Recommendations for including surgery on the public health agenda.
BACKGROUND
Surgical care has made limited inroads on the public health and global health agendas despite increasing data showing the enormous need. The objective of this study was to survey interested members of a global surgery community to identify patterns of thought regarding barriers to political priority.


METHODS
All active members of the nongovernmental organization Surgeons OverSeas were surveyed and asked why surgical care is not receiving recognition and support on the public health and global health agenda. Responses were categorized using the Shiffman framework on determinants of political priority for global initiatives by two independent investigators, and the number of responses for each of the 11 factors was calculated.


RESULTS
Seventy-five Surgeons OverSeas members replied (75 of 176; 42.6% response rate). A total of 248 individual reasons were collected. The most common responses were related to external frame, defined as public portrayals of the issue (60 of 248; 24.2%), and lack of effective interventions (48 of 248; 19.4%). Least cited reasons related to global governance structure (4 of 248; 2.4%) and policy window (4 of 248; 1.6%).


CONCLUSIONS
This survey of a global surgery community identified a number of barriers to the recognition of surgical care on the global health agenda. Recommendations include improving the public portrayal of the problem; developing effective interventions and seeking strong and charismatic leadership.
Surgeons OverSeas (SOS), New York, New York; Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: evan.wong@mail.mcgill.ca.
Evan G
EG
Wong
Surgeons OverSeas (SOS), New York, New York; Division of Paediatric Surgery, Department of Surgery, Ahmadu Bello University & Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Emmanuel A
EA
Ameh
Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Stanford University, Palo Alto, California.
Sherry M
SM
Wren
Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Wakisa
W
Mulwafu
Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Columbia University, New York, New York.
Mark A
MA
Hardy
Surgeons OverSeas (SOS), New York, New York; Department of Pediatric Surgery, Nationwide Children's, Hospital, Columbus, Ohio.
Benedict C
BC
Nwomeh
Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Columbia University, New York, New York; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Adam L
AL
Kushner
Surgeons OverSeas (SOS), New York, New York; Department of Surgery, Intermountain Health Care, Salt Lake City, Utah; Department of Surgery, University of Utah, Salt Lake City, Utah.
Raymond R
RR
Price
D001291:Attitude of Health Personnel; D014943:Global Health; D019538:Health Care Surveys; D006291:Health Policy; D006292:Health Priorities; D006801:Humans; D011057:Politics; D011634:Public Health; D066231:Surgeons; D013514:Surgical Procedures, Operative
Health priorities; Politics; Public health; Surgery