The burden of surgical conditions and access to surgical care in low- and middle-income countries.

a Department of Surgery and Global Health Sciences, University of California, San Francisco, CA, United States of America. b John F Kennedy School of Government and School of Public Health, Harvard University, Cambridge, MA, USA. c Global Initiative for Emergency and Essential Surgical Care, WHO, Geneva, Switzerland. d Harvard Humanitarian Initiative, Cambridge, MA, USA. Correspondence to Kelly McQueen (e-mail: [email protected]). doi:10.2471/BLT.07.050435 (Submitted: 18 December 2007 – Revised version received: 23 February 2007 – Accepted: 17 March 2008 – Published online : 6 June 2008) Introduction Surgery is an essential component of health systems but has generally been neglected within global public health. This is despite growing evidence documenting the cost-effectiveness of essential surgical care in lowand middle-income countries (LMICs).1 The overall burden of disease that may be cured, palliated or treated with surgical intervention is large and (probably) rapidly growing, and this concept must therefore be revisited. There are major gaps in knowledge related to surgery in LMICs. What exactly is the burden and distribution of surgical conditions in LMICs? What is the unmet surgical need? What resources (human, financial, physical) are required to improve access to surgical care? What impact would this have on global health disparities, and how does this compare with other interventions? How can essential surgical services be integrated into health systems’ surveillance and evaluation? This paper outlines a research agenda and argues that enough is already known to justify accelerated action.