The Lancet Global Health
Jun 2015 Volume 3 Number 6 e297-e340
http://www.thelancet.com/journals/langlo/issue/current

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Comment
Global access to surgical care: moving forward
Evan G Wong, Dan L Deckelbaum, Tarek Razek
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)00004-2
Summary
Global surgical care is gaining ground on the public health platform. Throughout 2015–16, the World Bank is publishing the long-anticipated third edition of its Disease Control Priorities (DCP3). First published in 1993,1 these reports aim to systematically identify effective interventions to address the disease burden in low-income and middle-income countries. For the first time since its inception, the DCP now includes a distinct volume on the value of surgical care. Volume 1—Essential Surgery2—focuses on the benefits of surgical care, including its potential to substantially decrease mortality while being exceptionally cost-effective; the issues of access to life-saving surgery, perioperative safety, and the inclusion of surgery in universal health coverage are also specifically addressed.

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Comment
Health and sustainable development: a call for papers
Richard Horton, Zoë Mullan
Published Online: 30 April 2015
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)00002-9
Summary
In just under 5 months’ time, the aspiration for the next 15 years of development efforts will be signed off at the UN General Assembly in New York, USA. These Sustainable Development Goals (SDGs) are already at an advanced stage of drafting—17 ambitious goals and 169 targets (panel), which have been criticised even by the UN General Secretary for being too voluminous.1 Amid this multitude of outcomes, those pertaining to health are reduced from three Millennium Development Goals to one SDG. What does this mean for global health research?

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Articles
Global access to surgical care: a modelling study
Blake C Alkire, MD*, Dr Nakul P Raykar, MD*, Mark G Shrime, MD, Thomas G Weiser, MD, Prof Stephen W Bickler, MD, John A Rose, MD, Cameron T Nutt, BA, Sarah L M Greenberg, MD, Meera Kotagal, MD, Johanna N Riesel, MD, Micaela Esquivel, MD, Tarsicio Uribe-Leitz, MD, George Molina, MD, Prof Nobhojit Roy, MD, John G Meara, MD, Prof Paul E Farmer, MD, *
Published Online: 26 April 2015
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)70115-4
Summary
Background
More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission’s vision.
Methods
We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with one-way sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis.
Findings
At least 4·8 billion people (95% posterior credible interval 4·6–5·0 [67%, 64–70]) of the world’s population do not have access to surgery. The proportion of the population without access varied widely when stratified by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access.
Interpretation
Most of the world’s population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all.
Funding
None.