Role of Surgery in Public Health? The time is right?

Global disparities in the delivery of qualified surgical care is assuming increasing importance in the developing world. This is due to an increase in the global burden of surgical disease attributable to the aging of the population and a rising need for surgical intervention for chronic diseases (diabetes and obesity) and cancer. In addition the need for surgical interventions such as circumcision to reduce the risk of HIV transmission and management of filariasis remains unmet. Surgical care is a critical component of basic healthcare services although it is seldom seen as such. The benefits of surgical care in terms of disability life years (DALYs) makes it a very cost-effective intervention, suited to low and middle resources countries that suffer from intense disparities in access to surgical care.

Access to qualified surgical interventions can transform individuals and communities at all levels of the socioeconomic strata. It requires innovative, transnational, and multi-sectoral collaboration to create new models of surgical care that can be affordable, relevant, acceptable and adaptable to the needs of different countries. This is different from the resource-intense model that is the hallmark of surgical care in wealthy counties. An estimated $33-$38/DALY averted for surgical care is comparable to $300-$500/DALY averted for antiretroviral therapy for HIV.

This paper will outline the interface of surgery and public health within a public health framework -- prevention, diagnosis, and treatment that includes surgical intervention and rehabilitation -- drawing on historical and contemporary examples.

Public practice and research methodologies can contribute by providing robust estimation of the global burden of surgical disease, evaluation of the effectiveness of surgical interventions, determining unmet surgical need, resources needed (physical, human financial) to meet these needs and its impact on global health disparities. Public health can contribute by exploring innovative ways to build global sustainable surgical capacity within a context of transnational migration.

There is a need for surgery to cross disciplinary boundaries, create multidisciplinary delivery care approaches with public health, innovatively integrate affordable technology and reframe its relevance in public health prevention and disease management. Surgery is relevant from an economic and a human rights perspective. It has been called the “neglected stepchild of public health” (Farmer and Kim, 2008). It is time for a paradigm shift and the development of new methods of integrating surgery and public health to improve the health of all.