hospital, and
that patients come to that hospital seeking attention for other non-surgical
conditions." He says it has a ripple effect, "when you provide
surgery, people are more likely to attend for all sorts of other
editorial notes there are also economic reasons for bringing surgery back into
the global health conversation. Providing basic surgical services compares
favorably, the article contends, with traditional programs like childhood
vaccinations. And non-doctors can be trained to provide some care, such as
Caesarian sections, even in the most resource-poor areas.
most public health funding is now targeted at a single disease or a specific
campaign, Yamey says there is a compelling reason for shifting some of the
money to improve surgical capacity in developing countries: "Surgery could
help to reach the United
Nations Millennium Development Goals.
U.N. document is the blueprint that has been agreed upon by all the world's
countries and leading development institutions to meet the needs of the world's
poorest. "The Millennium Development Goals lay out a certain number of
targets that we hope we can meet," Yamey explains, "for example,
reducing child mortality, improving maternal health, tackling infections. What's
fascinating, and we think pretty compelling, is that surgical services could
help in reaching many of these goals."
Yamey says he and his fellow editors are encouraged by the fact that surgeons
and public health professionals are coming together to build a movement to
promote surgery as a crucial tool in improving global public health.
editorial appears in the current issue of PLoS Medicine.