Worldwide, 5 billion people are excluded from surgery that could often save lives or avert disability, finds a study published in The Lancet. This represents two thirds of the world not having access to safe and affordable surgery and anesthesia when they need it - and it is largely the "poor, marginalized and rural" who "face impossible hurdles."

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For injury, appendix removal, or obstructed childbirth, we may take anesthesia and surgical expertise for granted - but even for these problems it is widely unavailable across the world.

These are the comments of Prof. John Meara and Dr. Sarah Greenberg, both from an initiative at Harvard Medical School in Boston, MA, named the Program in Global Surgery and Social Change. Their commentary introduces new studies on global surgical care forming part of a campaign launched by the medical journal.

"Surgery has, until now, been overlooked as a critical need for the health of the world's population," says The Lancet, which established a commission of 25 leading experts in surgery and anesthesia, and has taken contributions from more than 110 countries.

One of the lead authors in the commission, Dr. Lars Hagander, from Lund University in Sweden, says: "The problem is especially acute in the low- and middle-income countries of eastern, western and central sub-Saharan Africa, and South and Southeast Asia.

"Too many people are dying from common, treatable surgical conditions, such as appendicitis, obstructed labor and fractures."

Doctors deal with, broadly speaking, either surgical or medical conditions, and we hear more about the burden of disease from the latter. Yet conditions that could have been treated with surgery accounted for a total of 16.9 million deaths in 2010, the journal has found - which was just under a third (32.9%) of all deaths that year, "well surpassing the number of deaths from HIV/AIDS, TB and malaria combined."

The group of experts leading the studies calls for a global investment of $420 billion by 2030, an amount the commission says would give acceptable levels of access to surgery in those countries that have the worst availability.

They believe this would be an achievable cost "far outweighed by the devastating economic cost to countries, communities, and families incurred by the current global shortfall in access to surgery."

Prof. Meara, who is an associate professor of surgery at Boston Children's Hospital in addition to holding a professorship in global surgery at Harvard, believes the "scale-up costs are large, [but] the costs of inaction are higher" and that creating access to essential surgery where it is presently lacking would be a "highly cost-effective investment, rather than a cost." He adds the following call to action:

"Surgical conditions - whether cancers, injuries, congenital anomalies, childbirth complications or infectious disease manifestations - are ubiquitous, growing and marginalizing to those who are afflicted by them.

The good news is that we believe it is possible to turn this dire situation around within the next 2 decades - but only if the international community wakes up to the enormous scale of the problem, and commits to the provision of better global surgical and anesthesia care wherever it is needed."

'Quarter of surgical patients incur financial catastrophe'

The commission has been gathering evidence from a collection of studies in its campaign, and in its report, "Global surgery 2030: evidence and solutions for achieving health, welfare and economic development" it lists statistics that adversely affect low- and middle-income countries (LMICs) the most. The authors say that:

  • 9 in every 10 people "cannot access basic surgical care" in LMICs, and an extra 143 million surgical procedures "are needed in these countries to save lives and prevent disability"
  • Need is greatest in eastern, western, and central sub-Saharan Africa, and south Asia
  • Across the world, 33 million individuals each year face "catastrophic health expenditure" on surgery and anesthesia. "A quarter of people who have a surgical procedure will incur financial catastrophe as a result of seeking care"
  • Without urgent investment in surgery, "LMICs will continue to have losses in economic productivity, estimated cumulatively at 12.3 trillion US dollars" between 2015 and 2030
  • Surgery is an "indivisible, indispensable part of health care" and "should be an integral component of a national health system in countries at all levels of development."

A campaigning video produced by The Lancet at YouTube uses infographics to give a picture of the obstacles to surgical care that are faced by many: