Surgical Ecosystems: A critical component of public health education

International Public Health curricula typically do not include detailed analysis of the surgical components of healthcare. Yet the surgical ecosystem deserves its own study because of specific needs for infrastructure, personnel, supply chain and outcomes measures.

A complete consideration of traditional topics such as infectious disease, injuries, chronic disease and reproductive health would include the surgical components of these and their link to the “surgical ecosystem.” In most texts and curricula, surgery and surgical issues are not addressed except in as incidental to other primary themes.

The infrastructure and manpower required for surgical care should be considered in its own right because of the complexity of the system and the commonality of these requirements for many types of care. Infrastructure for trauma, for example, is similar to, but currently programmatically uncoupled from that of emergency maternal care and caesarian section in many public health initiatives. Manpower issues contributing to the increasing disparities in surgical care in central urban and rural areas must take into account market forces, including and privatization and industry.

The surgical ecosystem can be studied within the context of public health, but will require the public health community to enter and become expert in the inner workings of diagnostics, operating theaters, sterile processing units, supply chain and the training of surgical manpower.