Global neurosurgery in the context of Global Public Health Practice - a literature review of case studies

Neurosurgical conditions are a substantial contributor to surgical burden in the world, with LMICs carrying a disproportionately large part. Policy initiatives such as the National Surgical, Obstetrics and Anesthesia Plans (NSOAPs) and CHYSPR have highlighted the need for an intersectoral approach, not just at the hospital level but on a large scale encompassing national public health strategies. This article aims to illustrate through case studies, how addressing this surgical burden is not limited to the clinical context but extends to public health strategies as well. For example, vitamin B12 and folic acid are micronutrients that, if not at adequate levels, can result in debilitating neurosurgical conditions. In Ethiopia, through coalesced efforts between neurosurgeons and policy makers, the government has made strides in implementing food fortification programs at a national level to address the neurosurgical burden. Traumatic brain injuries (TBIs) are another neurosurgical burden that unevenly affect LMICs. Countries such as Colombia and India have demonstrated the importance of legislation and enforcement, coupled with robust data collection and auditing systems and strong academic advocacy of neurosurgeons can drastically reduce TBIs. Despite the importance of public health efforts in addressing neurosurgical conditions, there is lack of neurosurgeon involvement in public health and lack of integration of neurosurgical burden in national health planning systems. It is imperative that neurosurgeons advocate for and are included in aspects of public health policy. Neurosurgery does not stop within the bounds of the hospital, and neither should the role of a neurosurgeon