Assessing the effect of the COVID-19 pandemic, shift to online learning, and social media use on the mental health of college students in the Philippines: A mixed-method study protocol

INTRODUCTION

The COVID-19 pandemic declared by the WHO has affected many countries rendering everyday lives halted. In the Philippines, the lockdown quarantine protocols have shifted the traditional college classes to online. The abrupt transition to online classes may bring psychological effects to college students due to continuous isolation and lack of interaction with fellow students and teachers. Our study aims to assess Filipino college students' mental health status and to estimate the effect of the COVID-19 pandemic, the shift to online learning, and social media use on mental health. In addition, facilitators or stressors that modified the mental health status of the college students during the COVID-19 pandemic, quarantine, and subsequent shift to online learning will be investigated.

METHODS AND ANALYSIS

Mixed-method study design will be used, which will involve: (1) an online survey to 2,100 college students across the Philippines; and (2) randomly selected 20-40 key informant interviews (KIIs). Online self-administered questionnaire (SAQ) including Depression, Anxiety, and Stress Scale (DASS-21) and Brief-COPE will be used. Moreover, socio-demographic factors, social media usage, shift to online learning factors, family history of mental health and COVID-19, and other factors that could affect mental health will also be included in the SAQ. KIIs will explore factors affecting the student's mental health, behaviors, coping mechanism, current stressors, and other emotional reactions to these stressors. Associations between mental health outcomes and possible risk factors will be estimated using generalized linear models, while a thematic approach will be made for the findings from the KIIs. Results of the study will then be triangulated and summarized.

ETHICS AND DISSEMINATION

Our study has been approved by the University of the Philippines Manila Research Ethics Board (UPMREB 2021-099-01). The results will be actively disseminated through conference presentations, peer-reviewed journals, social media, print and broadcast media, and various stakeholder activities.

Disparities in access to cancer diagnostics in ASEAN member countries

Diagnostics, including laboratory tests, medical and nuclear imaging, and molecular testing, are essential in the diagnosis and management of cancer to optimize clinical outcomes. With the continuous rise in cancer mortality and morbidity in the Association of Southeast Asian Nations (ASEAN), there exists a critical need to evaluate the accessibility of cancer diagnostics in the region so as to direct multifaceted interventions that will address regional inequities and inadequacies in cancer care. This paper identifies existing gaps in service delivery, health workforce, health information systems, leadership and governance, and financing and how these contribute to disparities in access to cancer diagnostics in ASEAN member countries. Intersectoral health policies that will strengthen coordinated laboratory services, upscale infrastructure development, encourage health workforce production, and enable proper appropriation of funding are necessary to effectively reduce the regional cancer burden.

Leveraging national and global political determinants of health to promote equity in cancer care

Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions define the rules of play. We provide examples from around the world: Political interests have helped fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials-that is, in the distribution of epistemic power. Finally, historical institutions have helped perpetuate disparities related to racist and colonialist legacies. Present institutions have also been used to improve access for those in greatest need, as exemplified by the Butaro Cancer Center of Excellence in Rwanda. In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.

Disparities in Stage at Presentation for Disaggregated Asian American, Native Hawaiian, and Pacific Islander Patients with Breast Cancer

INTRODUCTION

Cancer is the leading cause of death among Asian American, Native Hawaiian, and Pacific Islander (AA&NHPI) populations, who are among the most diverse and rapidly growing racial/ethnic groups in the United States. Despite this population's diverse socioeconomic, cultural, and immigration backgrounds, little is known about the within-group disparities in breast cancer stages at diagnosis. This study aims to identify AA&NHPI subgroups at heightened risk for advanced breast cancer by analyzing detailed incidence rates and diagnostic stages across these diverse subgroups.

METHODS

Patient data spanning from 2004 to 2020 were extracted from the National Cancer Database, focusing on individuals newly diagnosed with breast cancer. Individuals were disaggregated into specific AA&NHPI subgroups by self-reported country of origin. Ordinal logistic regression, adjusting for clinical and sociodemographic factors, was used to calculate adjusted odds ratios (AORs). Higher adjusted odds ratios signify more advanced stage diagnoses.

