Food for Thought: Surgery and Public Health

By Nickey Jafari

This week, I want to discuss where surgery and public health intersect. First, a little personal background: I took a global public health class with Dr. Debra DeLaet at Drake University for my International Relations major and absolutely fell in love with public health.  I highly recommend her textbook, if you are interested in the subject. Since medical school, I have been a passionate supporter of Partners in Health, a community coordinator for their fundraising branch Partners in Health Engage, and a complete and total Dr. Paul Farmer fangirl. I also hope to pursue an MPH between my 3rd and 4th year of medical school.

The World Health Organization defines “public health” as “all organized measures to prevent disease, promote health, and prolong life among the population as a whole.” Sounds pretty important, right? A broad range of issues fall under this umbrella, from access to family planning to clean drinking water to vaccines and infectious disease control. However, throughout my admittedly limited experience with the study of public health, I have felt most of the conversation focuses overwhelmingly on better access to primary care. While I want to make it clear that I do not in any way disagree with how critical primary care is, I wanted to begin a discussion on the emerging opinion of how increased quality of and access to surgery worldwide will also make a considerable dent in the global burden of disease. My motivation for this? I would hate for someone who is interested in surgery, like myself, to feel discouraged from pursuing it because they feel as if it is not also an integral component to the overall well-being of populations. More importantly, this opinion will help save lives. After all, the keynote speaker at the American College of Surgeons Clinical Congress this past year was Dr. Paul Farmer himself, and his topic was “Addressing Unmet Surgical Need: The Role of Academic Surgery”. I believe that access to quality surgery is part of our basic right to health.

It is estimated that about 13% of the global burden of disease (Lancet Commission on Global Surgery, 2010)  is amenable to surgery, and that this number could be seriously underreported, especially in low and middle-income countries (LMIC). For those who are passionate about health disparities, the one we are addressing here is stark – the WHO estimated that 90% of deaths from injuries occur in LMIC, while the poorest third of the world’s population receives 3.5% of the 234 million surgical operations performed globally (read more here). Additionally, numerous studies show many surgical interventions can be cost-effective, especially in LMIC.

In addition, the Lancet Commission on Global Surgery has highlighted 5 key points to focus on for  public health disparities:

1. Five billion people do not have access to safe, affordable surgical and anesthesia care when needed.
2. 143 million additional surgical care procedures are needed in LMICs each year to save lives and prevent disability.
3. 33 million individuals face catastrophic health expenditure due to payment for surgery and anesthesia care each year.
4. Investing in surgical services in LMICs is affordable, saves lives, and promotes economic growth.
5. Surgery is an “indivisible, indispensable part of health care.”

My question is how can we take this information and begin to include the advances in the role of global surgery as part of our regular discussions regarding public health and medical training? It has never been more important.

“The need for surgery to be recognised on the public health agenda has never before been so requisite. With the epidemiological transition in disease patterns away from the infectious and towards the chronic and non-communicable it is time for surgery to be considered as a public health priority” World Surgical Association

Nickey Jafari is a 2nd year medical student at the University of Kansas School of Medicine. She was born in Tehran, raised in Kansas, and attended Drake University in Iowa for her Bachelor’s degree in International Relations and Biochemistry. She is passionate about global health and is interested in how better access to and quality of surgery can help tackle disparities in outcomes.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.