realized without an emphasis on improving surgical
access and quality. The third SDG calls for ensuring
healthy lives and promoting well-being for all.
Within this goal, the UN set a target of reducing
the global maternal mortality rate to less than 70 per
100,000 live births, cutting by one-third the rate of premature death from non-communicable diseases, and
halving the number of deaths due to road traffic accidents. The link bet ween achieving the third SDG and
surgical care is most direct, but the role of surgery
in development extends far beyond this milestone.
Strengthening the world’s surgical systems will be an
important step toward achieving targets for many other
SDGs. For example, the first SDG calls for ending poverty, the eighth SDG for promoting economic growth,
and the 10th for reducing inequality. The third edition
of the Disease Control Priorities and The Lancet
Commission both suggest that a lack of a strong surgical
system inhibits economic growth, hitting the lowest-income countries the hardest with a cumulative loss of
$12.3 trillion across LMICs from the burden of surgical
6 Achieving each of the SDGs will require interventions that include both prevention and treatment
and that fundamentally rely on robust hospital systems
offering comprehensive health care, including surgery.
Role of surgical organizations
At the North American launch of Global Surgery 2030,
ACS Executive Director David B. Hoyt, MD, FACS,
noted that the Commission’s report represents a call to
action for surgeons to recognize the deficits in global
surgical care and to accept responsibility for resolving
this problem. Extending access to surgical care beyond
the world’s wealthiest 2 billion people will require the
coordinated action of international agencies, national
governments, and clinicians. It also will necessitate the
attention and commitment of influential surgical orga-
nizations, particularly those in high-income countries.
Many surgical organizations have already begun
to heed this call to action. The ACS, the Royal Aus-
tralasian College of Surgeons (RACS), and the Royal
College of Surgeons of Ireland (RCSI) are already play-
ing an important role in this process.
The ACS Operation Giving Back (OGB) program
started in 2004 as a portal to coordinate American sur-
gical volunteerism around the globe.
10 Its mission is to
leverage the passion, skills, and humanitarian ethos of
the surgical community to effectively meet the needs
of medically underserved populations. OGB seeks to
provide the necessary tools to facilitate humanitarian
outreach among surgeons of all specialties at all stages
in their professional careers and with emphasis on both
domestic and international service.
The RACS Pacific Islands Project, established
in 1995, is a longitudinal program that focuses on
strengthening workforce and clinical support capac-
ity across the Asia-Pacific region. Meanwhile, the RCSI
has long-standing training collaborations with the Col-
lege of Surgeons of East, Central, and Southern Africa
11, 12 These initiatives have appropriately
garnered accolades as models of collaboration between
partners in high-income and LMICs.
But more can be done. One important strategy is to
continue to foster direct collaboration between surgi-
cal organizations in high- and low-income countries,
FIGURE 7. THE MILLENNIUM DEVELOPMENT GOALS
JUN 2016 BULLETIN American College of Surgeons
UNIVERSAL ACCESS TO SURGICAL CARE