Rising to the Challenge Rising to the Challenge of of

Global Surgery:Global Surgery:Basic Science or Basic Basic Science or Basic

Surgery?Surgery?

UCSF Surgery Grand RoundsUCSF Surgery Grand RoundsJanuary 31, 2007January 31, 2007

John Ziegler MD MScJohn Ziegler MD MScRochelle Dicker MDRochelle Dicker MDWilliam Schecter MDWilliam Schecter MDJennifer Wang MDJennifer Wang MD

Doruk Ozgediz MD MScDoruk Ozgediz MD MSc

Global Health:Global Health:Where are we now?Where are we now?

More $ for Global HealthMore $ for Global Health

►US Development AssistanceUS Development Assistance $11 to 28 billion (2001-2005)$11 to 28 billion (2001-2005) PEPFAR (2003) $15 billion over 5 yearsPEPFAR (2003) $15 billion over 5 years

►Global Fund for HIV/TB/Malaria (2002)Global Fund for HIV/TB/Malaria (2002) $3 billion over 3 years$3 billion over 3 years

►World Bank: $2 billion (2006) -> World Bank: $2 billion (2006) -> healthhealth

►Gates: $6.6 billion/ 6 yearsGates: $6.6 billion/ 6 years Buffett: to add $1.5 billion/yrBuffett: to add $1.5 billion/yr

Global Burden of Global Burden of DiseaseDisease

►Murray/Lopez 1996/2006Murray/Lopez 1996/2006►230+ conditions230+ conditions

Three GroupsThree Groups►CommunicableCommunicable►Non-communicableNon-communicable►InjuriesInjuries

Mortality + MorbidityMortality + Morbidity►““Disability-Adjusted Life Year” Disability-Adjusted Life Year” (DALY)(DALY)

►90% BOD in Developing Countries90% BOD in Developing Countries

Low-Low-IncomeIncome

High-High-IncomeIncome

TotalTotal

CommunicableCommunicable 4040 66 3636HIVHIV 55 0.40.4 55

PerinatalPerinatal 66 0.90.9 66RespiratoryRespiratory 66 22 66

Non-communicableNon-communicable 4949 8787 5353CancerCancer 55 1717 77

PsychiatricPsychiatric 1010 2121 1111CardiovascularCardiovascular 1313 2020 1414

InjuriesInjuries 1111 88 1111

TOTALTOTAL 100%100% 100%100% 100%100%

Composition of Burden of Disease (% DALYS)

Lopez et al. (2006) Global Burden of Disease and Risk factors Oxford U. Press

Disease Control Priorities Disease Control Priorities in Developing Countries in Developing Countries

(2006)(2006)►Surgical Conditions: 50% BODSurgical Conditions: 50% BOD

►Cost-effectiveness of Cost-effectiveness of interventionsinterventions Measles Vacc.:Measles Vacc.: $1-5/DALY averted$1-5/DALY averted

ARV’s for HIV: ARV’s for HIV: $300-500/DALY $300-500/DALY avertedaverted

Surgery: Surgery: $7-200/DALY averted$7-200/DALY averted

Challenges to Global Challenges to Global SurgerySurgery

►PriorityPriority

►WorkforceWorkforce

►InfrastructureInfrastructure

►FinanceFinance

““Translational” ResearchTranslational” Research

►Bench -> bedsideBench -> bedside

►Bedside -> populationBedside -> population

Learning ObjectivesLearning Objectives

► Burden of Cancer in Developing CountriesBurden of Cancer in Developing Countries

► Burden of Injury in Developing CountriesBurden of Injury in Developing Countries

► UgandaUganda Historical and Contemporary PerspectivesHistorical and Contemporary Perspectives FAST studyFAST study

► Conclusions-> The way forwardConclusions-> The way forward