Burden, need, or backlog: a call for improved metrics for the global burden of surgical disease

The global burden of disease (GBD) has been measured primarily through the use of the DALY metric. Using this approach, preliminary estimates were that 11% of the GBD is surgical. However, prior work has questioned specific aspects of the GBD methodology as well as its practicality. This paper refines other conceptual approaches based on met and unmet population need for services by considering incident and prevalent need as well as backlogs for treatment that can inform effective coverage of services. Some of these methods are tested using the example of surgical repair of cleft lip and palate. Measurement of disability incurred by delays in care may also be estimated through these approaches and has not previously been estimated through a validated model. These concepts may provide more practical information for individuals and organizations to advocate for scaling up surgical programs. While many surgical conditions are unique, as a single intervention can lead to cure, these concepts may also prove useful for non-surgical diseases. Further exploration of these approaches is merited in resource-limited settings.