RESULTS

Of 3,001,173 patients with breast cancer, 99,128 (3.30%) identified as AA&NHPI. Compared with NHW patients, AA&NHPI patients were younger (median age, NHW: 62 years versus AA&NHPI: 57 years, p < 0.001) and more likely to be uninsured (NHW: 1.50% vs. AA&NHPI: 2.60%, p < 0.001). The largest AA&NHPI subgroups were Filipino (n = 21,666, 21.9% of AA&NHPI), Chinese (n = 21,303, 21.5%), Indian/Pakistani (n = 20,295, 20.5%), Vietnamese (n = 6680, 6.74%), and Korean (n = 7776, 7.84%). In aggregate, AA&NHPI patients were less likely to present with advanced stage at diagnosis relative to NHW patients (AOR 0.89, 95% confidence interval [CI] 0.88-0.90, p < 0.001). However, AA&NHPI disaggregation demonstrated that Hawaiian (AOR 1.15, 95% CI 1.09-1.22, p < 0.001), Hmong (AOR 1.70, 95% CI 1.28-2.27, p < 0.001), Laotian (AOR 1.37, 95% CI 1.17-1.61, p < 0.001), and Pacific Islander patients (AOR 1.24, 95% CI 1.17-1.32, p < 0.001) were more likely to present at a more advanced stage relative to NHW patients. Relative to Chinese Americans (the reference AA&NHPI group), all AA&NHPI ethnic groups had higher odds of advanced-stage diagnosis with the highest odds in Hmong (AOR 2.41, 95% CI 1.81-3.20, p < 0.001), Laotian (AOR 1.89, 95% CI 1.61-2.20, p < 0.001), Pacific Islander (AOR 1.71, 95% CI 1.60-1.82, p < 0.001), and Hawaiian (AOR 1.57, 95% CI 1.48-1.67, p < 0.001) patients.

CONCLUSIONS

Our study characterizes disparities in the stage of breast cancer at presentation across disaggregated AA&NHPI groups, with notably advanced diagnoses in patients of Hmong, Laotian, Pacific Islander, Hawaiian, and Kampuchean descent. These findings underscore the need for disaggregated research exploring both risk factors and barriers to early diagnosis, as well as culturally tailored interventions that involve community leaders and leverage cultural norms to improve cancer screening and diagnosis.

Cancer incidence and mortality estimates in 2022 in southeast Asia: a comparative analysis

BACKGROUND

Cancer is a leading cause of morbidity and mortality in southeast Asia. We aimed to present and interpret cancer incidence and mortality statistics in the 11 constituent countries of Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste, and Viet Nam to inform research priorities, health services, and cancer policy.

METHODS

The number of new incident cases and deaths for all cancers combined and for leading cancers were extracted from the GLOBOCAN 2022 database developed by the International Agency for Research on Cancer for the 11 countries in southeast Asia. For comparison, we extracted estimates from China, India, Japan, Pakistan, South Korea, and the USA. We estimated age-standardised incidence rates (ASIRs) and age-standardised mortality rates (ASMRs) per 100 000 person-years; projections to 2050 were also estimated by multiplying ASIR and ASMR estimates for 2022 by the expected population for 2050. Data on race or ethnicity were not collected.

