Discussion with Dr. Walter Johnson, Lead of EESC, WHO

Dr. Johnson is the Lead of Emergency and Essential Surgical Care Program at the World Health Organisation in Geneva, Switzerland, and also a neurosurgeon.

The same day, Research Associates Luke Caddell, Robbie Patterson, Taylor Wurdeman and Joanna Ashby were excited to launch the PGSSC podcast series. Dr Johnson was able to join us for the interview. You can listen to the podcast here and watch the following clips:

• What is global surgery?

• The global need for surgical care

• Dr Walt Johnson's pathway to Global Surgery

Dr. Johnson and PGSSC Research Associates Taylor Wurdeman, Joanna Ashby and Robbie Patterson

Five things we learned from the talk and interview:

1. What is Dr. Johnson’s role at WHO and where else has he travelled and lived?

Dr. Walter Johnson has worked part-time at WHO since 2012, joining WHO full time in 2015. His primary responsibility is fulfilling the mandates of WHA Resolution 68.15 on strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage.

Dr Johnson completed his medical degree at Loma Linda University in California, a Neurosurgery residency at SUNY-Brooklyn, followed by a cerebrovascular/skull base fellowship at UCLA. His career has been in academic Neurosurgery and he was Vice-chairman of Neurosurgery at Loma Linda University until 2009.

He has been involved with Global Surgery during the majority of his career, teaching as visiting professor in Hangzhou, China for several years, and being directly involved in developing general surgery residency training programs throughout Africa, training African physicians to become surgeons. Dr. Johnson also holds a Masters degree in Business Administration from the Peter F. Drucker and Masatoshi Ito School of Management at Claremont Graduate University in California, as well as a Masters in Public Health from that same institution.

2. What is the EESC program at WHO and where does surgery fit in?

The Emergency and Essential Surgical Care Program (EESC) cuts across a wide variety of vertical initiatives which each include components of surgical care, such as maternal and child health, male circumcision to prevent HIV transmission, violence and injury prevention, and many others.

Activities have been focused at the country level, and have encouraged collaboration between WHO, ministries of health, and both local and international partners.

Johnson is the one lead focusing on global surgery. The goal is to strengthen local and country health care systems by better integrating emergency and essential surgical care and anesthesia into health system strengthening activities.

Prioritizing global surgery can only be accomplished through the collaborative efforts of multiple stakeholders with the ultimate goal to bring safe, timely and affordable surgical care to low- and middle-income countries through high-performing surgical healthcare systems and workforce.

3. There is still no global fund for surgery

Despite the incredible need for funding to address surgical disease globally, there is still no annual budget dedicated to surgery despite the associated annual 17 million deaths.

Proportionate need - deaths per year (millions) and annual budget

The Global health financing diagram below shows the flows of money from source to health focus area (WHO, 2017).

4. Political prioritization in global surgery is key, especially when it comes to cancer control

Surgeons need to advocate for their patients around the world, especially with regard to cancer control. When comparing surgery, radiotherapy and systemic therapy with regard to cancer control, surgery is the intervention that is in greatest need, with highest impact, and lowest cost.

Political prioritization of surgery

5. Prevention by stronger public health action is an important next step

Some of these include:

• tobacco control for lung cancer

• alcohol control for respiratory and digestive cancers

• Hepatitis B vaccine for liver cancer

• HPV vaccine for cervical cancer

• better nutrition and weight control for colorectal cancer.

And finally, it is important to improve access to surgical oncology services.

Thank you Dr. Johnson for joining us in Boston and for sharing this valuable insight into the higher-level workings at WHO that are so essential to prioritizing surgery globally.

You can follow Dr. Johnson on twitter at @drwaltjohnson

Podcast with Dr Johnson