Global surgery health impact pyramid

As collaborative efforts grow to decrease the global burden of surgical disease, several models have emerged with varying levels of investment, impact and unique potential pitfalls. We apply the Public Health Impact Pyramid to the classification of current models in global surgery to inform how individuals and groups can partake in these efforts relative to their interests, abilities, and resources. A narrative review of the literature was performed using keywords associated with global surgery care models. A total of 30 articles were identified and sorted into categories corresponding to levels of the Public Health Impact Pyramid to create the Global Surgery Health Impact Pyramid. For each level of the pyramid, the literature was synthesized to describe the range of impact, level of investment, advantages, and disadvantages of each effort, as well as examples of the described models. The Global Surgery Health Impact Pyramid is a 5-tier pyramid with interventions at the apex of the pyramid involving a more direct, hands-on approach to patient care with greater individual impact but less time and resource commitment and less sustainability. Descending the pyramid are models with increasing impact potential but larger corresponding commitments. These models have greater potential for population impact and sustainability but involve greater initiative and investment due to the required infrastructure building. These models from the apex to the base are short-term surgical missions, resource provision, long-term surgical missions, twinning partnerships, and health policy and advocacy. While not comprehensive of all existing models, the Global Surgery Health Impact Pyramid illustrates a representation of current models in global surgery, how each uniquely contributes to decreasing the burden of global surgical disease and fit into each other, and how an individual or group can partake in these efforts while recognizing the potential pitfalls of each model.