What the World Still Doesn’t Understand About Global Health

A woman in a rural village in Uganda feels a lump on her right breast as she dresses in the blue light of dawn. Her weathered fingers palpate invisible edges under skin as anxiety and fear set in on the significance of this finding.

Somewhere else in the world, a young man racing down a crowded city street on a motorcycle swerves to avoid a pedestrian and flies off his bike. He lands with a sickening crunch on the ground and his pupils grow as blood fills his brain.

A young boy in South America struggles to keep up with his friends during a soccer match, as his beating heart hums from the extra turbulence caused by a small hole in his its muscle wall. 

What do these people have in common? Although separated by age and geography, they all need one thing desperately: surgery.

The landscape of global health is changing significantly. While many of the challenges of the past century remain — including HIV, malaria, and tuberculosis — non-communicable diseases (NCDs) now pose much more danger to public health than many of the diseases that receive the bulk of the media attention.

The majority of NCD-related deaths are due to cardiovascular diseases, followed by cancer, respiratory disease, and diabetes. Other medical issues in this category include injuries, congenital anomalies, and mental illness. Each year, 41 million people die because of NCDs, accounting for nearly two-thirds of all premature deaths. Tragically, 80 percent of these deaths occur in low and middle-income countries.  

Not only are untreated NCDs creating significant harm to people’s health, they are dramatically stunting economic growth. New evidence suggests that from 2011 to 2031, the five most dangerous NCDs will cause a cumulative loss of economic output totaling $47 trillion.

Unfortunately, progress in tackling NCDs has been stagnant. Unlike with many infectious diseases, the solution to reducing the damage caused by NCDs can’t be found by creating a new vaccine or implementing an antibiotics campaign. NCDs are diverse and complex, and their burden on a country’s population is intimately tied to its poverty rate, culture, and the condition of its health care system. Preventative strategies are critical to addressing these diseases, but in many cases, including those listed above, prevention is just not possible.

Surgical conditions represent a substantial portion of NCDs, and we know that the majority of patients with NCDs will require some form of surgical treatment at some point in their lifetime, such as surgical resection of tumors, treatment for heart attacks or strokes, orthopedic or neurosurgical care for traumatic injuries, cesarean section procedures for obstetric related complications, or even amputation of limbs affected from diabetes.  

Dr. Walt Johnson, the head of the Emergency and Essential Surgical Care Program for the World Health Organization, recently told me in an interview, “With the steep global rises in NCDs, the demand for surgical care rises in parallel. The situation of enormous lack of access to surgical care is only getting worse.”

Roughly 5 billion people worldwide do not have access to timely, safe, and affordable surgical, anesthesia, and obstetric (SAO) care. Public health officials must shift more resources and attention toward treatment of NCDs, especially those that require surgery.

Although many public health officials are still learning for the first time about these problems, they have started to attract much-needed attention from some health care providers, policymakers, and global leaders. Several countries have started to implement largescale plans to reform their national surgical, obstetric, and anesthesia systems. In the past few years alone, Zambia, Tanzania, Rwanda, and several other countries in sub-Saharan Africa have initiated this process and are in various stages of drafting and implementing their revised plans. In November Pakistan launched a two-day multi-stakeholder conference in Islamabad dedicated to implementing a national/provincial surgical, obstetric and anesthesia plan.

The goal for policymakers should be to weave NCD reforms seamlessly into their existing health systems, both inpatient and outpatient. It starts with creating preventative strategies for patients at risk for NCDs, but systems must also be designed so that physicians have the ability to diagnose problems quickly and efficiently and then pursue surgery if needed. Patients also need access to rehabilitative services once they leave hospitals.

Strengthening SAO services sounds like it might be too costly for many countries, but the truth is that much research shows when the economic benefits of a healthier population are added into the equation, it’s clear investments in SAO care are affordable.

Remarkable strides have been made in global health over the past century, but to continue making progress, policymakers and health care providers need to shift their focus to reforming health systems to put a much greater emphasis on treating NCDs, a task that can best be accomplished by addressing the world’s surgical care crisis.

Jacquelyn Corley, M.D., is a research fellow at Harvard’s Program in Global Surgery and Social Change, a neurological surgery resident at Duke University Medical Center, and a human rights journalist focusing on health-care-related topics. Follow her on twitter @JacquelynCorley.