FINDINGS

Data were extracted on Dec 5, 2024. For the 11 countries in southeast Asia for all cancers combined, 545 725 (47·6%) of a total of 1 146 810 incident cases were estimated in men and 601 085 (52·4%) incident cases were estimated in women in 2022. In the same period, 385 430 (53·8%) of a total of 716 116 deaths were estimated in men and 330 686 (46·2%) deaths were estimated in women. The total cancer ASIR in men and women was highest in Singapore (235·89 per 100 000 and 231·01 per 100 000 respectively), while the corresponding ASMR was greatest in Laos for men (132·91 per 100 000) and Brunei for women (104·20 per 100 000). Breast cancer was the most common cancer among women in all countries (highest ASIRs in Singapore [72·61 per 100 000] and the Philippines [60·34 per 100 000]), and the most common cause of cancer mortality among women in the Philippines (ASMR 21·47 per 100 000), Malaysia (19·30 per 100 000), Singapore (17·82 per 100 000), Viet Nam (14·67 per 100 000), Indonesia (14·35 per 100 000), and Timor-Leste (10·24 per 100 000). Among men, lung cancer was the most frequently diagnosed cancer in the Philippines (ASIR 37·66 per 100 000), Malaysia (23·23 per 100 000), Myanmar (21·59 per 100 000), and Indonesia (21·30 per 100 000), and the leading cause of death due to cancer in the Philippines (ASMR 33·59 per 100 000), Singapore (31·94 per 100 000), Brunei (23·84 per 100 000), Malaysia (20·42 per 100 000), Myanmar (19·91 per 100 000), Indonesia (18·96 per 100 000), and Timor-Leste (12·95 per 100 000). Liver cancer contributed the greatest incidence and mortality in men in Cambodia, Laos, Viet Nam, and Thailand, and was also the leading cause of death due to cancer among women in Laos (ASMR 13·49 per 100 000), Cambodia (13·34 per 100 000), and Thailand (12·14 per 100 000). Cervical cancer was the leading cause of death due to cancer in women in Myanmar (ASMR 13·37 per 100 000); colorectal cancer was the most common cancer in men in Singapore (ASIR 39·41 per 100 00) and Brunei (37·70 per 100 000). By 2050, 2·03 million new cases of cancer are anticipated in southeast Asia annually, an 89·2% increase in men and a 65·6% increase in women, relative to 2022.

INTERPRETATION

The current patterns of cancer incidence and mortality in southeast Asia are primarily driven by breast cancer in women and lung cancer in men, but infection-related cancers (liver and cervix) are common in some countries. Regional collaborations must be strengthened to improve cancer prevention, diagnosis, care, and research in southeast Asia.

FUNDING

National Cancer Institute and the Prostate Cancer Foundation.

Travel Burden of Radiation Therapy in the Philippines

Purpose

Travel burden negatively impacts the stage at diagnosis, treatment, outcome, and quality of life among patients with cancer. Travel burden-quantified as distance, time, and cost of travel-is magnified in low- and middle-income countries like the Philippines, where radiation therapy (RT) resources are lacking and are inequitably distributed.

Methods and Materials

We compared Philippine Radiation Oncology Society data and the population census to determine the distribution and density of RT facilities across the country's 17 regions. For distance and travel time, we used the Google Maps route planner to determine the best routes from each province to the nearest private and government RT facility. Travel cost was calculated by multiplying distance by the local price of diesel per liter and the mean fuel economy of passenger vehicles in the Philippines.

Results

There are only 54 RT facilities in the Philippines (0.5 per 1 million population). More than a third are in the National Capital Region (NCR). Four regions do not have an RT facility. Nationally, the average distance to any RT facility is 101.02 km with a travel time of 2.66 hours and a travel cost of PHP 4811.11 ($85.91). Travel burden to any RT facility is the least in NCR and greatest in Visayas. Travel burden to a government RT facility is greater, with an average distance of 136.94 km, travel time of 3.05 hours, and travel cost of PHP 6353.43 ($113.45). Travel burden to a government RT facility is least in NCR and greatest in Mindanao.

Conclusions

The travel burden of RT in the Philippines is significant and varies regionally and by RT facility type (private or government). Data-driven installation of government RT facilities in underserved regions, alternative reimbursement systems to encourage hypofractionation when appropriate, patient subsidies for housing/transportation while on treatment, better public transportation, and patient navigation are needed.

Nasopharynx Cancer in the United States: Racial and Ethnic Disparities in Stage at Presentation

INTRODUCTION

Although nasopharynx cancer (NPC) is rare in the United States, global epidemiology varies greatly. Therefore, understanding NPC disparities in the diverse US setting is critical.

METHODS AND MATERIALS

Data from the National Cancer Database (NCDB, 2004-2021) identified patients with NPC; NCDB allows disaggregation by Asian American (AA) subgroups. Multivariable ordinal logistic regression adjusting for demographic and socioeconomic factors defined adjusted odds ratios (aORs).

