Opinion: How digital health can bring about equity in global surgery

Moore’s Law, a widely recognized technology principle, predicts that computer processing power doubles approximately every two years. This exponential growth has fueled rapid advancements in various fields, including health care. At the 77th United Nations General Assembly, a digital health strategy called “Stay Left, Shift Left-10x” was introduced. Inspired by Moore’s Law, the 10x aspect of the strategy aims to revolutionize health care by leveraging technology to achieve an exponential improvement in accessibility, affordability, and effectiveness. Stay Left refers to the idea of preventing the need for surgery wherever possible. This involves public health initiatives — promoting healthy lifestyles, disease prevention, and early detection of health conditions; primary care interventions such as strengthening primary health care systems; and preventive surgeries and strategies, such as screenings and early interventions to reduce the need for more complex procedures later. Shift Left refers to decentralizing surgical care and making it more accessible in remote areas. This can involve task shifting and sharing to empower nonphysician health care providers to perform certain tasks traditionally carried out by surgeons, telemedicine, and mobile clinics to bring surgical services to remote communities. By combining these two approaches, the “Stay Left, Shift Left-10x” framework seeks to improve the overall health outcomes of populations, reduce the burden of surgical diseases, and make surgical care more equitable and accessible worldwide. With the emphasis on digital health at UNGA 2024, and the upcoming Devex @UNGA 79 summit’s “Innovating for global health and well-being” track, at a time when access to surgical care is a pressing issue affecting over 5 billion people, it is imperative to harness innovation and digital health as a means of bridging the equity gap. Low- and middle-income countries, or LMICs, are disproportionately affected: 9 in 10 people cannot access basic surgical care. Digital health in global surgery is crucial for improving access and achieving universal health coverage, or UHC, and LMICs present a ripe environment and opportunity for the implementation of several cost-saving and life-saving innovations. The areas below can ensure the rollout of the “Stay Left, Shift Left-10x” framework, catalyzing progress toward equitable global surgery. Simulation Surgical training has rapidly progressed via the use of simulations. For example, a team with members from Ethiopia, Kenya, and Cameroon has created a low-cost, laparoscopic box trainer using locally sourced materials, to train surgeons in “keyhole” or minimally invasive techniques. Similarly, researchers have developed a cost-effective, 3D-printed simulator for laparoscopic surgical training and tested its usability in India. Telementoring Beyond increasing training infrastructure, technology can rapidly enhance connectivity and accessibility, amplifying collaboration and mentorship to improve surgical care delivery in low-resource settings. Now a global company, Proximie is an augmented reality platform first started in Lebanon, which allows surgeons to virtually “scrub in” to any operating room around the world, providing real-time guidance and support. Other similar telementoring platforms have helped train surgeons across global settings, from Brazil to China, in a variety of surgical subspecialties. Diagnostics Innovation and technology in health care can help solve clinical problems such as mortality and poor outcomes. For example, due to limited access and minimal post-op follow-up, surgical site infections, or SSIs, are a leading cause of death in LMICs. To combat this and empower community health care workers, a team in Rwanda is utilizing mobile health and artificial intelligence to detect SSIs based on smartphone thermal cameras. These examples are nonexhaustive and highlight how technology can enhance the continuum of surgical care delivery, from training and workforce building to on-ground diagnostic support — Figure 1. When spearheaded by leaders in LMICs, who benefit from local understanding of need and resource availability, the resulting impact is not only more substantial, but also contextual, affordable, and sustainable. Without an equity lens, however, digital health risks widening disparities in access to care. Strategies such as digital literacy programs, data protection policies, and ethical AI use regulations are essential to ensure equity. Furthermore, aligning infrastructure development with industry innovation, as seen in India’s “digital revolution” following the launch of free internet packages by a major telecom provider, can create sustainable impact across sectors, including health care. Funding the LMIC innovation industry offers a chance to bridge health equity gaps and generate financial returns, but the fragmented economic landscape needs greater private sector involvement. Digital health presents a critical opportunity to enhance accessibility, quality, and efficiency of surgical care in LMICs. However, it requires strategic investment in infrastructure, technologies, and skills development to advance the overall global health agenda. This effort demands collaboration among governments, private sector entities, and international organizations. The United Nations and other international agencies must not only highlight digital health at high-level meetings, but also emphasize the need for equitable access, prioritizing inclusivity in the implementation of digital health strategies, to accelerate progress toward UHC. The future of health care is digital; we must ensure that we leave no one behind. Editor’s note: The authors would like to acknowledge the contributions of Ramya Reddy, Dawn Poh, and Jade Tso during the writing process.