Integrated emergency, critical, and surgical care must be strengthened and scaled up globally, warn authors of a new paper (1) published in the March issue of the Bulletin of the World Health Organization.
Their research found that emergency medical conditions, such as heart attacks and strokes, caused around 27 million deaths and led to the loss of over a billion years of healthy life due to disability or early death (measured as DALYs) world-wide in 2019. Low-income countries were particularly affected.
Operative conditions which require surgical intervention, such as road traffic injuries or cancer, were responsible for nearly 18 million deaths and about 620 million DALYs.
In addition, conditions which fell into both categories, such as postpartum haemorrhaging and appendicitis, resulted in around 7 million deaths and over 300 million DALYs (2).
Dr Rocco Friebel, Director of the Global Surgery Policy Unit at LSE, Associate Professor of Health Policy and lead author of the paper, said: “In 2023 the World Health Organization Member States pledged to strengthen their health systems. Our research underscores the need for health care services to be aligned and connected at all levels, from primary care to specialized tertiary care. This is essential to address a substantial proportion of the world's leading causes of death and morbidity.”
In particular, the research highlights the need for improved rapid, coordinated, and multidisciplinary care for maternal haemorrhage, a leading cause of death among mothers. In 2019, it caused 46,429 deaths and over three million DALYs worldwide. To save lives, immediate resuscitation and potentially surgical procedures, such as uterine artery ligation or hysterectomy, are sometimes necessary.
Similarly, the research identifies appendicitis as an emergency-and-operative condition requiring urgent attention. In 2019, appendicitis accounted for 33,341 deaths and nearly one and a half million DALYs worldwide. Prompt recognition and surgical intervention are essential to prevent severe complications, including perforation and peritonitis.
Dr Rocco Friebel said: “Emergency, critical, and operative conditions impose a significant economic burden, with operative conditions alone projected to result in US$12.3 trillion in lost economic productivity between 2015 and 2030.
“Substantial public and private investment are essential to enhance the planning and provision of these lifesaving care services, ensuring resilient and secure public health systems.”
The researchers call for: