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:
- Quality of data collection, disease
prevention and access to adequate health care have improved in many countries
- Global rates for under-5 mortality have
declined by 44% since 2000 and HIV cases have decreased by 35% since 2000
- About 60% of the at-risk malaria
population had access to insecticide-treated nets, compared to 34% in 2010
- Approximately 86% of children receive
their DTP3 vaccine and the administration of all three doses of hepatitis B
vaccine reached 84% in 2015
- 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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.