More than 5 billion people worldwide lack access to safe, affordable, and timely surgical and anesthesia care.
1 These global deficits in surgical and anesthesia care—and the means to alleviate them—
moved into sharper focus in 2015, as the result of initiatives led by the
World Bank, The Lancet Commission on Global Surgery, and the World
Health Organization ( WHO). Additionally, a new surgery-focused advocacy group called the G4 Alliance formed in May 2015, and the United
Nations (UN) has adopted a new health systems framework that will set
the global health agenda for the next 15 years. These initiatives are not
merely the latest academic and political trends; rather, they represent a
paradigm shift regarding the importance of quality health and surgical
care access for resource-poor populations. This article summarizes these
initiatives and offers a context for the future role of the American College
of Surgeons (ACS) in making surgical care available to patient populations that are without access at present.
Disease Control Priorities
In March 2015, the World Bank released the first volume of its third edition
of Disease Control Priorities.
2 Disease Control Priorities in Developing Countries
was published in 1993 against the backdrop of the growing human immunodeficiency virus (HIV) pandemic and a global malnutrition crisis.
with the World Bank’s 1993 World Development Report, which focused on
investing in health care (see Figure 1, page 14), the first edition of Disease
Control Priorities provided policymakers with strategies that would produce
the greatest benefits to the public welfare and promote economic growth
with limited resources.
4 Surgery was not mentioned in the first edition
of the report. The second edition of Disease Control Priorities, however,
included a chapter on the cost-effectiveness of surgery, in which Haile T.
Debas, MD, FACS, and colleagues estimated that 11 percent of the global
burden of disease could be addressed with surgical care.
5 Until it was significantly revised upward in 2015, this estimate was one of the most widely
cited statistics in global surgery.
The third edition of Disease Control Priorities, the first full volume of
which is titled Essential Surgery, breaks with the past and recognizes recent
evidence that proves that surgical care is cost-effective and essential for
meeting health care targets in low-resource settings. The authors of the
third edition describe the importance of assessing the cost-effectiveness
of surgical care platforms, such as the rural, first-level hospital, which
can provide a broad array of surgical and other health care services. The
authors demonstrate that surgical care is cost-effective, with spending at
• Summarizes recent efforts
to improve global access
to surgical care
• Highlights reports from the
World Bank and The Lancet
Commission on Global Surgery,
and the activities of the
WHO, WHA, and the UN
• Describes how surgical
the ACS, can assist in
eliminating disparities in
care around the world
JUN 2016 BULLETIN American College of Surgeons
UNIVERSAL ACCESS TO SURGICAL CARE