RESULTS

Of 15,862 patients, 11,173 (70.4%) were male (median age 59). Commonest groups included 10,034 (63.3%) White, 2,272 (14.3%) Black, 1,103 (7.0%) Chinese, 442 (2.8%) Filipino, and 338 (2.1%) Vietnamese patients. Prior to disaggregation, the proportion of stage IV disease at presentation was 43.2% among White (ref), 50.0% among Black (aOR 1.12, p = 0.012), 52.0% among Native American (aOR 1.18, p > 0.05), 41.9% among AA (aOR 0.97, p > 0.05), and 55.1% among Native Hawaiian and Other Pacific Islander patients (aOR 1.47, p = 0.021). Upon disaggregation, the proportion of stage IV disease was the greatest (>50%) among Black (50.0%, aOR 1.12, p = 0.012), Laotian (61.5%, aOR 2.21, p = 0.001), Hmong (73.2%, aOR 2.92, p < 0.001), and Other Pacific Islander patients (60.9%, aOR 1.83, p = 0.004); 44.2% of Filipino patients also presented with stage IV disease (aOR 1.21, p = 0.033). Odds of presenting with advanced stage disease were lower among Chinese patients (35.7% stage IV, aOR 0.72, p < 0.001).

CONCLUSIONS

Although most NPC patients were Chinese, White, or Black, stage IV disease at presentation was most common among Hmong, Laotian, non-Hawaiian Pacific Islander, and Black patients. Efforts are needed to improve awareness of NPC among less canonically affected groups.

LEVEL OF EVIDENCE

4 Laryngoscope, 135:1113-1119, 2025.

Palliative and Supportive Care in the Philippines: Systems, Barriers, and Steps Forward

Although integral to alleviating serious health-related suffering, global palliative care remains systemically and culturally inaccessible to many patients living in low- and middle-income countries. In the Philippines, a lower-middle income country in Southeast Asia of over 110 million people, up to 75% of patients with cancer suffer from inadequate pain relief. We reviewed factors that preclude access to basic palliative care services in the Philippines. PubMed and Google Scholar were searched thoroughly; search terms included but were not limited to "palliative care," "supportive care," "end-of-life care," and "Philippines." We found that a limited palliative care workforce, high out-of-pocket healthcare costs, and low opioid availability all hinder access to palliative care in the archipelago. Religious fatalism, strong family-orientedness, and physician reluctance to refer to palliative care providers represent contributory sociocultural factors. Efforts to improve palliative care accessibility in the country must address health systems barriers while encouraging clinicians to discuss end-of-life options in a timely manner that integrates patients' unique individual, familial, and spiritual values. Research is needed to elucidate how Filipinos-and other global populations-view end-of-life, and how palliative care strategies can be individualised accordingly.

Does diversity beget diversity? A scientometric analysis of over 150,000 studies and 49,000 authors published in high-impact medical journals between 2007 and 2022

Background

Health research that significantly impacts global clinical practice and policy is often published in high-impact factor (IF) medical journals. These outlets play a pivotal role in the worldwide dissemination of novel medical knowledge. However, researchers identifying as women and those affiliated with institutions in low- and middle-income countries (LMIC) have been largely underrepresented in high-IF journals across multiple fields of medicine. To evaluate disparities in gender and geographical representation among authors who have published in any of five top general medical journals, we conducted scientometric analyses using a large-scale dataset extracted from the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), The British Medical Journal (BMJ), The Lancet, and Nature Medicine.

Methods

Author metadata from all articles published in the selected journals between 2007 and 2022 were collected using the DimensionsAI platform. The Genderize.io API was then utilized to infer each author's likely gender based on their extracted first name. The World Bank country classification was used to map countries associated with researcher affiliations to the LMIC or the high-income country (HIC) category. We characterized the overall gender and country income category representation across the medical journals. In addition, we computed article-level diversity metrics and contrasted their distributions across the journals.

