When 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.
Gavin 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 conditions."
The 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.
While 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.
The 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."
Gavin 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.
Their editorial appears in the current issue of PLoS Medicine.