Violence Against Women

Violence against women has been defined as: "physical, sexual and psychological violence occurring in the family and in the general community, including battering, sexual abuse, dowry-related violence, rape, female genital mutilation and other traditional practices harmful to women, non-spousal violence and violence related to exploitation, sexual harassment and intimidation at work, in educational institutions and elsewhere, trafficking in women, forced prostitution and violence perpetrated or condoned by the state."[102] In addition to causing injury, violence may increase "women's long-term risk of a number of other health problems, including chronic pain, physical disability, drug and alcohol abuse, and depression".[103] The WHO Report on global and regional estimates on violence against women found that partner abuse causes women to have 16% more chances of suffering miscarriages, 41% more occurrences of pre-term birth babies and twice the likeliness of having abortions and acquiring HIV or other STDs[104]

Although statistics can be difficult to obtain as many cases go unreported, it is estimated that one in every five women faces some form of violence during her lifetime, in some cases leading to serious injury or even death.[105] Risk factors for being an offender include low education, past exposure to child maltreatment or witnessing violence between parents, harmful use of alcohol, attitudes accepting of violence, and gender inequality.[106] Equality of women has been addressed in the Millennium Development Goals. Now, gender equality is Sustainable Development Goal 5. Preventing the violence against women needs to form an essential part of the public health reforms in the form of advocation and evidence gathering. Primary prevention in the form of raising women economic empowerment facilities, microfinance and skills training social projects related to gender equality should be conducted.

Activities promoting relationship and communication skills among couples, reducing alcohol access and altering societal ideologies should be organized. Childhood interventions, community and school-based education, raising media-oriented awareness and other approaches should be carried out to challenge social norms and stereotypical thought processes to promote behavioral change among men and raise gender equality. Trained health care providers would play a vital role in secondary and tertiary prevention of abuse by performing early identification of women suffering from violence and contributing to the addressing of their health and psychological needs. They could be highly important in prevention of the recurrence of violence and the mitigation of its effects on the health of the abused women and their children.[107] The Member States of the World Health Assembly endorsed a plan in 2016 for reinforcing the health system's role in addressing the global phenomenon of violence against women and girls and working towards their health and protection.[108]

Global surgery

Halfdan T. Mahler, the 3rd Director-General of the World Health Organization (WHO), first brought attention to the disparities in surgery and surgical care when he stated, "the vast majority of the world's population has no access whatsoever to skilled surgical care and little is being done to find a solution".[109]

While significant progresses have been made in fields within global health such as infectious diseases, maternal and child health, and even other non-communicable diseases over the past several decades, the provision of surgery and surgical care in resource-limited settings have largely remained unmet with about 5 billion people lacking access to safe and affordable surgical and anesthesia care.[110] This is especially true in the poorest countries, which account for over one-third of the population but only 3.5% of all surgeries that occur worldwide.[111] In fact, it has been estimated that up to 30% of the total global burden of disease (GBD) could be attributable to surgical conditions, which include a mix of injuries, malignancies, congenital anomalies, and complications of pregnancy.[112][113] As a result, global surgery has become an emerging field within global health as "the multidisciplinary enterprise of providing improved and equitable surgical care to the world's population, with its core belief as the issues of need, access and quality" and has often been described as the "neglected stepchild of global health", a term coined by Dr. Paul Farmer to highlight the urgent need for further work in this area.[114][115] Furthermore, Jim Young Kim, the former President of the World Bank, proclaimed in 2014 that "surgery is an indivisible, indispensable part of health care and of progress towards universal health coverage."[116]

In 2015, the Lancet Commission on Global Surgery (LCoGS) published the landmark report titled "Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development", describing the large, pre-existing burden of surgical diseases in low- and middle-income countries (LMICs) and future directions for increasing universal access to safe surgery by the year 2030.[110] The Commission highlighted that 143 million additional procedures were needed every year to prevent further morbidity and mortality from treatable surgical conditions as well as a $12.3 trillion loss in economic productivity by the year 2030.[110] It emphasized the need to significantly improve the capacity for Bellwether procedures — laparotomy, caesarean section, open fracture care — which are considered a minimum level of care that first-level hospitals should be able to provide in order to capture the most basic emergency surgical care.[110][117] In order to address these challenges and track progress, the Commission defined the following core indicators for assessing access to safe and affordable surgical d anesthesia care:[110]