Tim Crocker-Buqué5th Year – University of Nottingham

Professor Harold Ellis Medical Student Prize for Surgery

9th October 2009

What Effect can Surgeons have on World Health?

GAPMINDER

Disability Adjusted Life Year - DALY

1 DALY = 1 year of ‘healthy’ life lost to disability or death

Quantifying the global burden of disease:

Murray and Acharya, 1997

The World Proportional to Total Population

United Nations Development Programme’s 2004 Human Development ReportFrom: www.worldmapper.org

The World Proportional to Absolute Poverty (<$2 per day)

United Nations Development Programme’s 2004 Human Development ReportFrom: www.worldmapper.org

Low income countries: LIC

The World Proportional to Number of Deaths from Injuries per Year

United Nations Development Programme’s 2004 Human Development ReportFrom: www.worldmapper.org and Ozgediz & Rivello, 2008)

90% Injury Deaths in LIC

African children >5yo – more deaths from injuries than HIV, Malaria and TB combined 63,000,000

DALYs

Only 33% injured patients in Africa reach a health facility

The World Proportional to Number of Deaths from Congenital Birth Defects per Year

United Nations Development Programme’s 2004 Human Development ReportFrom: www.worldmapper.org

The World Proportional to Number of Deaths from Congenital Birth Defects per Year

United Nations Development Programme’s 2004 Human Development ReportFrom: www.worldmapper.org

14,000,000 DALYs

The World Proportional Maternal Mortality

United Nations Development Programme’s 2004 Human Development ReportFrom: www.worldmapper.org and Ozgediz & Riviello, 2008)

500,000 surgically preventable deaths PA

99% maternal deaths in LICs

10,000,000 DALYs

Contribution of surgically treatable diseases:

164,000,000 Disability Adjusted Life Years

=

11 - 15% Global Disease Burden

Debas at al., 2006

What Effect can Surgeons have on World Health?

Almost nothing.

The World Proportional to Number of Working Doctors

World Health Organisation’s 2006 World Health ReportFrom: www.worldmapper.org

1 Doctor:15,000 population

1 Surgeon:30,000 population UgandaOzgediz et al., 2008

Education

Education

Education

Questions?

Thank you

Recruitment and Retention of Doctors in LICs

Remuneration and incentives

Resources: equipment and drugs

Safe working environment

Training and mentoring

Cost of of treating surgical disease:

Measles Vaccine

HIV Antiretroviral Therapy

Basic Surgical Care

$5

$300 - $500

$11 - $33

Estimated cost (USD) per DALY averted