“As a nation and as a world, we have to reject the current dogma that surgery is not part of global health,” said Sherry Wren, Stanford Medical Center professor of general surgery, during her TEDx talk at Stanford on Saturday.

Wren said surgery lacks a presence in global health agendas because it is perceived as a costly luxury item and requires more trained personnel.

“It is a commonly held dogma that surgery is expensive and not cost effective,” Wren said. “Anybody in the U.S. with a surgery bill would think it’s expensive.”

But Wren noted that surgery is cost effective. She explained that an average surgery costs between $11 and $33 per disability-adjusted life year, a measure used to assess disease burden. She then compared that to the cost of common public health campaigns like HIV treatment or condom distribution, which both cost hundreds of dollars more per disability-adjusted life year.

Wren said that surgery is a part of basic care as opposed to a luxury item.

Currently, surgery is a luxury item for those in low-income countries. Less than four percent of all surgeries are performed in low-income countries. Two billion people lack access to surgical care, and although one-twenty-fifth of people in the world undergo surgery, 30 percent of that population accounts for 75 percent of the operations, she said.

Wren highlighted the fact that surgery is necessary for basic care, noting that 11 percent of diseases are treatable with surgery. These common diseases or ailments include burns, hernias, cancer, infection, congenital birth defects, gastrointestinal diseases, trauma and maternal-fetal health risks. Ninety percent of injury-related deaths occur in low-income countries, Wren said.

Stressing that surgery should be considered basic care, she asked the audience to consider that one in every four men will have a hernia in his lifetime, amounting to 20 million per year.

Finally, Wren said that a lack of well-trained personnel required by many surgeries is a barrier in considering surgery part of global public health.

At present, a large disparity in number of trained surgeons relative to a country’s population is evident between low and high-income countries, Wren said.

To counteract this disparity, she recommended that developed countries fund surgical training in low-income countries. Wren is currently working with Stanford on a training program in Zimbabwe.

Reducing this disparity in surgeons is vital, Wren said.

“Flying me to Africa to do operations is not a solution to the problem,” she said. “Basic health includes surgical care.”