BlessWorld Foundation International

Affecting the World Through Health
A Global Health Initiative

Archive for February, 2019

Inequality is the uneven distribution of resources in a given society through systems that perpetuate specific patterns with regards to distinct categories of people. Inequality is characterized by the presence of unequal opportunities and rewards for different social groups or statuses within a population or society. It encompasses structural and recurrent forms of unequal and unfair distributions of rights, privileges, resources, health care and services, labor market, income sources, freedom of speech, education, political representation and participation and judgments.

Inequalities result when societies are organized by hierarchies of power, religion, kinship, prestige, race, ethnicity, gender, age, sexual orientation, and class that regulate access to resources and rights in ways that make their distribution unequal. Instances of inequalities reflected in several areas include income and wealth inequality, unequal access to education and cultural resources, differential treatment by the police and judicial systems. Inequality in a society leads to stress and status anxiety, which results in poor health. More so, people live longer, are less likely to be mentally ill or obese and have lower rates of infant mortality in societies that are more equal-with less inequality.

Although some level of inequality is inevitable in any society, it can be reduced by decreasing the gaps between the rich and the poor. A major way to reduce, and possibly, overcome inequality in a society is through Education. Education is perhaps the most critical means of improving the welfare of disadvantaged populations, especially as more of the world enters into the global knowledge society. It is the cornerstone for improving both social justice and economic productivity because it increases peoples’ knowledge of their rights, earning potential and social status as well as empowers them to take control of their lives through information. Education is inextricably linked to the health, social, economic and security status of individuals and societies. As such, it is better positioned as a core concern of the entire community, including families, business and other organizations.

To defend human right and reduce the gap between the haves and the have-nots, broad access to quality education must be pursued as one of the strongest social values. The most important level of education is higher education offered by universities. Universities play critical roles in helping countries improve their economic productivity and social quality of life by educating the skilled, internationally engaged and creative individuals needed as entrepreneurs and leaders for businesses to compete effectively. Universities also create the research, scholarship and knowledge that inspire the development of value-added products and processes. They also provide a hub for high-level international networks and partnerships. Consequently, it is vital that the higher education sector focuses on performance and quality, as well as accessibility, to ensure that society reaps maximum value from its investment.

Other approaches to overcome inequality and defend human rights include:

  • Increase in minimum wage
  • Expansion of the Earned Income Tax
  • Building assets for working families
  • Reducing tax rate for low income earners while increasing that of high earners
  • Making the tax code more progressive

Primary health care (PHC) is healthcare practice that entails rendering health promotional medical care and services to people, communities and populations, rather than simply treating specific diseases or conditions. Healthcare resources include health professionals, equipment, facilities, educational tools and workshops, health promotional programs and drugs. Basically PHC is the core and foundation of public health and global health because it integrates the aims and activities of both preventive and curative medicines. These activities include a spectrum of services that range from prevention (for example, vaccinations and family planning) to management of chronic health conditions including palliative and geriatric care. PHC is composed of three major branches and they include: Empowered people and communities; Multi-sectoral policy and action; Primary care and essential public health functions as the core of integrated health services. PHC is important because it is usually the first point of contact in a community. It is also cost effective and more accessible to people due to its unique design. Ideally, PHCs are designed to be specific to communities such that each local community has a PHC. That way, health problems specific to such communities are well understood so that health promotion and disease prevention strategies are targeted accordingly for effectiveness. PHC can meet the majority of an individual’s health needs over the course of their life.

Health systems with strong PHC deliver better health outcomes, efficiency and improved quality of care compared to other models. On the other hand, health systems with weak PHC do the opposite sadly- deliver poor health outcomes, inefficiency and poor quality of care. Weak PHC systems lack essential drug supply and the capacity to provide basic health-care services. In addition, issues such as poor staffing, inadequate equipment, poor distribution of health workers, poor quality of health-care services, poor condition of infrastructure and inefficient management are markers of weak PHC systems.

PHC provides essential health care which makes universal health care possible and accessible to all individuals and families in a community. In essence, health systems with strong PHC are necessary to achieve universal health coverage and the health related Sustainable Development Goals. In addition, PHC is an approach to health beyond the traditional health care system given that it focuses on health equity-producing social policy. It encompasses all areas that play a role in health, such as access to health services, environment and lifestyle. Therefore, a combination of primary healthcare and public health measures may be considered the cornerstones of universal health systems.

Due to under investment, lack of political will and misconceptions about roles and benefits, the development of PHC has been unequal across the world. Notwithstanding, Universal health coverage requires a renewed focus on primary care and their importance for individuals, health systems and health for all. Consequently, PHC meds complete participation and financial investment so that communities and countries can afford to maintain it at every stage of their development through self-reliance and self-determination.

