More than two billion people, mostly those with low income or living in poor countries, lack access to surgical treatment and sites, according to a study of the Harvard School of Public Health (HSPH).

The study, which will appear in the print version of the Lancet journal, said 75 percent of the 234 million operations done each year were for the wealthiest third of the population while only 4 percent were for the poorest third.

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, quoted Atul Gawande as saying.

Gawande is an associate professor in HSPH's Department of Health Policy and Management and a surgeon at Brigham and Women's Hospital. He is the senior author of the study that appeared in the online version of the Lancet on Thursday.

High income regions have 10 time more operating theaters per person than low0income regions, added Luke Funk, who is also from the HSPH department and hospital as Gawande.

Funk and Gawande based their findings from the profiles of 769 hospitals in 92 countries participating in the World Health Organization's Safe Surgery Saves Lives initiative. The initiative aims to reduce surgical deaths and is led by Gawande.

Comparing the number of functional operating theatres to hospital beds in seven geographical regions worldwide, the two U.S. researchers found that all high-income regions had at least 14 operating theatres per 100,000 people.

Those in low-income regions, on the other hand, had less than 2 operating theatres per 100,000 despite having a higher burden of surgical disease.

It is important for the public health community to close the gaps between rich and poor regions if it wants to address the burden of surgical disease in developing countries, said Funk, according to This will become even more important in the next several decades as chronic diseases -- which are often surgical conditions -- increase with the aging of the global population.