The best solutions move us closer to global health equity.
Global health equity means that people everywhere have access to the tools and means of good health and well being. Equity is tied to the idea of “the golden rule,” the idea that we should treat others as we, ourselves, would like to be treated. Confucius, when asked to describe in one word how best we should live, said “is not reciprocity that word”? We must inspire people to pursue equity with the same passion they pursue their own good. Equity is also tied to the idea of interdependence. Much of our education promotes the idea of independence, yet the real world requires interdependence.
Ultimate global health equity has only been achieved once for humans–with the eradication of smallpox–but that should not discourage us from seeking levels of equity short of this ultimate goal. Equity is something that we can measure, and we can make sure that every program has as one of its goals the achievement of equity. Every program should be designed to measure and reduce inequities.
PART 9.1
An effective vaccine for preventing smallpox had been discovered and tested by 1796. And by the 1970’s widespread vaccination resulted in most people in rich countries being vaccinated and almost completely protected. Smallpox was actually eliminated from developed countries in the 1970s. But the burden of smallpox was inequitably distributed. People in some poor countries remained vulnerable and faced high risks of mortality from smallpox. It was within the poorest communities that smallpox was spread. In some countries, such as India, vaccine programs were struggling to eradicate the disease. As long as there were pockets of smallpox in poor communities within low-income countries, the entire world was at risk of smallpox. This is a pattern that is seen with many different diseases and conditions today: wealthier people in high-income countries tend to be free from or protected against diseases and injuries that continue to affect low-income people. The health problems and risks of the poor continue long after they have been reduced or eliminated for the wealthy. Diseases and conditions continue to circulate among the poor and in low-income countries creating big disparities.
FEATURING
Dr. Bill Foege, Senior Advisor, Bill & Melinda Gates Foundation
Dr. Susmita Parashar, Associate Professor, Emory University School of Medicine
PART 9.2
Partners in Health (PIH) is a non-profit global health organization established by Paul Farmer, Jim Kim, and three colleagues to bring health care to the poorest people in low-income countries. PIH believed that these people deserve healthcare that was as good as the healthcare that rich people in the most advanced countries received. They found that poor people living in a shanty town outside of Lima, Peru had very high rates of multidrug-resistant tuberculosis (MDR TB), a disease that was notoriously hard to treat. But MDR TB was not only very difficult to treat, requiring 18 months of treatment with 7 different drugs that had many toxic side-effects, it was very expensive to treat. When an outbreak of MDR TB occurred in New York City in the 1990’s, each successful treatment cost $200,000; more than 200 times the cost of treating a case of drug-susceptible TB. This led the World Health Organization to declare that when MDR TB occurred in poor people in resource-poor settings, they should not be treated, which meant that they would be left to die. Jim and Paul felt that this policy actively endorsed inequity and was unacceptable. To get this policy changed meant that they would have to demonstrate that MDR TB could be treated just as effectively in resource-poor settings for much less than $200,000 for each case.
FEATURING
Dr. Jim Kim, co-founder of Partners in Health and former President of the World Bank Group
Dr. Mark Rosenberg, President Emeritus, The Task Force for Global Health
PART 9.3
Story A
There are medicines that could save the lives of the 500,000 children who die from malaria each year. Most of these children live in the low-income countries of Sub-Saharan Africa. Novartis manufactures the drug, artemisinin-based combination therapy, that is the standard of care for the treatment of P. falciparum malaria, the most deadly form of the disease. Although the global health community has for a long time been skeptical and wary of the private sector where profit was the driving force, Novartis happened to have a CEO who came from the field of global health and was inspired by the vision of global health equity. But neither these malaria-endemic countries nor WHO could afford to purchase commercially the amounts of this drug needed to treat the children who were at risk.
Story B
We live in an environment where each of us is impacted by the health of others. The social determinants of health are the conditions under which we are born, grow, get educated and work. For example, some children live in places where there is no safe place to play and they do not get good nutrition. They may also lack access to quality education and good jobs. Racism and poverty also contribute to health inequities. These social determinants have a major impact on equity and can be major barriers to good health and well-being. But policy makers are often looking for quick wins, and simple solutions. They often don’t have the patience necessary to understand and address complex issues like these social determinants of health.