Findings

We studied 151,536 authors across 49,764 articles published in five top medical journals, over a long period spanning 15 years. On average, approximately one-third (33.1%) of the authors of a given paper were inferred to be women; this result was consistent across the journals we studied. Further, 86.6% of the teams were exclusively composed of HIC authors; in contrast, only 3.9% were exclusively composed of LMIC authors. The probability of serving as the first or last author was significantly higher if the author was inferred to be a man (18.1% vs 16.8%, P < .01) or was affiliated with an institution in a HIC (16.9% vs 15.5%, P < .01). Our primary finding reveals that having a diverse team promotes further diversity, within the same dimension (i.e., gender or geography) and across dimensions. Notably, papers with at least one woman among the authors were more likely to also involve at least two LMIC authors (11.7% versus 10.4% in baseline, P < .001; based on inferred gender); conversely, papers with at least one LMIC author were more likely to also involve at least two women (49.4% versus 37.6%, P < .001; based on inferred gender).

Conclusion

We provide a scientometric framework to assess authorship diversity. Our research suggests that the inclusiveness of high-impact medical journals is limited in terms of both gender and geography. We advocate for medical journals to adopt policies and practices that promote greater diversity and collaborative research. In addition, our findings offer a first step towards understanding the composition of teams conducting medical research globally and an opportunity for individual authors to reflect on their own collaborative research practices and possibilities to cultivate more diverse partnerships in their work.

Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders

BACKGROUND

Over 20 million people in the United States identified as Asian American, Native Hawaiian, or Pacific Islander in 2022. Despite the diversity of immigration histories, lived experiences, and health needs within the Asian American, Native Hawaiian, or Pacific Islander community, prior studies in cervical cancer have considered this group in aggregate.

OBJECTIVE

We sought to analyze disparities in cervical cancer stage at presentation in the United States, focusing on disaggregated Asian American, Native Hawaiian, or Pacific Islander groups.

STUDY DESIGN

Data from the United States National Cancer Database from 2004 to 2020 of 122,926 patients newly diagnosed with cervical cancer were retrospectively analyzed. Asian American, Native Hawaiian, or Pacific Islander patients were disaggregated by country of origin. Logistic regression, adjusted for clinical and sociodemographic factors, was used to calculate adjusted odds ratios. Higher adjusted odds ratios indicate an increased likelihood of metastatic versus nonmetastatic disease at diagnosis.

RESULTS

Out of 122,926 patients with cervical cancer, 5142 (4.2%) identified as Asian American, Native Hawaiian, or Pacific Islander. Compared to non-Hispanic White patients, pooled Asian American, Native Hawaiian, or Pacific Islander patients presented at lower stages of cancer (non-Hispanic White: 58.7% diagnosed local/regional, Asian American, Native Hawaiian, or Pacific Islander : 85.6% at local/regional, χ2 P<.001). The largest Asian American, Native Hawaiian, or Pacific Islander subgroups included Filipino Americans (n=1051, 20.4% of Asian American, Native Hawaiian, or Pacific Islander), Chinese Americans (n=995, 19.4%), Asian Indian/Pakistani Americans (n=711, 13.8%), Vietnamese Americans (n=627, 12.2%), and Korean Americans (n=550, 10.7%) respectively. Asian American, Native Hawaiian, or Pacific Islander disaggregation revealed that Pacific Islander American patients had higher odds of presenting with metastatic disease (adjusted odds ratio 1.58, 95% confidence interval 1.21-2.06, P=.001) relative to non-Hispanic White patients. Conversely, Chinese American (adjusted odds ratio 0.47, 95% confidence interval 0.37-0.59, P<.001), Vietnamese American (adjusted odds ratio 0.54, 95% confidence interval 0.41-0.70, P<.001), Hmong American (adjusted odds ratio 0.46, 95% confidence interval 0.22-0.97, P=.040), and Indian/Pakistani American (adjusted odds ratio 0.76, 95% confidence interval 0.61-0.94, P=.013) patients were less likely to present with metastatic disease. Compared to the largest Asian American, Native Hawaiian, or Pacific Islander group (Chinese American), 9 other subgroups were more likely to present with metastatic disease. The largest differences were observed in Pacific Islander American (adjusted odds ratio 3.44, 95% confidence interval 2.41-4.91, P<.001), Thai American (adjusted odds ratio 2.79, 95% confidence interval 1.41-5.53, P=.003), Kampuchean American (adjusted odds ratio 2.39, 95% confidence interval 1.29-4.42, P=.006), Native Hawaiian American (adjusted odds ratio 2.23, 95% confidence interval 1.37-3.63, P=.001), and Laotian American (adjusted odds ratio 2.02, 95% confidence interval 1.13-3.61, P=.017). In contrast, Vietnamese American (adjusted odds ratio 1.20, 95% confidence interval 0.85-1.71, P=.303), and Hmong American (adjusted odds ratio 1.09, 95% confidence interval 0.50-2.37, P=.828) patients did not show a statistically significant difference in presenting with metastatic disease compared to Chinese American patients.

