Surgery and global health: a Lancet Commission.

Delivery of surgical care—defi ned here as surgery, anaesthesia, nursing, and work by allied health pro fessionals, including managers—plays a fundamental part in prevention, diagnosis, treatment, and palliation of a broad range of medical disorders (fi gure), and is a crucial component of a properly functioning health-care system and a prerequisite for universal health coverage. Today, an estimated two billion people worldwide are without adequate access to surgical care, and a substantial global gap exists between surgical need and the equitable provision of safe surgical care. Low-income and middleincome countries have the greatest burden of untreated surgical disease; addressing this inequity—borne largely by low-income populations—is a moral imperative for the so-called reimagining of global surgery. In addition to the moral imperative, there are also strong economic reasons to prioritise surgery. The untreated surgical disease burden translates into great economic strain on local and regional economies. However, despite the cost-eff ectiveness of providing surgical interventions in resource-constrained environ ments, there is a perceived absence of political priority both nationally and globally, and a paucity of policy support and scalable solutions for development of functional surgical systems in low-income and middle-income countries. Surgery has now reached a crucial juncture in global health. A Lancet Commission on Global Surgery is timely. A commission is needed to acknowledge surgical care delivery as a core component of health systems, and to embed surgical care within present global health initiatives and the post-2015 global health agenda. The Lancet Commission on Global Surgery will engage experts across the global health community to defi ne the best strategies for provision of surgical care with a focus on low-income and middle-income health systems, while also recognising the major issues related to equitable delivery of high-quality surgical care in areas of confl ict, disaster, and in high-income settings. The Commission will provide advocacy for defi nitive action and an impetus for implementation of surgical health system reform. The commissioners include clinicians, scientists, educators, and policy leaders in multiple and allied health specialties related to surgical care delivery from around the world. The Commission will have three cochairs leading the process (John G Meara, Andrew J M Leather, and Lars Hagander) who will also call on a group of international advisers to provide specifi c content expertise for the many diff erent aspects of the Commission’s remit. The process will be open and consultative, incorporating advice and input from all stakeholders involved in providing, funding, or governing surgical care. Seven of the initial commissioners began the planning process during the spring of 2013. After preparatory meetings in Boston, London, and Lund, and multiple teleconferences, the Commission on Global Surgery will formally launch on Jan 17–18, 2014, in Boston. The fi rst meeting will convene more than 80 people including commissioners, advisers, and global health leaders from around the world. Additionally, it will have representatives from previous commissions and other global health initiatives to generate a unifi ed force for change. After the Boston meeting, two subsequent meetings will be held in Sierra Leone in May, and at a venue yet to be decided in September. The Commission will begin by examining the present state of surgery within the global health agenda and will then characterise the role, nature, and range of surgery within health systems. This initial investigation will build on the growing body of global surgery literature, and will be coordinated by