Levelling up: prioritisation of global health

Trauma has been described as “The forgotten pandemic” (Rossiter in Int Orthop 46:3–11, 2022 10.1007/s00264-021055213-z) or “The hidden pandemic” (Graham SM, Laubscher M, Lalloo DG, Harrison WJ, Maqungo S in The Surg, 20, 231–236. 10.1016/j.surg.2021.04.005, 2022). If you add all deaths and disability from all contagious disease including: HIV, TB, malaria and COVID-19 these do not come close to the numbers affected annually from trauma/injury (Rossiter in Int Orthop 46:3–11, 2022; Annual deaths from the WHO Global Health Observatory (25); in: Preventing Injuries and Violence: A Guide for Ministries of Health, WHO, Geneva, 26). Prior to the present pandemic contagious disease received approximately 35% of global healthcare spending, whilst trauma received just 1% (Wesson et al. in Health Policy Plan 29:795–808, 2014). The global healthcare spending on contagious disease in the last two years has doubled and that of trauma has proportionately decreased, highlighting the significant issue of prioritisation of healthcare globally. Trauma is the greatest cause of mortality and morbidity in the 5 to 30 age group (Wesson et al. in Health Policy Plan 29:795–808, 2014). Most of the world lives in a country where the majority of the population are under the age of 35, the working population, who are disproportionately affected by trauma. Investment into trauma/injury could dramatically improve the GDP of that country and the situation of the population (https://www.thinkglobalhealth.org/article/golden-hour-critical-time-between-life-and-death). It is also estimated that 5 billion people globally lack “Available Accessible Acceptable & Quality” (the AAAQ framework) Surgical Obstetric Trauma & Anaesthetic (SOTA) (Meara JG et al. in Lancet, 386(9993):569–624. 10.1016/S0140-6736(15)60160-X, 2015). Access to this care is an agreed human right (Price R, Makasa E, Hollands M in World J Surg, 39(9):2115–25. 10.1007/s00268-015-3153-y. PMID: 26239773, 2015). It forms part of the 17 Millennium Sustainable Development Goals from the United Nations to be achieved within 20 years (https://sdgs.un.org/goals#goals). By 2014, it was recognised that AAAQ SOTA care was not going to be achieved within the next 5 years and so the G4 Alliance was born with the aim of achieving this by 2030 (https://www.theg4alliance.org).