CONCLUSION

Aggregated evaluation of the Asian American, Native Hawaiian, or Pacific Islander monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger Asian American, Native Hawaiian, or Pacific Islander population-including Pacific Islander American and Thai American patients-may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community-based disaggregated research and tailored interventions is necessary to close these gaps.

Diversity in the medical research ecosystem: a descriptive scientometric analysis of over 49 000 studies and 150 000 authors published in high-impact medical journals between 2007 and 2022

OBJECTIVES

Health research that significantly impacts global clinical practice and policy is often published in high-impact factor (IF) medical journals. These outlets play a pivotal role in the worldwide dissemination of novel medical knowledge. However, researchers identifying as women and those affiliated with institutions in low- and middle-income countries (LMICs) have been largely under-represented in high-IF journals across multiple fields of medicine. To evaluate disparities in gender and geographical representation among authors who have published in any of five top general medical journals, we conducted scientometric analyses using a large-scale dataset extracted from the New England Journal of Medicine, Journal of the American Medical Association, The BMJ, The Lancet and Nature Medicine.

METHODS

Author metadata from all articles published in the selected journals between 2007 and 2022 were collected using the DimensionsAI platform. The Genderize.io Application Programming Interface was then used to infer each author's likely gender based on their extracted first name. The World Bank country classification was used to map countries associated with researcher affiliations to the LMIC or the high-income country (HIC) category. We characterised the overall gender and country income category representation across the five medical journals. In addition, we computed article-level diversity metrics and contrasted their distributions across the journals.

RESULTS

We studied 151 536 authors across 49 764 articles published in five top medical journals, over a period spanning 15 years. On average, approximately one-third (33.1%) of the authors of a given paper were inferred to be women; this result was consistent across the journals we studied. Further, 86.6% of the teams were exclusively composed of HIC authors; in contrast, only 3.9% were exclusively composed of LMIC authors. The probability of serving as the first or last author was significantly higher if the author was inferred to be a man (18.1% vs 16.8%, p<0.01) or was affiliated with an institution in a HIC (16.9% vs 15.5%, p<0.01). Our primary finding reveals that having a diverse team promotes further diversity, within the same dimension (ie, gender or geography) and across dimensions. Notably, papers with at least one woman among the authors were more likely to also involve at least two LMIC authors (11.7% vs 10.4% in baseline, p<0.001; based on inferred gender); conversely, papers with at least one LMIC author were more likely to also involve at least two women (49.4% vs 37.6%, p<0.001; based on inferred gender).

CONCLUSION

We provide a scientometric framework to assess authorship diversity. Our research suggests that the inclusiveness of high-impact medical journals is limited in terms of both gender and geography. We advocate for medical journals to adopt policies and practices that promote greater diversity and collaborative research. In addition, our findings offer a first step towards understanding the composition of teams conducting medical research globally and an opportunity for individual authors to reflect on their own collaborative research practices and possibilities to cultivate more diverse partnerships in their work.

Access to surgical treatment for hepatopancreaticobiliary cancer in the Philippines

Hepatopancreaticobiliary cancers are among the most diagnosed cancers in the world. However, although high-income countries have the highest incidence rates, low- and middle-income countries have the highest mortality rates. In this article, we describe the geographic distribution of board-certified hepatopancreaticobiliary surgeons who provide surgical management for patients with these diseases in the Philippines. We draw attention to the geographic disparities in the distribution of these surgeons and the other factors that contribute to the lack of access. Lastly, we suggest ways forward.