Global Surgery at the National Landscape: Perspectives after the XXXIV Brazilian Congress of Surgery

ABSTRACT The XXXIV Brazilian Congress of Surgery included Global Surgery for the first time in its scientific program. Global Surgery is any action in research, clinical practice, and policy-making that aims to improve access and quality of care in surgical specialties. In 2015, The Lancet Commission on Global Surgery highlighted that five billion people lack safe, timely, and affordable surgical care. Even more critical, nine of ten people cannot access essential surgical care in low and middle-income countries, where a third of the worldwide population resides, and only 6% of global surgical procedures are performed. Although Brazilian researchers and institutions have been contributing to lay the movement’s foundations since 2014, Global Surgery remains a barely debated subject in the country. It is urgent to expand the field and break paradigms regarding the surgeons’ role in public health in Brazil. Accomplishing these standards requires a joint effort to strategically allocate resources and identify collaboration opportunities, including those from medical societies and regulatory bodies. As members of the International Student Surgical Network of Brazil - a nonprofit organization by and for students, residents, and young physicians focused on Global Surgery - we review why investing in surgery is cost-effective to strengthen health systems, reduce morbimortality, and lead to economic development. Additionally, we highlight and propose key recommendations to foster the field at the national level.


INTRODUCTION
T he XXXIV Brazilian Congress of Surgery started on the 2 nd of September 2021 and highlighted different tools to facilitate the daily clinical-surgical practice of general surgeons.Amidst round tables and panels, the almost centenary Brazilian College of Surgeons included Global Surgery as a topic for the first time with the session "Global Surgery: Promoting Equity in Access to Surgical Care".Indeed, Global Surgery is an emerging and seldom debated subject in our country, even though Brazilian researchers and institutions have been contributing to lay the movement's international and national foundations since 2014.Seven years later, there is still an urgency to expand Global Surgery and break paradigms regarding the surgeons' role in public health in Brazil.

A B S T R A C T A B S T R A C T
The XXXIV Brazilian Congress of Surgery included Global Surgery for the first time in its scientific program.Global Surgery is any action in research, clinical practice, and policy-making that aims to improve access and quality of care in surgical specialties.In 2015, The Lancet Commission on Global Surgery highlighted that five billion people lack safe, timely, and affordable surgical care.Even more critical, nine of ten people cannot access essential surgical care in low and middle-income countries, where a third of the worldwide population resides, and only 6% of global surgical procedures are performed.Although Brazilian researchers and institutions have been contributing to lay the movement's foundations since 2014, Global Surgery remains a barely debated subject in the country.It is urgent to expand the field and break paradigms regarding the surgeons' role in public health in Brazil.Accomplishing these standards requires a joint effort to strategically allocate resources and identify collaboration opportunities, including those from medical societies and regulatory bodies.As members of the International Student Surgical Network of Brazil -a nonprofit organization by and for students, residents, and young physicians focused on Global Surgery -we review why investing in surgery is cost-effective to strengthen health systems, reduce morbimortality, and lead to economic development.Additionally, we highlight and propose key recommendations to foster the field at the national level.
Keywords: Global Health Strategies.Health Equity.Quality Indicators, Health Care.Health Workforce.
Surgery highlighted that five billion people lack safe, timely, and affordable surgical care.Even more critical, nine of ten people cannot access essential surgical care in low-and middle-income countries -(LMICs), where a third of the world's population resides and only 6% of global surgical procedures are performed 1,2 7 .Another hazard is related to the higher density of professionals in the private sector, while 71,5% of Brazilians depend exclusively on the public health system 7 .Also, the burden of diseases is changing in Brazil, without being followed by the Ministry of Health priority agenda.Even though infectious diseases are no longer the leading causes of mortality, they remain a priority for funding and policies.
In contrast, surgical conditions, such as trauma, remain the leading cause of morbidity and do not appear on the public health agenda 6