change among men and raise gender equality. trained health care providers would play a vital role in secondary and tertiary prevention of abuse by performing early identification of women suffering from violence and contributing to the addressing of their health and psychological needs. they could be highly important in prevention of the recurrence of violence and the mitigation of its effects on the health of the abused women and their children. the member states of the world health assembly endorsed a plan in 2016 for reinforcing the health system's role in addressing the global phenomenon of violence against women and girls and working towards their health and protection. global surgery halfdan t. mahler, the 3rd director-general of the world health organization (who), first brought attention to the disparities in surgery and surgical care when he stated, "‘the vast majority of the world’s population has no access whatsoever to skilled surgical care and little is being done to find a solution,". while significant progresses have been made in fields within global health such as infectious diseases, maternal and child health, and even other non-communicable diseases over the past several decades, the provision of surgery and surgical care in resource-limited settings have largely remained unmet with about 5 billion people lacking access to safe and affordable surgical and anesthesia care. this is especially true in the poorest countries, which account for over one-third of the population but only 3.5% of all surgeries that occur worldwide. in fact, it has been estimated that up to 30% of the total global burden of disease (gbd) could be attributable to surgical conditions, which include a mix of injuries, malignancies, congenital anomalies, and complications of pregnancy. as a result, global surgery has become an emerging field within global health as 'the multidisciplinary enterprise of providing improved and equitable surgical care to the world's population, with its core belief as the issues of need, access and quality' and has often been described as the 'neglected stepchild of global health,' a term coined by dr. paul farmer to highlight the urgent need for further work in this area. furthermore, jim young kim, the former president of the world bank, proclaimed in 2014 that “surgery is an indivisible, indispensable part of health care and of progress towards universal health coverage." in 2015, the lancet commission on global surgery (lcogs) published the landmark report titled "global surgery 2030: evidence and solutions for achieving health, welfare, and economic development," describing the large, pre-existing burden of surgical diseases in low- and middle-income countries (lmics) and future directions for increasing universal access to safe surgery by the year 2030. the commission highlighted that 143 million additional procedures were needed every year to prevent further morbidity and mortality from treatable surgical conditions as well as a $12.3 trillion loss in economic productivity by the year 2030. it emphasized the need to significantly improve the capacity for bellwether procedures – laparotomy, caesarean section, open fracture care – which are considered a minimum level of care that first-level hospitals should be able to provide in order to capture the most basic emergency surgical care. in order to address these challenges and track progress, the commission defined the following core indicators for assessing access to safe and affordable surgical d anesthesia care: core indicators definition target access to timely essential surgery the proportion of the population that can access, within 2 hours, a facility that can do cesarean delivery, laparotomy, and treatment of open fracture (the bellwether procedures) a minimum of 80% coverage of essential surgical and anesthesia services per country by 2030 specialist surgical workforce density the number of specialist surgical, anaesthetic, and obstetric physicians who are working, per 100,000 population 100% of countries with at least 20 surgical, anaesthetic, and obstetric physicians per 100, 000 population by 2030 surgical volume the number of procedures done in an operating theatre, per 100,000 population per year 80% of countries by 2020 and 100% of countries by 2030 tracking surgical volume; a minimum of 5000 procedures per 100,000 population by 2030 perioperative mortality all-cause death rate before discharge in patients who have undergone a procedure in an operating theatre, divided by the total number of procedures, presented as a percentage 80% of countries by 2020 and 100% of countries by 2030 tracking perioperative mortality; in 2020, assess global data and set national targets for 2030 protection against impoverishing expenditure the proportion of households protected against impoverishment from direct out-of-pocket payments for surgical and anesthesia care 100% protection against impoverishment from out-of-pocket payments for surgical and anaesthesia care by 2030 protection against catastrophic expenditure the proportion of households protected against catastrophic expenditure from direct out-of-pocket payments for surgical and anesthesia care 100% protection against catastrophic expenditure from out-of-pocket payments for surgical and anaesthesia care by 2030 meeting these goals by the year 2030 would require increases in anesthetists, obstetricians, surgeons, nurses, and facilities with operating rooms as well as pre- and post-surgical care capacities. data from who and the world bank indicate that scaling up infrastructure to enable access to surgical care in regions where it is currently limited or is non-existent is a low-cost measure relative to the significant morbidity and mortality caused by lack of surgical treatment. in fact, a systematic review found that the cost-effectiveness ratio – dollars spent per dalys averted – for surgical interventions is on par or exceeds those of major public health interventions such as oral rehydration therapy, breastfeeding promotion, and even hiv/aids antiretroviral therapy. this finding challenged the common misconception that surgical care is financially prohibitive endeavor not worth pursuing in lmics. in terms of the financial impact on the patients, the lack of adequate surgical and anesthesia care has resulted in 33 million individuals every year facing catastrophic health expenditure – the out-of-pocket healthcare cost exceeding 40% of a given household's income. in alignment with the lcogs call for action, the world health assembly adopted the resolution wha68.15 in 2015 that stated, "strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage." this not only mandated the who to prioritize strengthening the surgical and anesthesia care globally, but also led to governments of the member states