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Global Surgery 2030: a roadmap for high income country actors
  1. Joshua S Ng-Kamstra1,2,
  2. Sarah L M Greenberg2,3,
  3. Fizan Abdullah4,5,
  4. Vanda Amado6,7,
  5. Geoffrey A Anderson2,8,
  6. Matchecane Cossa9,
  7. Ainhoa Costas-Chavarri2,10,
  8. Justine Davies11,
  9. Haile T Debas12,13,
  10. George S M Dyer10,14,
  11. Sarnai Erdene15,
  12. Paul E Farmer16,17,
  13. Amber Gaumnitz17,
  14. Lars Hagander18,
  15. Adil Haider19,20,
  16. Andrew J M Leather21,
  17. Yihan Lin2,22,
  18. Robert Marten23,24,
  19. Jeffrey T Marvin17,
  20. Craig D McClain25,26,
  21. John G Meara2,27,
  22. Mira Meheš28,
  23. Charles Mock29,30,
  24. Swagoto Mukhopadhyay2,31,
  25. Sergelen Orgoi32,33,
  26. Timothy Prestero34,
  27. Raymond R Price35,36,
  28. Nakul P Raykar2,37,
  29. Johanna N Riesel2,38,
  30. Robert Riviello19,39,
  31. Stephen M Rudy40,
  32. Saurabh Saluja2,41,
  33. Richard Sullivan21,42,
  34. John L Tarpley43,44,
  35. Robert H Taylor45,
  36. Louis-Franck Telemaque46,47,
  37. Gabriel Toma2,
  38. Asha Varghese48,
  39. Melanie Walker49,
  40. Gavin Yamey50,
  41. Mark G Shrime2,51
  1. 1Department of Surgery, University of Toronto, Toronto, Canada
  2. 2Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
  3. 3Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  4. 4Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
  5. 5Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  6. 6Department of Surgery, Maputo Central Hospital, Maputo, Mozambique
  7. 7Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
  8. 8Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  9. 9National Program of Surgery, Ministry of Health of Mozambique, Maputo, Mozambique
  10. 10Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
  11. 11The Lancet Diabetes and Endocrinology, London, UK
  12. 12University of California, San Francisco School of Medicine, San Francisco, California, USA
  13. 13University of California Global Health Institute, San Francisco, California, USA
  14. 14Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
  15. 15Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
  16. 16Harvard University, Cambridge, Massachusetts, USA
  17. 17Partners In Health, Boston, Massachusetts, USA
  18. 18Pediatric Surgery, Department of Clinical Sciences in Lund, Division of Pediatrics, Lund University, Lund, Sweden
  19. 19Center for Surgery and Public Health, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
  20. 20Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
  21. 21King's Centre for Global Health, King's Health Partners and King's College London, London, UK
  22. 22Department of Surgery, University of Colorado Faculty of Medicine, Denver, Colorado, USA
  23. 23The Rockefeller Foundation, New York, New York, USA
  24. 24Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  25. 25Department of Anaesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  26. 26Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
  27. 27Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
  28. 28The G4 Alliance, New York, New York, USA
  29. 29Department of Global Health, University of Washington, Seattle, Washington, USA
  30. 30Global Injury Section, Harborview Injury Prevention and Research Centre, Seattle, Washington, USA
  31. 31University of Connecticut School of Medicine Integrated General Surgery Program, Farmington, Connecticut, USA
  32. 32Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
  33. 33WHO Collaborating Centre for Essential Emergency and Surgical Care (MOG1), Ulaanbaatar, Mongolia
  34. 34Design that Matters, Salem, Massachusetts, USA
  35. 35Department of Surgery, Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
  36. 36Intermountain Surgical Specialists, Intermountain Healthcare, Salt Lake City, Utah, USA
  37. 37Department of Surgery, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA
  38. 38Harvard Plastic Surgery Combined Residency Program, Boston, Massachusetts, USA
  39. 39Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
  40. 40Gradian Health Systems Inc, New York, New York, USA
  41. 41Department of Surgery, Weill Cornell Medicine, New York, New York, USA
  42. 42Institute of Cancer Policy, King's College London, London, UK
  43. 43Department of Surgery, Section of Surgical Sciences, Vanderbilt University, Nashville, Tennessee, USA
  44. 44Surgical Service, VA Tennessee Valley Health Care System, Nashville, USA
  45. 45Department of Surgery, Branch for International Surgical Care, University of British Columbia, Vancouver, Canada
  46. 46Department of Surgery, State Medical School, Port-au-Prince, Haiti
  47. 47State University Hospital, Port-au-Prince, Haiti
  48. 48Developing Health Globally, GE Foundation, Fairfield, Connecticut, USA
  49. 49President's Delivery Unit, World Bank Group, Washington DC, USA
  50. 50Duke Global Health Institute, Duke University, Durham, North Carolina, USA
  51. 51Department of Otology and Laryngology and Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  1. Correspondence to Dr Joshua S Ng-Kamstra;{at}


The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.

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