Nepal Earthquake Underscores Lack of Access to Critical Care

As the international community struggles to provide aid and resources to Nepal following Saturday’s devastating earthquake, a commission has shed light on the consequences of inadequate or inaccessible critical care around the globe.

A study recently published in The Lancet examined the importance of surgery in improving health care globally, particularly in low- and middle-income countries. Based on the research of 25 surgery and anesthesia expects, as well as contributions from 110 countries, the commission determined 32.9% of worldwide deaths result from conditions treatable with surgery.

“Too many people are dying from common, treatable surgical conditions, such as appendicitis, obstructed labor, and fractures,” said study co-author Lars Hagander, MD, PhD, MPH, in a press release. “The problem is especially acute in the low- and middle-income countries of eastern, western, and central sub-Saharan Africa, and South and Southeast Asia.”

Alarmingly, 5 billion individuals worldwide lack access to safe and affordable surgery and anesthesia when they require it, and as few as 10% of individuals have access to basic surgical care in some low-income countries. Additionally, only about 5% of the surgeries that occur each year are performed on the poorest third of the world’s population.

“In the absence of surgical care, common, easily treatable illnesses become fatal,” said study co-author Andy Leather, MBBS, FRCS, MS, in the press release. “The global community cannot continue to ignore this problem—millions of people are already dying unnecessarily, and the need for equitable and affordable access to surgical services is projected to increase in the coming decades, as many of the worst affected countries face rising rates of cancer, cardiovascular disease, and road accidents.”

While the situation is critical, the commission estimated access to surgery across the globe could be scaled up to acceptable levels with an investment of $420 billion—a price the authors said is ultimately dwarfed by the economic costs incurred from a lack of surgical access.

“There is a pervasive misconception that the costs of providing safe and accessible surgery put it beyond the reach of any but the richest countries,” said lead author John Meara, MD, in the press release. “But our work for this commission clearly shows that not only are the costs of providing these essential services lower than might have been thought, but that scale-up of surgical and anesthesia care should be viewed as a highly-cost-effective investment, rather than a cost.”

The study authors added that any investments in surgery would need to be accompanied by sustainable financing mechanisms across the health care system, as well as a greater commitment to universal health coverage throughout the global community.

“Surgical conditions—whether cancers, injuries, congenital anomalies, childbirth complications, or infectious disease manifestation—are ubiquitous, growing, and marginalizing to those who are afflicted by them,” Dr. Meara stated. “The good news is that we believe it is possible to turn this dire situation around within the next 2 decades—but only if the international community wakes up to the enormous scale of the problem, and commits to the provision of better global surgical and anesthesia care wherever it is needed.”