recognizing the urgent need for increasing capacity in surgery and anesthesia. additionally, the third edition of disease control priorities (dcp3), published in 2015 by the world bank, declared surgery as essential and featured an entire volume dedicated to building surgical capacity. a key policy framework that arose from this renewed global commitment towards surgical care worldwide is the national surgical obstetric and anesthesia plan (nsoap). nsoap focuses on policy-to-action capacity building for surgical care with tangible steps as follows: (1) analysis of baseline indicators, (2) partnership with local champions, (3) broad stakeholder engagement, (4) consensus building and synthesis of ideas, (5) language refinement, (6) costing, (7) dissemination, and (8) implementation. this approach has been widely adopted and has served as guiding principles between international collaborators and local institutions and governments. successful implementations have allowed for sustainability in terms of longterm monitoring, quality improvement, and continued political and financial support. the nihr global health research unit on global surgery seven surgical research hubs in benin, ghana, india, mexico, nigeria, rwanda and south africa with an extensive network of urban and rural ‘spoke’ hospitals have joined to create the nihr. the nihr global health research unit on global surgery is led by the university of birmingham which provides overall oversight in relation to the unit strategy, infrastructure and delivery, research and finance. the network prioritized surgical topics that needed research and has performed multiple surgical studies. the network resulted in many research groups including globalsurg i, ii, iii and covidsurg and many other trials with worldwide collaborations as project falcon and cheetah. the research was published in over 40 articles in high impact journals in topics like surgical site infections, covid-19 and mortality. other global surgery collaborations more trials have emerged to assess surgical outcomes around the world using big data from thousands of centers. other notable trials include: global paedsurg; the study was published in the lancet examined the risk of mortality for nearly 4000 babies born with birth defects in 264 hospitals around the world. the study found babies born with birth defects involving the intestinal tract have a two in five chance of dying in a low-income country compared to one in five in a middle-income country and one in twenty in a high-income country. aporg: the african perioperative research group (aporg) was launched in south africa asos and asos-2; the studies showed that death after surgery is a major public health problem in africa. surgical patients in africa are twice as likely to die in hospital following surgery when compared to the global average. acccos global health research group on children’s non-communicable diseases collaborative many scholars from around the world have participated in overlapping trials whether as principal investigators, dissemination committee or regional leaders to promote the research and oversee data collection. notable collaborators from these networks include the list included key figures from around the world as prof bruce biccard (south africa), prof adesoji ademuyiwa (nigeria), prof kokila lakhoo (oxford, uk), dr naomi wright (oxford, uk), dr emrah aydin (turkey), prof mahmoud elfiky (egypt) and prof milind chitnis (south africa). multimorbidity, age-related diseases and aging multimorbidity is "a growing public health problem worldwide", "likely driven by the ageing population but also by factors such as high body-mass index, urbanisation, and the growing burden of ncds (such as type 2 diabetes) and tuberculosis in low- and middle-income countries (lmics)". around the world, many people do not die from one isolated condition but from a multitude of factors and conditions. a study suggested there is a paucity of multimorbidity and comorbidity data globally and mapped comorbidity patterns. with aging populations, there is a rise of age-related diseases which puts major burdens on healthcare systems as well as contemporary economies or contemporary economics and their appendant societal systems. healthspan extension and anti-aging research seek to extend the span of health in the old as well as slow aging or its negative impacts such as physical and mental decline. modern anti-senescent and regenerative technology with augmented decision making could help "responsibly bridge the healthspan-lifespan gap for a future of equitable global wellbeing". aging is "the most prevalent risk factor for chronic disease, frailty and disability, and it is estimated that there will be over 2 billion persons age > 60 by the year 2050", making it a large global health challenge that demands substantial (and well-orchestrated or efficient) efforts, including interventions that alter and target the inborn aging process. infertility crisis further information: male infertility crisis a scientific review found that human sperm counts fell by 62% in the last 50 years, are decreasing at an accelerating rate and are decreasing worldwide, likely a result of factors such as poor diets, endocrine disruptors in prevalent products, unhealthy lifestyles and toxic forever chemicals in air and water. health interventions global interventions for improved child health and survival include the promotion of breastfeeding, zinc supplementation, vitamin a fortification, salt iodization, hygiene interventions such as hand-washing, vaccinations, and treatments of severe acute malnutrition. the global health council suggests a list of 32 treatments and health interventions that could potentially save several million lives each year. many populations face an "outcome gap", which refers to the gap between members of a population who have access to medical treatment versus those who do not. countries facing outcome gaps lack sustainable infrastructure. in guatemala, a subset of the public sector, the programa de accessibilidad a los medicamentos ("program for access to medicines"), had the lowest average availability (25%) compared to the private sector (35%). in the private sector, the highest- and lowest-priced medicines were 22.7 and 10.7 times more expensive than international reference prices respectively. treatments were generally unaffordable, costing as much as 15 days wages for a course of the antibiotic ceftriaxone. the public sector in pakistan, while having access to medicines at a lower price than international reference prices, has a chronic shortage of and lack of access to basic medicines. journalist laurie garrett argues that the field of global health is not plagued by a lack of funds, but that more funds do not always translate into positive outcomes. the problem