title: Surgery, public health, and Pakistan.
abstract: BACKGROUND
  Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly.
  
  
  METHODS
  We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect.
  
  
  RESULTS
  Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent.
  
  
  CONCLUSIONS
  Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.
authors.affiliation: Department of Surgery, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan. zafar.nabeel@gmail.com
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.forename: K A Kelly
authors.initials: KA
authors.lastname: McQueen
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D010154:Pakistan; D011634:Public Health / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000592:standards*