The health care dollars that are spent in resource-poor nations historically have been directed toward the use of medicines to treat long-term, chronic conditions and communicable diseases. However, according to research presented at the 2008 Clinical Congress of the American College of Surgeons, approximately one-third of the disease burden in poorer countries is potentially surgically treatable and curable. "Surgery and surgical interventions are currently not considered a mainstay in stemming the side effects of ill health in the developing world. However, if poorer nations were equipped with better surgical infrastructures, then today or tomorrow or six months from now, nearly a third of their health problems could potentially be managed in the operating room. So it makes sense that we should consider gearing our health care investment priorities toward making surgical care more accessible in these areas," according to Lara L. Devgan, MD, MPH, a resident in plastic surgery in the Columbia and Cornell University/New York Presbyterian Plastic Surgery Program, New York, NY.
Dr. Devgan analyzed data from the World Health Organization's Global Burden of Disease Project, which comprehensively analyzes the effect of 107 diseases and injuries, as well as 10 selected risk factors, on populations around the world and in eight major geographic regions and individual countries. The project calculates the disability-adjusted life year (DALY) statistic, which reflects the total number of years lost because of premature death or disability.
Dr. Devgan identified the 60 countries that have the lowest per capita income in the world and then related DALY in those countries to categories of illnesses that are commonly treated surgically. For the year 2005, Dr. Devgan found that more than 281 million out of a total of 864 million DALY, or 32.5 percent of the disease burden in the world's poorest nations, were due to illnesses or conditions that are surgically manageable. Traumatic injuries accounted for 35.5 percent of the surgically treatable disease burden in these countries. Cardiovascular diseases accounted for 24.3 percent, and cancer and other neoplasms for 8.6 percent. "The point of my study is not that every single person who has cancer or heart disease or a motor vehicle accident requires an operation, but rather, that every person with those conditions requires a surgical decision to be made. Even a decision not to operate is one that requires a surgical framework to be in place," she said.
Dr. Devgan admits that developing a surgical capability in third-world countries would be a massive undertaking. "It's a huge system problem, but the first step is acknowledging that more surgical infrastructure is needed. From there, the discussion can focus on how best to achieve that goal," she said.
Dr. Devgan hopes the findings from this study will begin a new dialogue on the use of health resource dollars. "If in a given year, we are going to spend a certain amount of dollars on health care in poorer countries, we need to have serious policy-level discussions about the best ways to allocate those investment dollars. Many of the surgical treatments and interventions we have available are short-term strategies, and they are relatively low in cost because they do not require multi-year investments in the development of new drugs or vaccines. We, as a society, have a finite amount of resources to direct toward the health care infrastructure in countries that are underserved and overburdened. We need to start thinking about how we can best spend those resources," she said.