Editor’s note: This introduction is based on the foreword to
the report published in Surgery and The Lancet Global Health.
This report is the second in a series of articles that The Lancet
Commission on Global Surgery has submitted regarding its
efforts. A progress report on the commission’s activities was
published in the April issue of the Bulletin.
Following is an Executive Summary of The Lancet Commission on Global Surgery (LCoGS) report on global health care disparities. LCoGS’ vision is
“universal access to safe, affordable surgical and anesthesia care when needed.” 1 At present, 5 billion people
are unable to receive surgical interventions that could
save lives or prevent disability. 2 In an era in which we
discuss the dawn of personalized medicine and genetic
engineering with frequency and familiarity, how can
more than half the world’s population live in a health
care time warp, trapping them centuries in the past
without access to quality care?
As the Executive Summary reveals, disparities in
global surgical care are due to inaccurate assumptions,
competing priorities, and a lack of resolve. For years
the public health community assumed that surgery was
too costly and too complex, leading public health intelligentsia to concentrate on ostensibly more cost-effective
interventions, including vaccines and infectious disease
treatments—all of which are necessary but no more cost-effective than surgery. 3 In addition, the surgical and anesthesia community lacked a cohesive resolve to reverse
the marginalization of surgery.
Integration of surgery and anesthesia care is critical
to achieving the emerging global health care goals of
sustainable development and universal health coverage. Without immediate attention and scale-up, lack of
surgical care will not only continue to result in prevent-able death and disability but will also lead to an estimated reduction of the gross domestic product of low- and
middle-income countries by as much as 2 percent by
2030.4 This decrease will be crippling for fragile economies struggling to emerge from poverty and instability.
In January 2014, World Bank president Jim Yong Kim,
MD, PhD, addressed these realities at the first Assembly of the LCoGS, stating that “surgery is an indivisible,
indispensable part of health care.” 5 Fortunately, Dr. Kim’s
words landed on fertile ground, prepared by the hard
by John G. Meara, MD, DMD, MBA, FACS,
and Sarah L. M. Greenberg, MD, MPH
Global Surgery 2030: