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Key Points

  • image There are five major forces reshaping priorities and strategies for the globalization of surgical care:

    1. The epidemiologic transition of diseases

    2. The mobile nature of the world’s populations

    3. Ubiquitous information access

    4. A revolution for equity and human rights

    5. Recognition of the cost-effectiveness of surgical care for treatment and prevention of disease

  • image The burden of disease is greatest in areas where human resources—physicians, nurses, pharmacists, and other healthcare workers—are the least.

  • image Surgery should be viewed as an investment rather than a cost.

  • image The key components of the global surgery ecosystem include technology, education, community, healthcare, business, and multidisciplinary engagement between a variety of disciplines.

  • image Understanding and addressing the necessary communication, energy, and transportation technologies along with the underlying cultural context represent the foundation critical to implementing sustainable infrastructure for appropriate surgical care.

  • image There has been a significant shift from communicable, maternal, neonatal, and nutritional causes of disease to noncommunicable causes, many of which require surgical care.

  • image Patients and their communities in low- and middle-income countries (LMICs) bear a much greater share of the burden of cancer than high-income countries (HICs).

  • image Globally, trauma has become a leading cause of death and disability; 90% of trauma deaths occur in LMICs.

  • image Essential surgical services should be integrated into comprehensive health care delivery, with the potential to avert 1.5 million deaths per year in LMICs.

  • image Surgery is gaining an increasingly recognized role for improving public health, having a role in prevention as well as treatment.

  • image The cost-effectiveness of surgical care has been demonstrated, and its value as a public health investment is increasingly understood by policymakers.

  • image Developing capabilities for surgical care has the ability to promote system-strengthening in resource-poor countries and to mitigate migration of health professionals at all levels.

  • image Academic global surgery provides a unique environment to study health systems, identify solutions and implement them collaboratively, fulfilling many institutions’ missions to strengthen multidisciplinary training, advocacy, and research.

  • image Surgical innovations that bring value by balancing cost with quality designed for challenging energy environments will foster equity in surgical care for LMICs.


Modern surgery can save lives, help expand economies, and offer hope to individuals and communities. Prior to the acceptance and availability of aseptic technique to prevent or decrease infections, and improved anesthesia for controlling pain, surgery as a specialty was held in very low esteem by medical doctors and the general public. Over the last 100 years, surgery has developed into a highly regarded discipline that not only provides opportunities for curing certain diseases but also fulfills a special role in preventing and mitigating disability.

Yet, surgery is currently unavailable to most people worldwide. The vast majority—90%—of the world’s population receives only 10% of the surgical care delivered. Said another way, 90% of surgical resources are consumed by the most privileged 10% of the world’s population. More than 5 billion people lack access to safe, timely, and affordable surgical care.1...

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