How Surgery Can Fight Global Poverty
Last week, The New York Times published an Op-Ed discussing the inherent need for improving surgical systems and building reliable surgical infrastructure as a way to strengthen the health care system. While HIV, tuberculosis, and malaria continues to be the main focus of global health policies, access to surgical care remains limited for most of the world.
Surgery is more than just facial tumors, breast cancer and trauma; it is a crosscutting intervention, involved in every disease category from infections to blindness, from congenital abnormalities to maternal conditions, from the neurological to the cardiac to the neoplastic. To put this in perspective, H.I.V., tuberculosis and malaria — which have captured the global conversation — currently make up less than one-tenth of the global disease burden, combined.
Why, then, has surgery been ignored? In part, because expanding surgery seems daunting and expensive. Why not just focus global energy on vaccines, for example, which can be mass-produced and delivered to the population, rather than scaling up an entire health infrastructure? After all, providing surgery requires reliable electricity, water, suction, sterilization, oxygen — as well as surgeons, anesthesiologists, nurses and biomedical technicians.
But this is exactly what makes improving surgery ideal. Improve a surgical system, and you improve the very things that are necessary for the delivery of health care in general. Doing so is less costly than it might initially seem. The cost of scaling up a surgical system in resource-poor countries — about $300 billion over 18 years — represents only about 5 percent of the total combined expenses that governments in low- and lower-middle-income countries spend on health annually, and pales in comparison with the $12.3 trillion cost of inaction. And spending that money now will not only lower the current surgical disease burden and allow patients to return to economic productivity, but it will also make the health system itself more resilient when shocks like Ebola hit.