Research Article Open Access Doorley et al., Trop Med Surg 2013, 1:2 DOI: 10.4172/2329-9088.1000113 Review Article Open Access Tropical Medicine & Surgery Volume 1 • Issue 2• 1000114 Trop Med Surg ISSN: 2329-9088 TPMS, an open access journal Keywords: Population distributions; Urbanization; Globalization Introduction In the past two decades, Non-communicable diseases (NCD) have increasingly contributed to the global burden of disease [1]. By 2020 cardiovascular disease will be the leading cause of global mortality. Injury and trauma will be in the top five and cancer will be in the top ten leading causes of global death [2] (Table 1). Many of these disease states have surgical interventions that decrease disability and premature death, and are cost effective solutions even in LICs. Surgical intervention oſten provides treatment, cure or palliation for these conditions and has the potential to decrease disability and improve life quality for patients with these diseases [3]. e social determinants of health- poverty, resource distribution, education, gender, housing, transportation and government-have been well recognized in the public health literature, but have not been specifically applied to specialty and surgical medical care [4]. e work and writings of Paul Farmer have brought communicable diseases like HIV/AIDS and tuberculosis into the social determinants sphere, but the same has not been done with the Non-Communicable Diseases (NCDs) or the growing burden of chronic disease [5]. While the Global Burden of Disease Project (GBD) does not specifically evaluate social contributors to health, it is obvious from the distribution of global disease that countries most impacted by poverty, malnutrition and poor governance are disproportionately affected by disease and have the fewest resources to change this reality [6]. Surgical disease is no exception. Social determinants impact surgical health outcomes and the global burden of disease. Poverty, nutrition, education, and lack of access to health care all contribute to late diagnoses of cancer, preventable trauma deaths and to the lack of expectation for emergency obstetrical services [1]. Political decisions and war influence health outcomes related to surgical disease through the subsequent impact on food distribution, population displacement, and interruption in the existing health systems [7]. Resource allocation on a local and global scale impact access to care and surgical health outcomes [8]. A majority Abstract Population distributions and patterns have evolved over time to emphasize urbanization and globalization. These realities have not been favorable for public health. Similarly patterns of disease have evolved, causing the global burden of disease to change considerably in the last 20 years. Chronic disease and non-communicable disease has replaced infectious disease as the largest contributor to global disability and death. The leading causes of death now include cardiovascular disease, trauma and cancer, and maternal mortality continues to be unacceptably high. The disease patterns emerging require a new approach to diagnosis, treatment and follow up. Non-communicable disease including trauma and cancer, as well as some infectious disease and maternal conditions may be treated, cured or palliated with surgical intervention. These interventions, when immediately available, decrease disability and premature death associated with these conditions. But a majority of this disease occurs in low-income countries where, up until recently, there were few options for surgery and safe anesthesia. The advent of datum supporting the practical and cost-effective role of surgery within global public health mandates a change in planning and delivery of healthcare services in low-income countries. The social determinants of health are well-identified contributors to the health of a population, and certainly impact the outcomes of surgical disease in low-income countries. These factors, nutrition, education, poverty, governance, gender, housing and transportation must be considered and addressed in a new era of non-communicable disease where emergency and essential surgery must be available to insure population health. Social Determinants of the Impact of Surgical Disease on Health Sara L Doorley 1 *, Noemi C Doohan 2 , Sindhura Kodali 3 and Kelly McQueen 4 1 Stanford Medical Center, Board of Directors, Doctors for Global Health, San Jose, CA, USA 2 Director of Family Medicine Inpatient Service, Eisenhower Medical Associates, CA, USA 3 University of Michigan, USA 4 Department of Anesthesiology, Vanderbilt University Medical Center, USA *Corresponding author: Sara L Doorley, Medical Director, Valley Homeless Healthcare Program, Department of Ambulatory Care, Santa Clara Valley Medical Center, Clinical Instructor, Stanford Medical Center, Board of Directors, Doctors for Global Health, San Jose, CA, USA, E-mail: Sara.Doorley@hhs.sccgov.org Received February 27, 2013; Accepted March 19, 2013; Published March 23, 2013 Citation: Doorley SL, Doohan NC, Kodali S, McQueen K (2013) Social Determinants of the Impact of Surgical Disease on Health. Trop Med Surg 1: 113. doi:10.4172/2329-9088.1000113 Copyright: © 2013 Doorley SL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Worldwide DALYs (x 10 6 ) Cum % Ischemic heart disease 1388.8 Unipolar major depression 82.3 5.9 Road-traffic accidents 78.7 11.6 Cerebrovascular disease 61.4 21.1 Chronic obstructive pulmonary disease 57.6 25.3 Lower respiratory infections 42.7 28.4 Tuberculosis 42.5 28.4 War injuries 41.3 34.4 Diarrheal diseases 37.1 37.1 HIV 36.3 39.7 Table 1: Ten projected leading causes of DALYs in 2020 according to baseline projection. T r o p i c a l M e d i c i n e & S u r g e r y ISSN: 2329-9088