Challenges are inevitable in a dynamic world like ours; especially in the area of healthcare. Before we take note of some challenging problems of global health in the last decade, it is important to appreciate the progress that global health has made so far. In May 2017, the World Health Organization (WHO) released its annual World Health Statistics report, which monitors countries’ progress on the Sustainable Development Goals (SDGs). In as much as the report highlighted the fact that the international community has more work to do to improve health and achieve the SDGs, significant progress was made collectively by nations, organizations, health workers, companies, individuals and many other partners. Specifically, the following mark significant advancement in global health:

  1. Quality of data collection, disease prevention and access to adequate health care have improved in many countries
  2. Global rates for under-5 mortality have declined by 44% since 2000 and HIV cases have decreased by 35% since 2000
  3. About 60% of the at-risk malaria population had access to insecticide-treated nets, compared to 34% in 2010
  4. Approximately 86% of children receive their DTP3 vaccine and the administration of all three doses of hepatitis B vaccine reached 84% in 2015
  5. The risk of dying from one of the four major non-communicable diseases – diabetes, cancer, chronic lung disease, and cardiovascular disease – declined by 17% among people aged 30-70 since 2000

Despite these advancements, global health has faced and still faces challenges today. Changing patterns of disease and transformations in global health practice create challenges for practitioners. Below are some of the most pressing global health problems we face today:

  1. Building Public Health Systems: One of the most pressing challenges today is the need to invest in patient-centered public health systems that respond timely to the range of factors that shape patterns of health and illness.
  2. Coordinating Global Health Initiatives: Bureaucratic rules and regulations in different countries continue to hinder effective coordination, contributing to redundancies and delays in meeting global health targets. Approaches such as partnerships with the government and flexibility in regulations are needed to facilitate the coordination of global health programs.
  3. Facilitating Participation: New governing structures that link the range of global health practitioners to state and local stakeholders should be created. More so- beyond receiving aids and funds, programs and workshops that encourage and increase participation are essential.
  4. Prioritizing the Needs of the Most Marginalized: The needs of the most marginalized populations have remained neglected. As a result, declining poverty rates have been accompanied by widening inequalities. In the next decade, it is essential to prioritize the health needs of the most marginalized populations, and to devise innovative initiatives to work with these populations to improve their health outcomes.
  5. Increasingly fragile health of sub-Saharan Africa:  The last decade witnessed widening gaps in health worldwide to the extent that the entire African continent is left behind in global health progress. For millions of children today, particularly in Africa, the biggest health challenge is to survive until their fifth birthday, and their chances of doing so are less than they were a decade ago. This is a result of the continuing impact of communicable diseases. Overall, 35% of Africa’s children are at higher risk of death than they were 10 years ago.
  6. Global increase in non-communicable diseases, especially in Africa: Here, life expectancy is always shorter than almost any part of the world. In some African countries, it has been cut by 20 years and life expectancy for men is less than 46 years. The international community must continue to carry Africa along so that the poor health systems and outcomes stop sabotaging global health efforts and progress.

A “health system” is described as all the organizations, institutions, resources, and people whose primary purpose is to improve health (World Health Organization [WHO], 2010). Health system strengthening (HSS) is a global health term which represents the activities and actions targeted towards the improvement of a country’s health care system. It is a broad term which includes various activities such as funding for health infrastructure, conversations to improve health policy, attempts to achieve universal healthcare and other forms of health improvement measures. It is important to note that strong, flexible and well-resourced health systems are essential to achieving universal health coverage as well as ensuring global health security, including resilience in the context of health and other emergencies.

Lately, there has been a shift in the global health agenda from disease-specific approaches to HSS; this improves the effectiveness of health services. WHO has also placed emphasis on the significance of health systems in delivering effective and affordable care so as to achieve increased health equity, especially for poorer populations. More so, WHO and global partners have developed a framework for measuring HSS; comprised of six core components or building blocks: service delivery, health workforce, health information systems, access to essential medical products, vaccines and technologies, health financing and leadership and governance. Furthermore, USAID in a recent article termed strengthening health systems a strategic imperative and highlighted the importance of investing in HSS in the present time. A strong health system is also the best insurance developing countries can have against an unstable and unpredictable disease burden.

Health systems- being the resources and activities that work together to improve the health of populations, ensures quality across most or all of the six building blocks of WHO mentioned above. The needs of patients and health care professionals are the driving forces for the system to continually improve and evolve. Understanding these needs aid and position governments to prioritize HSS by providing high-quality, comprehensive health care to all citizens. Consequently governments partner with private and public organizations in order support their efforts in strengthening health systems, as well as improve care for all, especially the poor and vulnerable.

A practical example of HSS is the partnership between United States Center for Disease Control and Prevention and Nigeria in a program called: The Nigeria Field Epidemiology Laboratory Training Program (N-FELTP). The N-FELTP is a program designed by CDC to strengthen the public health workforce in Nigeria. N-FELTP trains residents in various fields such as public health laboratory, epidemiology and veterinary epidemiology to work in leadership and technical positions in the Nigeria Federal Ministry of Health (FMOH), Agriculture and Rural Development (FMARD) and state levels. This two-year program helps to strengthen health systems within the country by increasing knowledge and skills in field epidemiology and laboratory science as well as building a team of skilled and well-trained health professionals in Nigeria. Since its commencement in 2008, N-FELTP has assisted in the detection, investigation and response to more than 70 disease outbreaks including lead poisoning in Zamfara State, multi-state outbreaks of Lassa fever and cholera, as well as polio eradication efforts.