Anesthesiology and Global Health

Globalization has connected people, markets and governments all over the world; thus, health policy has become an international issue.¹ This includes promoting health across borders and assisting countries in assessing and acting on international public health risks.¹ Global health initiatives range from non-governmental organizations² to governmental institutions³ to humanitarian programs such as Médecins Sans Frontières (Doctors Without Borders).⁴ As clinicians who are crucial to pain management and surgical procedures, anesthesia providers should be familiar with global health issues and associated organizations, types of global health efforts and anesthesiology professionals’ roles in global health care. 

Global health issues change constantly depending on patterns of infectious diseases, humanitarian crises or environmental factors.⁵ According to the World Health Organization (WHO), ten of the main global health issues in 2019 were air pollution and climate change, noncommunicable diseases such as diabetes and cancer, the global influenza pandemic, places with little access to health care, antimicrobial resistance from medication overuse, Ebola and other high-threat pathogens, weak primary health care, vaccine refusal, dengue fever and HIV.⁵ The WHO has a five-year plan with three main “billion” targets: one billion more people to benefit from universal health coverage, one billion more people better protected from health emergencies and one billion more people enjoying better health and well-being.⁶ Nongovernmental organizations (NGOs) working in global health include international organizations, such as the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Bank and the World Health Organization; scientific organizations such as the American Society of Tropical Medicine and Hygiene (ASTMH), the Consortium of Universities for Global Health (CUGH), the International Society for Infectious Diseases (ISID) and the International Diabetes Federation (IDF); advocacy/policy organizations such as the Earth Institute or the Global Alliance for Chronic Diseases (GACD); foundations such as the Bill and Melinda Gates Foundation and UN Foundation (UNF); and resources such as the Institute for Health Metrics and Evaluation (IMHE) and Worldmapper.⁷ 

Global health efforts often aim to improve health outcomes in low- and middle-income countries (LMICs) by strengthening health systems, which entails global investment and national intervention.⁸ At the national level, health systems improvement involves increasing capacity to manage and deliver services, situating interventions firmly within national strategies, ensuring effective implementation and coordinating external support with local resources.⁸ Countries have been collaborating to tackle health issues with specific interventions for centuries.⁹ For example, in the mid-1800s, several countries negotiated international agreements on how to combat cross-border outbreaks of diseases such as cholera and yellow fever.⁹ Among other historical milestones, the WHO was founded in 1948, the Alma-Ata Declaration of 1978 brought the focus of global health to primary care and the Global Fund to Fight AIDS, Tuberculosis and Malaria was established in 2002.¹⁰ Noncommunicable diseases, injuries and mental health have required more attention in contemporary global health efforts,¹¹ which include medical and non-medical work in the field for expatriates¹² and in-country policy changes.¹¹ 

Anesthesia providers play a crucial role in global health efforts.¹³ Surgical disease is an important cause of death and disability in LMICs; however, there remains a shortage of trained anesthesia providers in LMICs who can respond to the need for surgical care.¹³ In today’s highly connected world, application- and technology-based health solutions may expand surgical services, improve patient care and increase patient education within anesthesiology.¹⁴ Anesthesiology practitioners may focus on teaching and providing anesthesia care in a country’s teaching hospitals¹⁵ or contribute to life-supporting care during disaster management.¹⁶ Though improvements in anesthesiology are vital to global health efforts, the relationship between global health and anesthesia care remains ill-defined and unappreciated.¹⁷ Global health education in anesthesiology residency is inconsistent in program structure, goals, curricula and funding.¹⁸ In the future, outreach programs for anesthesiology residents or fellows may allow them to explore global health work and reduce the work-related barriers associated with global health care participation.¹⁹ 

As people all over the world connect through technology and travel, international health systems improvement becomes a main focus of health care efforts. Global health challenges cross borders and are constantly changing, with organizations targeting a variety of diseases and environmental issues throughout different regions. As the need for surgery rises, anesthesia providers become more vital to global health efforts. In the future, anesthesiology professionals should investigate global health curricula and opportunities for anesthesia providers to participate in global health work. 

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19.McCunn M, Speck RM, Chung I, Atkins JH, Raiten JM, Fleisher LA. Global health outreach during anesthesiology residency in the United States: A survey of interest, barriers to participation, and proposed solutions. Journal of Clinical Anesthesia. 2012;24(1):38–43.