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 worldwide, with low- and middle-income countries carrying a disproportionately large part. Policy initiatives such as the National Surgical, Obstetrics and Anesthesia Plans and Comprehensive Policy Recommendations for the Management of Spina Bifida and Hydrocephalus in Low-and-Middle-Income countries 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 show 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 affects LMICs. Countries such as Colombia and India have shown the importance of legislation and enforcement, coupled with robust data collection and auditing systems; strong academic advocacy of neurosurgeons can drastically reduce TBIs. Despite the importance of public health efforts in addressing neurosurgical conditions, there is a 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.

Diversity in Neurosurgery: Trends in Gender and Racial/Ethnic Representation Among Applicants and Residents from U.S. Neurological Surgery Residency Programs.

OBJECTIVE: To assess trends in gender, racial, and ethnic diversity of applicant pools and subsequent resident cohorts in neurosurgical residency programs in the United States. METHODS: Applicant and residency data from 2009 to 2018 were analyzed from the Electronic Residency Application Service, Journal of the American Medical Association, and National Resident Matching Program to evaluate trends in diversity. RESULTS: There was no statistically significant difference between applicant sex from 2009 to 2013 compared with 2014 to 2018 (P > 0.05). From 2009 to 2018, the percentage of female residents saw a statistically significant increase from 12.9% to 17.5% but remained less reflective of women's representativeness in the United States (50.8%). The percentage of Black and Hispanic applicants decreased across the observed period (4% and 1%, respectively). While Black people represented 5.2% of the resident pool in 2009, this decreased to 4.95% by 2018. Hispanic residents saw a <2% net increase (5.5% to 7.2%) in resident representation but still fell behind when compared with census statistics. The application pool did not see a significant change in the percentage of White and Asian applicants; however, the percentage of residents did decrease slightly over the observed decade. CONCLUSIONS: Current efforts to improve racial and ethnic diversity have not been sufficient in generating parity in the recruitment and retention of racially underrepresented groups in neurosurgery. Although the presence of women in applicant and resident pools has increased, not much is known about the impact on women who also identify within racially underrepresented groups. More proactive measures for recruitment and retention are needed to reach equity in the future neurosurgical workforce.