The Lancet Commission on Global Surgery

<Cross-posted from here>

Two weeks ago, the Lancet Commission on Global Surgery had its inaugural meeting in Boston. Although it was a downright excellent meeting, I’ve been struggling with how to summarize two days spent talking about what, in the end, is a really nebulous concept. Surgery, unlike, say, vaccinations, is difficult to define; its borders are indistinct. So improving surgery, writ large, is difficult, because surgery is writ pretty large.

The Commission faces a daunting task. Not least because, in addition to examining the health impacts of surgery, it has set itself up to look at provision through a far broader lens. January’s conference concerned itself with developing and evaluating metrics for access, with issues around the financing and economics, with workforce issues, issues of management, and issues around training and development.

This is a good thing. Think about it: up to 28% of the global burden of disease is potentially amenable to surgical intervention, and nearly 90% of the cancer burden has some surgical aspect to its treatment. Surgery is an absolutely integral part of health delivery.

Simultaneously, it is absolutely different from other health interventions. Compare it, for example, to antiretrovirals. Both require advanced technology, but all of the advanced technology for the latter can be, for better or worse, sited somewhere else—all that technology is then effectively packaged into a small, transportable pill.

Not true with surgery. The managerial, workforce, development, and delivery systems must all be transported somewhere kind of close to the patient—and then the patient herself has to be brought to that system.

Two very fundamental changes, which make studying and delivering surgery difficult—but also give it the potential for a large impact.

Here, I think, is where the commission—and all of us interested in global surgery—need to be daring. It’s easy to look at public health interventions that have worked before and try to model our efforts on those interventions. This, I think, would be a mistake because of how fundamentally different they are from surgery itself. We need to bring the private sector into the conversation, for example. We need to pay a lot of attention to that vast, disorganized, parallel universe of surgical delivery that happens—and happens well, even—in the NGO sector. (After all, some 20% of the surgical burden is borne by this sector).

We need to be bold, to view ourselves not as another public health intervention, but as an integral part of delivering that most basic human right to the highest attainable standard of health.

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