A Crucial Role for Surgery in Reaching the UN Millennium Development Goals

Doruk Ozgediz andRobert Riviello made a convincing case that surgical conditions should be considered as "neglected diseases" disproportionately affecting the world's poorest people [1]."Patients with untreated surgical conditions," they wrote, "as well as the local clinicians struggling to care for them, must gain greater recognition by the global public health community."We welcome their call to bring surgery into the global health conversation.There are at least five important reasons why providing surgery should be considered a global public health priority.The first is that surgical conditions-defined by Haile Debas and colleagues as conditions that require suture, incision, excision, manipulation, or other invasive procedures that usually, but not always, require local, regional, or general anesthesia [2]-constitute a substantial global burden of disease.In an innovative attempt to measure the burden of surgical conditions, Debas and colleagues estimated that these comprise 11% of the world's disabilityadjusted life years (DALYs; one DALY represents the loss of one year of equivalent full health) [2].Africa faces the world's highest regional rate of surgical DALYs (38 per 1,000 people) [2].The surgical burden of disease is led by injuries, followed by malignancies, congenital anomalies, pregnancy complications, cataracts, and perinatal conditions.Debas and colleagues state that when they searched the medical literature they found "no data of value except maybe for cataracts" to inform their estimates [2].They therefore used an international survey of 32 surgeons, 18 of whom returned completed questionnaires, a methodology that leaves substantial uncertainty around the authors' 11% estimate.Such uncertainty calls for a concerted, coordinated effort to conduct a more formal evaluation of global surgical DALYs.