“More than 2 billion people worldwide do not have adequate access to surgical services, and low-income countries in particular have low levels of surgical care,” according to a study published online Thursday in the Lancet, HealthDay News/Modern Medicine reports (7/1).

The study based its findings on “ratios of the number of functional operating theatres [surgical sites] to hospital beds in seven geographical regions worldwide” using profiles of 769 hospitals from 92 countries who participate in the WHO’s Surgery Saves Lives initiative, according to a Harvard School of Public Health (HSPH) press release. The researchers also analyzed the availability of pulse oximetry, “a monitor that measures the amount of oxygen in patients’ blood during surgery and an essential component of safe anesthesia and surgery, as an indicator of” resources at the surgical sites.

“The results showed that all high-income regions had at least 14 operating theatres per 100,000 people. In contrast, those in low-income regions had [fewer] than 2 operating theatres per 100,000 despite having a higher burden of surgical disease,” according to the release (6/30).

“[A]bout 19% of operating theatres did not have pulse oximeters, which corresponds to about 77, 700 operating theatres worldwide,” according to the study. The authors continue, “In low-income subregions, we estimated that 23.6% of theatres in urban areas and 66.5% in rural areas were without pulse oximetry. Conversely, high-income subregions had pulse oximeters in more than 99% of their operating theatres. We estimate that around 32 million operations are undertaken every year without pulse oximetry” (Funk et al., 7/1).

“It is not news that the poor have worse access to hospital services like surgery. But the size of this population is a shock,” senior author Atul Gawande of the Harvard School of Public Health said, according to the HSPH press release. “Our findings indicate that one third of the world’s population remains effectively without access to essential surgical services – services such as emergency cesarean section and treatment for serious road traffic injuries. Surgery has been a neglected component of public health planning and this clearly needs to change” (6/30).

An accompanying Lancet editorial reflects on the role the global shortage of health-care workers also plays in unequal access to health services worldwide. There are “2.4 million too few physicians and nurses to provide essential care,” the authors of the editorial write. “Developed countries have an increasing reliance on international graduates for around 25% of their physicians,” while developing countries spend upwards of “$500 million every year to educate health-care workers who eventually leave to work in developed countries.”

The piece notes the recent movement of the WHO and professional societies to address the issue of health care worker migration from developing to developed countries, before concluding, “Today’s study provides compelling data that should raise awareness of the inequality of access to safe and effective surgery around the world. The extent of the problem is now clearer: the solution is what needs much more work. In addition to the disparity in surgical sites and resources suggests the disparity” (Myles/Haller, 7/1).