Global Surgery and Health Equity: Integrating Education, Research, and Policy—A Perspective Review
Abstract
Background: Global surgery is intended to guarantee that all people can access safe, timely, and affordable surgical, obstetric, and anesthesia care, but wide disparities remain, mostly in low- and middle-income countries (LMICs). When the 17.9 million annual preventable deaths from surgical conditions are considered, the LDCS face a debilitating deficit of personnel, infrastructure, and policy-required backing. Mitigating these disparities calls for a comprehensive approach, which includes education, research, and policy. Methods: This perspective article reviews findings distilled from the global health literature, policy papers and reports, and leading initiatives such as the Lancet Commission on Global Surgery, National Surgical, Obstetric, and Anesthesia Plans (NSOAPs), and academic partnerships. It reviews pressing issues and solutions aimed at workforce development, research equity, and systems-level policy change. Results: Despite emerging awareness of the importance of surgery in universal health coverage, major gaps remain. Over 20% of public health practitioners lack fundamental knowledge of global surgery, and LMICs produce a minority of surgical research, reinforcing dependence on high-income country (HIC) frameworks. Successful interventions include integrating global surgery into public health curricula, fostering academic "twinning" partnerships, supporting South-South collaborations, and leveraging digital innovations like tele-mentoring and AI-based tools. NSOAPs have shown promise in driving national reforms but remain underfunded and unevenly implemented. However, integrated approaches also face practical challenges, including variable political commitment, competing health priorities, and limited absorptive capacity within under-resourced systems. Conclusion: Bridging global surgical inequities demands a coordinated, decolonial approach linking education, research, and policy. Building local capacity, prioritizing LMIC leadership, and embedding surgical care within broader health systems are essential to achieving sustainable, equitable progress. Global surgery must evolve from fragmented efforts into a cohesive movement that views surgical care as a fundamental human right. Future work should articulate clearer stakeholder-specific strategies, particularly for governments, academic institutions, NGOs, and funders, to ensure that integrated approaches translate into actionable, context-appropriate reforms.