The Study: The chiropractic workforce: a global review.                    

 The Facts: 

a. There was a world shortage of approximately 7.2 million health care workers in 2013.

 b. However, the unmet need as applies to musculoskeletal problems is not well established.

 c. The authors conducted a study of 193 United Nations countries.

 d. They received results from 90 countries who had at least one chiropractor in that country.

 e. High income countries have a disability rate of 11.8% and that is higher in low income countries at 18.0%.

 f. Musculoskeletal pain is the main cause of disability and the incidence increases with age.

 g. Musculoskeletal pain is the cause of more years lived with disability than any other condition.

 h. But the total number of chiropractors in the world was determined to be only103,469.

 i. The number of chiropractors per capita varied widely.

 j. The U.S. had the highest number at 23.7 chiropractors per 100,000 people.

 k. But only 0.0007 chiropractors per 100,000 people in India.

 l. “Chiropractic education was offered in 48 institutions in 19 countries. They were predominantly located in English-speaking and/or high-income countries.”

 m. At the time of the study, the U.S. had 18 chiropractic colleges and Australia had 4.

 n. Patients can directly access chiropractic services in 81 countries but in the Bahamas and Saudi Arabia a medical referral was needed.

 o. “The practice of chiropractic was legally recognized in 68 (75.6%) of the 90 countries included in the survey.

 p. Chiropractors can “own, operate, or prescribe x-rays…” in only 48 of these countries.

 q. Chiropractic “was explicitly illegal in 12 (13.3%) countries; one in Africa (Egypt), two in South America (Argentina and Columbia), four in Europe (Austria, Estonia, Greece, and Hungary), and five in Asia (Lebanon, Republic of Korea, Taiwan, Turkey and Ukraine).”

 r. “In the remaining 10 (11.1%) countries, chiropractic did not fall under any law or the statutory legislation is unknown.”

Take Home: 

Chiropractic is represented in 90 countries, but the distribution of clinicians as well as chiropractic educational institutions favors high-income countries.” Chiropractic remains woefully underrepresented in many countries.

 Reviewer's Comments:

I think most of Science In Brief readers are from the U.S., however, it is important at times to take a broader view. This is a very interesting article which gives us a worldwide look at the status of chiropractic. In addition I want to put in a plug for taking a historical look at chiropractic. The Association for the History of Chiropractic (AHC) publishes the Journal of Chiropractic History which is the foremost history journal in the chiropractic profession and I am certain my view is in no way affected by virtue of my being the Assistant Editor of that journal! I encourage the interested reader to click the link to access this article and please give some thought to joining the AHC. 

 Reviewer:  Roger Coleman DC

 Editor: Mark R. Payne DC

 Reference: Stochkendahl MJ, Rezai M, Torres P et al. The chiropractic workforce: a global review. Chiropr Man Therap. 2019 Jul 24;27:36. doi: 10.1186/s12998-019-0255-x. eCollection 2019.

 Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/31367341

 Association for the History of Chiropractic website: http://www.historyofchiropractic.org/the-journal/