International Women’s Day: Embracing Equity in Global Health
This International Women’s Day, Rashida Ferrand, Professor of International Health at the London School of Hygiene & Tropical Medicine and the 2022 Donald Mackay Medal recipient, reflects on the persisting and future problems that we, the global health community, are confronted with.
There have been monumental advances in public health methods and practice in the last century. Vaccine development and widespread use, clean water, improved nutrition and sanitation, family planning and recognition of tobacco use as a health hazard are a few examples of achievements that have had a substantial impact on mortality and longevity. Attention to occupational and environmental health and improved preparedness and response to global health threats have made significant contributions to current and future population health. Advanced approaches to assess disease burden, a growing armamentarium of interventions to prevent and manage disease and more organised and sophisticated health systems promise even more efficiency and effective public health across the globe.
I have spent the past two decades in southern Africa, developing and evaluating approaches to improve access to HIV testing and antiretroviral therapy and treatment outcomes for adolescents and young people. Young people are at higher risk of acquiring HIV infection - particularly young women - and are much less likely to know their HIV status and have worse treatment outcomes compared to other age-groups. In a recent population survey of nearly 17,000 young people we conducted in Zimbabwe, about 50% of individuals with HIV were unaware of their HIV-positive status.
This is one of many manifestations of the pervasive issue of “health inequity”- systematic differences in health status or in the distribution of health resources between different population groups. There is ample evidence that social determinants of health such as poverty, unequal access to health care, lack of education, unemployment, low income level, stigma and racism are underlying contributing drivers of health inequities. These inequities have profound social and economic costs both to individuals and societies and persist across generations.
Many of these factors continue to drive the poor HIV and other health outcomes observed in adolescents and young people. The COVID-19 pandemic brought to the fore long-standing inequities that resulted in certain groups not only bearing a disproportionate burden of the disease, but also the longer term adverse consequences.
Embracing Equity in Global Health
It is often “easier” to focus on biomedical pathways of disease and we often omit to address underlying health inequities. Global health equity is paramount to making Universal Health Coverage a reality and achieving the Sustainable Development Goals.
Achieving health equity needs an architecture of global health that challenges and goes beyond the existing narrow biomedical focus on “disease, diagnoses and drugs”. It requires focused and ongoing societal efforts to address historical and contemporary injustices, eliminate economic, social and other disparities and address social determinants of health. Improving access to and delivery of education, affordable, safe and resilient housing and quality health care and other public services in proportion to need is key to addressing global health inequity. Global health partnerships, particularly global North-South partnerships that actively address racism and supremacy are key to driving this agenda.
Global power asymmetries- the unequal distribution of money, knowledge or political authority- within or between countries drive global inequities and by extension, achieving global health equity requires action on their political-economic origins. Policy, legislation, regulation and taxation should drive a fairer share of income, power and wealth.
Today, on International Women’s Day, I find myself reflecting on the persisting and future problems that we, the global health community, are confronted with. We are facing dramatic global population growth, increased ageing of populations associated with improved longevity, and climate change -which is altering the pattern of disease, human settlements, food, water and sanitation.
Aspiring to a world in which no one is disadvantaged from achieving the highest attainable level of health because of their geography or their demographic, social, economic, cultural or political circumstances and #EmbracingEquity is critical and central to effectively addressing these unprecedented challenges.