Surgery as a public health intervention: common misconceptions versus the truth

 

From the Bulletin of the World Health Organization (WHO)

The world’s attention has recently been focused on the escalation of violence in north and west Africa. Daily reports of deaths and injuries from the region have raised concerns. What is missing from the picture, however, is the fact that many of these countries lack surgical capacity to treat the injured, and this inability to provide surgical care is contributing to a significant rise in the death toll. A recent World Health Organization (WHO) study found that more than 90% of deaths from injuries occur in low- and middle-income countries.1 This is not surprising, considering that the poorest third of the world’s population receives only 3.5% of the surgical operations undertaken worldwide.2 Many hospitals in these countries do not have a reliable supply of clean water, oxygen, electricity and anaesthetics, making it extremely challenging to perform even the most basic surgical operations.3

Despite such a surgical imbalance around the world, surgery is still “the neglected stepchild of global health”.4 No global funding organization focuses specifically on the provision of surgical care, and none of the major donors are willing to support and acknowledge surgery as an imperative part of global public health. This is largely due to the following common misperceptions about surgery that are not grounded in truth.

First, many people think that surgical care can only address a very limited part of the global burden of diseases and thus is of low priority. In reality, injuries kill more than five million people worldwide each year, accounting for nearly one out of every ten deaths globally…..

…Second, there is a common notion that surgical care is too expensive to be implemented as part of public health interventions. However, surgery can be remarkably cost-effective, even in comparison to non-surgical interventions that are commonly implemented as public health measures. ….

….Lastly, the focus of the global health community on the issue of surgical imbalance has been largely confined to providing short-term relief through medical missions. …

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