Anesthesia and Global Health Equity

More than 5 billion of the world’s 7 billion people lack access to safe anesthesia and surgical services, and a similarly large proportion also lack access to critical care and oxygen. Surgical disease accounts for 30% of the global disease burden, yet less than 1% of development assistance for health supports the delivery of anesthesia and surgical care. Lack of access to safe anesthesia, analgesia, and surgical services is among the most neglected global public health crises and sources of health disparities for both rich and poor countries. Pain is one of the top causes of morbidity worldwide, yet 5.5 billion people have limited or no access to narcotic medications for analgesia. Key drug control policies, organizations, and politics continue to influence issues of access and abuse, with disproportionately negative impacts on poor communities. Critical shortages and the inequitable distribution of anesthesia providers are significant barriers to increasing access to safe anesthesia, surgical care, and critical care. The density of surgery, anesthesia, and obstetric providers is 0.7 per 100,000 population for low-income countries as compared with 57 per 100,000 population for high-income countries. Anesthesia, analgesia, and surgical services are feasible in resource-constrained settings and are as cost-effective as many other public health interventions (e.g., vaccinations). Preparing anesthesia providers with the knowledge and skills needed to address global health equity challenges in anesthesia will become increasingly important to expand access to safe and affordable anesthesia, surgery, and critical care around the world and in our own towns. The global anesthesia community is lagging behind other health disciplines in addressing global health disparities. It must rapidly expand investment in initiatives to help characterize (research), address (implementation and policy), and support (financing) global health challenges.