Confronting inequalities in health care

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Grace Munene, Assistant Director, International Summer Service Learning Program for Africa, Center for Social Concerns, May 2019

The recently concluded Global Health and Innovation Conference convened a wide range of stakeholders in the field of global health from former ministers of health, leaders of non-profit organizations, faculty, health professionals, researchers, journalists, artists, and students, among others. Attendees come from almost every state in the United States and from other countries in Africa, Asia, Australia, Europe and Latin America. The discussions held at this annual meeting explore innovative ways that attendees are applying to respond to the need for access to quality health care for every person around the world. Specifically, approaches that take into account the inequalities that exist in the world today in the field of health care. Having an understanding that global health is about mutual survival for everyone, discussions at the conference refer to a framework of health as a thermometer for justice, to share lessons learned and explore ways to tackle health issues affecting people in the world today from infectious diseases to non-communicable diseases.

“Of all the forms of inequality, injustice in health is the most shocking and the most inhumane” – Dr. Martin Luther King

There is evidence in the field of global health to show that there is a connection between health outcomes and injustices that we experience in our day to day lives. “Eating trauma” weakens our immune system making us susceptible to falling ill. For example, using certain descriptions to refer to people facing a particular disease by using that disease’s name e.g. TB people, Ebola people. The use of such language not only exacerbates the level of health inequalities, it further worsens health outcomes for these populations as they struggle to not only fight a disease but also the labels and marginalization that will take quite a long time to be erased¹. In addition, when we get used to using this kind of language that further divides communities, we find ourselves making decisions and acting in a way that lacks compassion or humanity. We inherit a form of injustice unknowingly. An injustice that uses language and approaches to further propagate colonialism, racism, and superiority.

Recipients of inequality share a transnational culture. They are all around us. And so are the ones who benefit from inequality. Interclass differences exist in every country. At a time when we have experienced so much advancement in science and technology in health care, how can we celebrate this achievement when we still have people dying from preventable diseases because they lack access to basic health care services? How can we use words like “cost effectiveness” when the reality is that providing care to recipients of inequality will definitely cost more as we try to roll back the negative effects that have been years in the making? As Paul Farmer noted, “attempting to provide a ‘basic care package’ for the poor is something that should be done apologetically, not proudly²”.

“There is no such thing as a single issue struggle because we do not live single issue lives” – Audre Lorde

According to Liberation theologians, the poor are as a result of a system that we live by and by which some of us benefit from and therefore we are responsible for. To counter this system from a social justice perspective means that we are willing to analyze health systems historically (looking back to several generations in the past in order to understand the present experiences of a people) and geographically (since we are interconnected—we are members of the same system that deprives some and benefits others).

Addressing inequalities in health care call for us to recognize health as a human right. The knowledge that somebody around you is unwell and unable to receive the care that you can easily access, should make us all advocates for equal access to health care. It should make us rethink training health professionals to not only acquire technical skills and knowledge to tackle diseases, but also how to build a strong health care system. It also requires health professionals who are culturally competent to be able to recognize and acknowledge injustices experienced by recipients of inequality.

Further, tackling global health concerns requires that we develop approaches that guide us on how best to work with each other as professionals in the field. Our approaches need to be mutually beneficial. We need to be asking questions such as how do we make common cause with peers in the field and with communities that we are working with? How do we make sure that there is adequate access to health care for everyone? It is through seeing health professionals in these communities as equals³. It is through seeing patients as people who deserve care provided to them in a way that preserves their human dignity. Taking time to listen and understand each other’s struggles so that we can be able to address the injustices that are occurring. It is also about bringing other professionals into the field. For instance, involving artists in addressing health issues. Using film, poetry, dance and music, has been shown to bring attention to health campaigns. As previously noted, global health is about survival of everyone on the planet.

Unite for Sight is one of the partners for the Center for Social Concerns International Summer Service Learning Program. Through our partnership with them, Notre Dame students have had an opportunity to interact and learn from health professionals in Ghana. The students and a team of eye care doctors work in the most remote parts of Ghana where patients would otherwise have no access to quality eye care. This opportunity enables students to examine the practicality of the field of global health and how we are all interconnected.

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¹Russell, Lisa. ”Intersectionality in Global Health: How Arts and Storytelling Can Bring Global Health and Social Justice Movements Together” (Workshop, Yale University, April 14, 2019)
²Farmer, Paul. Pathologies of Power: Health, Human Rights, and the New War on the Poor. University of California Press. 2005
³Mukherjee, Joia. “Sustainable Development Goals and Health as a Human Right”. (Keynote Address, Yale University, April 13, 2019).

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