ASJ Anniversary

7 THE GLEANER | SUNDAY, MARCH 3, 2019 P UBLIC HEALTH may be con- cisely defined as the societal practices geared towards the maintenance and improvement of the health of the population as a whole. These practices involve not only the systems specifically dedi- cated to healthcare, but also social services, such as provision of safe water supply, sanitation, food-safety controls, food security, and even poverty alleviation. In traditional public health prac- tice, there has been greater empha- sis on disease prevention rather than on treatment – for the simple reason that prevention strategies achieve proportionally much greater gains in population health than cura- tive services. This was particularly true in the era in Jamaica when communicable and nutritional illnesses posed the predominant threat to population health. Prevention strategies, including immunisation programmes and the social services mentioned above, have been phenomenally successful in improving population health in Jamaica, enabling us to achieve life expectancy approaching that in de- veloped countries. This success story should not be taken for granted; our successive governments, over the past 60 years, have served us well in this regard, as they remained steadfast in support of progressive public health policy, ideological dif- ferences in approach to governance notwithstanding. In this scenario, surgery, being a curative discipline involving sec- ondary care or treatment after the occurrence of illness, did not play a proportionally major role in im- proving overall population health. Surgery improves the quality of life of individuals afflicted by surgically treatable illness, and, of course, indi- viduals make up a population. But in the era of high infectious dis- ease prevalence, surgical disease constituted a relatively small pro- portion of illnesses in general and, therefore, could not be considered a significant threat to population health. Surgical diseases, which are diseases completely or partially treatable by surgery and excluding obstetric emergencies for the pur- poses of this discussion, include 60 per cent of cancers, orthopaedic and other injuries, diabetic foot compli- cations, blindness from cataracts, congenital abnormalities, and other miscellaneous conditions. But because of local societal changes – such as almost complete reliance onmotor vehicles for trans- portation, the ready availability of guns, which are more destructive implements of interpersonal vio- lence than the population hitherto had access, the ageing of our pop- ulation and the success of public health strategies in controlling communicable diseases – surgical and other non-communicable dis- ease now constitutes a much larger proportion of illnesses in general. This transition from predominantly communicable to non-communi- cable disease as the major threats to population health, referred to in public health jargon as the ep- idemiological transition, occurred in Jamaica towards the end of the 1970s into the 1980s. Except for the threat of reversal of this trend from HIV at the height of the epidemic, now reasonably well controlled, the transition is essentially complete. ‘NEGLECTED STEPCHILD’ Internationally, this trend to- wards an increasing threat to pop- ulation health from surgical disease has been recognised by the World Health Organization (WHO) and World Bank for at least a decade. In 2008, Jim Kim, current president of the World Bank, along with Paul Farmer, a co-founder along with Kim and others of the organisation Partners in Health, made the mo- mentous declaration that “surgery may be thought of as the neglected stepchild of global public health”. The trend is occurring even in pop- ulations that have yet to experience the epidemiological transition, ag- gravated in these poor countries by woefully inadequate surgical ser- vices; a study by Weiser and others published in the journal Lancet in 2008 estimated that the poor- est third of the world’s population receives only 3.5 per cent of the surgical operations undertaken worldwide. So, what do we know about the current ranking of surgical disease as a cause of morbidity in the Jamaican population? There are no statistics available which specifically separate‘surgical disease’fromother The role of surgery and surgeons in public health The evolution of surgical disease as a public health problem PLEASE SEE SURGERY, 8 ASSOCIATION OF SURGEONS IN JAMAICA 60TH ANNIV SARY FEATURE: THE SUNDAY GLEANER MAGAZINE | MARCH 3, 2019