FEATURING
Dr. Vas Narasimhan, CEO, Novartis
Dr. David Satcher, 16th United States Surgeon General
The best solutions move us closer to global health equity.
Equity is when everyone has an equal access to the tools and means of good health and wellbeing. The tools include knowledge, resources and access to people, and the ability to access the health system.
Equity increases opportunities for all people. When there is more opportunity, more choices are available and quality of life improves.
Every program should have an equity goal.
Both the process we use to implement our programs and the outcomes of our programs should be equitable. We can measure health equity and work deliberately to eliminate inequities and health disparities.
Health equity is a human right. Equal health cannot be guaranteed because genetics and the social, economic and political determinants of health are not equally distributed.
Nobody is safe until everyone is safe. The health conditions that affect the most vulnerable will also impact the most wealthy, whether you are talking about the health of individuals or populations.
The core value of public health is social justice.
LESSON 9:
THE BIG IDEAS
To learn more about this topic, refer to the additional resources below. For in-depth concepts, refer to the deeper dives. Click the glossary link to find key terms in this lesson.
Additional Resources
The values behind this Partners in Health co-founder’s success.
National Center for Civil and Human Rights, an institution that has put equity and the Campaign for Equal Dignity front and center.
My Quest for Health Equity - Notes on Learning While Leading, Dr. David Satcher
The Partners Report on MDR-TB Treatment: The message is hope. The Task Force for Global Health, Decatur, GA, USA. 2015
An approach that says WHO and church missions should always concentrate on the most disenfranchised is explained in Contact Magazine, Issue 13.
Global Health Ethics - A Framework for Thinking from Dr. Greg Martin
Larry Gostin Global Health Security, A Blueprint for the Future. Harvard University Press, 2021.
Deeper Dives
Dr. Bill Foege shares his lessons on global health equity, how that has shaped his career and what it means for the current state of global health and the COVID-19 pandemic. Learn more here: Bill Foege shares his lessons on global health equity – and unscrambling eggs
Expo2020 Dubai was a key moment for the international community to assess the impact of COVID-19 on health, societies, and economies. As we look forward and prioritize prevention, promoting equity is essential. Learn more here: Event Summary: Preventing pandemics means investing in equity
LESSON 9:
Additional resources
THIS LESSON WAS MADE POSSIBLE BY THE FOLLOWING CONTRIBUTORS
Kate Adelung, Shalimar Adorno, Nina Alcacio, Vinnie Amendolare, Brad Allen Bartee, Michael Bartenfeld, Sarah Borgman, Amanda Brayman, Hannah Burris, Amy Carzo, Prarthna Desai, Gabriel Diamond, Veronica Garcia, Gates Notes, Eric Hansen, Lynn Heinisch, Mary Hilpertshauser, Graham Justice, Bruce Lowry, Amy Mayberry, Nancy Messonnier, Ben Pyne, Sumon Ray, Svetlomir Slavchev, Joel Stanojevich, Emily Staub, Kelly Stewart, Anushka Swalef, Lisa Valente, Connie Ward-Cameron, Bill Warren, Lisa Wiley, and Sydney Yang
Images and Videos provided by: Bending the Arc, Bill & Melinda Gates Foundation, CDC Public Health Image Library, Emory University, Gates Archive, Gavi, The Vaccine Alliance, Getty Images, MAP International, Novartis, Partners in Health, Personal Collection of Susmita Parashar, Private collection of David Satcher, Private collection of Jim Kim, Private collection of Mark Rosenberg, Shutterstock, The Carter Center, The Gates Notes, LLC, The Task Force for Global Health, and the World Health Organization
OUR FUNDERS
CONRAD N. HILTON FOUNDATION, CDC FOUNDATION, FORD FOUNDATION, GATES VENTURES, ROCKEFELLER FOUNDATION, SKOLL FOUNDATION, THE CARTER CENTER, THE TASK FORCE FOR GLOBAL HEALTH