The future of surgical care advocacy at the United Nations General Assembly: The last stretch to 2030

Sir,

The annual meeting of the 78th United Nations (UN) General Assembly in September 2023 is the first to be held since the UN's health entity, the World Health Organization (WHO), declared “with great hope” the end of coronavirus disease 2019 as a global public health emergency. ¹ Taking place were three health-related High-Level Meetings on pandemic prevention, preparedness, and response (PPPR), universal health coverage (UHC), and the fight against tuberculosis, ² and ongoing preparations for an upcoming high-level meeting on anti-microbial resistance in 2024. ³ The outcomes of these meetings will be political declarations—documents that represent the commitments of UN Member States at the highest level of government. ² These meetings build upon a longer standing commitment of the UN toward ensuring health for all.

In 2012, world leaders met in Rio de Janeiro to kick-start the post-2015 agenda on sustainable development, ⁴ a process that would eventually lead to the launch of the Sustainable Development Goals (SDGs), a set of 17 goals to be met by all countries by 2030. Goal number 3 “Ensure healthy lives and promote well-being at all ages” contains a list of targets and indicators ranging from fighting malaria to decreasing neonatal mortality and achieving UHC. ⁵ A notably absent topic however in the SDGs is increasing access to surgical care. This flaw in the SDGs has been partially rectified by a resolution voted by the World Health Assembly, WHA68.15 which established surgical care as a component of UHC. ⁶

None of this year's High-Level Meetings target surgical care directly, however all of them tackle issues that are of great importance to health care systems globally and to the daily practice of surgical providers. The systems that deliver surgical care – including but not limited to the workforce, infrastructure, and health delivery processes – play a unique role in linking the PPPR and health security agenda to the advancement of UHC based on a primary health care approach.

Advocacy for surgical care has been taking place at the UN for over a decade, but experiences on the ground have shown that they tend to be fragmented and lack clear direction. ⁷ Consensus on which policy priorities deserve the most attention is lacking within the surgical community, and so is a deep understanding of UN processes and civil society engagement structures. Organizations such as the NCD Alliance ⁸ and the Partnership for Maternal, Newborn, and Child Health ⁹ do not have an equivalent in the surgical community to this day. Additionally, although these highly networked organizations cover a wide range of diseases that sometimes require surgical intervention, their advocacy efforts are not directly aimed to address the political and practical challenges of strengthening surgical care. As such, targeted and structured surgical advocacy is necessary at every level at the UN.

The increasing number of health-related meetings at the UN over the years, and an upcoming “Summit on the Future” where future challenges and targets will be discussed, signal growing attention on health at the UN. ¹⁰ The need for informed participation by health experts in these meetings and environments will only increase, and there is an important role for the surgical workforce in assuring that their patients are not forgotten in the political commitments our governments make. Examples of advocacy opportunities include making sure that surgical diseases are included in data collection efforts and that surgical care is specifically named in financial commitments, and advocating for health workforce education and training to better serve our surgical patients.

The UN offers numerous pathways for allowing the voices of health care providers to be heard. Given the fragmented nature of surgical advocacy, a multifaceted approach will be needed to ensure proper engagement of the surgical community in health prioritization within the UN system. Concretely we want to make the surgical and non-surgical community aware of the following paths to advocate for surgical care:

- Join a webinar or formal course on policy and advocacy to understand the functioning of important policy-generating institutions and potential avenues for contribution.

With an increasing number of health challenges globally, the time for the surgical community to act is now. It will require a bold effort from the surgical workforce to listen, learn and be present in these spaces, and to convince the UN system of our important role in health advocacy. An outstretched hand from the surgical community can go a long way in making health for all a reality in the next decade.