Four Pillars Part 3: Global Health Equity

August 29, 2022

Over the past several months, I’ve been sharing more about GHC’s four focus areas of work — our “pillars,” as we refer to them. So far, I’ve written about three of them the collective need for strong and effective multilaterals, and GHC’s belief in the necessity of shifting the global health security narrative to be more holistic and human-centered. Health equity is the pillar that, in my view, underpins all of the others. We can infuse the other pillars with as many resources, meetings and consultations, and guidance documents as we want. But unless we tackle the issue of health equity, we will be hard-pressed to make sustainable change. We must truly shift our thinking and actions to reflect the idea that health for some is not good enough — it’s essential that everyone has an equitable opportunity to be as healthy as possible. Unless we do, we will continue to struggle to make progress on global health goals, including the other three pillars of GHC’s work.

I likely don’t need to recite history or statistics with this community. The conversation around decolonization, the need to put local communities in the driving seat, and the systemic racism that pervades international development — including global health — has been happening for quite some time. This conversation has been amplified throughout the global response to COVID-19, as disparities that have existed for centuries have been highlighted. There has been a definitive uptick in how often the global health community emphasizes the importance of equity. This open conversation is an important step in making change. But is it all talk or are we truly moving the needle?   

Today, social determinants of health — such as education, access to decent housing, and the ability to afford nutritious foods — are responsible for up to 70% of the variation in individuals’ health outcomes. Barriers to these essential components of health are preventing the poorest and most marginalized populations from accessing quality healthcare, leading to an increased risk for diseases, health conditions, and mental health issues. Discriminatory systems and structures that drive inequitable policies, budgets, and services only reinforce these barriers to care; true health equity cannot be achieved without dismantling these systems.

The world was behind in making global health equity a reality even before the pandemic, but we’ve lost further ground in the past two years. For example:

  • Already weak health systems were overwhelmed by COVID. With under-funded and under-prioritized healthcare systems and insufficient investment in human resources, the most devastating impacts of COVID-19 have been in low- and middle-income countries.
  • The role of civil society organizations (CSOs) in supporting communities during the pandemic has been vitally important. Yet, CSOs serving the most impacted groups have largely been excluded from national and global pandemic responses and recovery, including in the Access to COVID-19 Tools (ACT) Accelerator (ACT-A) and the Pandemic Treaty negotiations.
  • Community health systems play an essential role in enabling hard-to-reach and marginalized groups’ access to healthcare, never more so than in times of crisis. Yet, community health systems are under-funded and under-prioritized in health financing. They are left on the outskirts of broader health systems rather than in the lead, where they rightly should be.
  • Women make up the majority of the global health workforce. They are on the frontlines of the COVID response and, therefore, at far greater risk of infection. Yet, global health governance continues to be led by men, with women holding only 25% of leadership roles in health.

We need to reframe the global health equity agenda to focus on the foundational causes of health inequalities. We no longer have time to waste.  To have any hope of making global health equity a reality, actionable steps must be taken immediately:

  • We must break down obstacles—such as poverty, racism, discrimination, and stigma—that continue to adversely affect those who are marginalized and unable to access care. One way to do this is by addressing the lack of data on the most marginalized populations. Disaggregated data allows us to track and address the underlying problems and social determinants that affect them. It also helps us to create culturally appropriate responses to health problems. Without this data, these populations, and the ongoing health disparities that impact them, remain largely invisible.
  • As funding and policy decisions are made, key affected populations must play a leading role in developing the solutions that will work best in their unique community contexts. 
  • We must shift the balance of power so that global health planning, programming, and resourcing decisions are community-led. Financing for health systems strengthening, especially at the community level, must be scaled up. This includes investing in community health workers who should be at the heart of healthcare program planning; they have the field experience to make the most effective and community-oriented programmatic decisions. 
  • Women must be included as key representatives in global and national health decision-making processes, and they must be compensated fairly for their work, including in pandemic response and recovery teams. Women’s voices must be heard, respected, and prioritized.

In order to achieve health equity, we have to break down the obstacles that continue to adversely affect those who are marginalized and unable to access care. It’s time to turn talk of global health equity into action. 

All the best,
Elisha Dunn-Georgiou