The world wants health equity by 2030, but how do we scale up to get there? It starts with a clear understanding of what health and health equity really means, writes BroadReach co-founder Dr Ernest Darkoh.
According to the World Health Organisation (WHO), health is the state of an individual’s physical, mental and social well-being – not just the absence of infirmity or disease. This is driven by social determinants of health (SDoH), including nutrition, education, economic status, safety and security and housing.
Health equity is the absence of unfair, avoidable or remediable differences among groups of people, whether they are defined socially, economically, demographically, geographically or by other dimensions of inequality (e.g., sex, gender, ethnicity, disability, or sexual orientation). The WHO says health is a fundamental human right and that health equity is achieved when everyone can attain their full potential for health and well-being.
The SDoH interact and affect each other differently to impact a society or community’s health equity. Without proper education, people are at higher risk of poverty, which means a lack of food, shelter, and security, a higher risk for violence, increased stress and a higher likelihood of substance abuse. Poor health results from failures and deficits in the SDoH. Health facilities, therefore, only address a small part of what constitutes health and should be the last line of defence after things go wrong.
Circles of influence
The fundamental business of healthcare is to keep people well. This means ensuring most people never get ill, and those who do – which should be few – have adequate health services. Ultimately, needing to build more hospitals and hire more health workers is a sign of a health system’s failure, not success.
There are four foundational requirements to create better sustainable health systems at scale:
- Other well-functioning systems address SDoH, closing the tap on disease so that very little ‘bad health’ is generated.
- A functional, efficient, and cost-effective model of care to deliver the required treatment and curative services equitably for those in need. This includes public, private and faith-based health facilities and partner organisations to support the patient journey and the entire service delivery value chain.
- Partners who address the SDoH are just as important as hospitals with their doctors, nurses, pharmacists, and lab technicians. These include government departments, NGOs, FBOs, private sector organisations and civil society groups. Donor aid has always been a key support. However, it is not usually scalable and certainly not sustainable for the long term.
- We need social entrepreneurs who have made it their life’s work to find sustainable and equitable market-based solutions to many SDoH and treatment delivery challenges. They are our secret weapon to actualise the value of a programme. The launch of the Global Alliance for Social Entrepreneurship at the World Economic Forum 2023 was a promising step.
Healthcare is multifactorial, with many interlinked drivers that must be addressed in an integrated way. No one partner or entity can do it all. To achieve genuinely equitable health, partners must work with the numerous actors focused on delivering better and more equitable treatment and curative healthcare services.
What it would take to make true health equity work
Health equity starts with every administrative geo-level being able to clearly define where the biggest inequities exist related to physical, mental, and social well-being and burdens of disease. We must know who is suffering, who is at risk, and what they lack so we can devise a way to provide it in a timely fashion. This means having the necessary data and intelligence systems and scaling them to target scarce resources for maximum impact.
To speed up progress, we need to shorten the learning curve by working with partners who have the most effective solutions and proven expertise in addressing the issues at scale. Partners must work in an accountable partnership model with communities affected by these health equity initiatives, giving them a leading role in problem-solving and monitoring the initiatives. Similarly, individuals in those communities must be informed, educated, and mobilised to participate maximally at all stages of the process. This must be the formally sanctioned default operational model for delivering programmes on the ground – no more government versus private sector as the only axes of consideration.
Funding requires unprecedented levels of trust, and like an orchestra, partnerships must be well-managed. This skill set is hard to find and is a significant factor in why many partnerships fail. Social entrepreneurs tend to have this skill set – another benefit of working with this group.
COVID-19 revealed how inextricably our fates are tied together when it comes to global threats. The African continent must develop a ‘Marshall Plan’ linked to the SDGs around certain non-negotiables to shut off the tap of poor health. Countries and partners with unique competitive advantages can take on regional or continent-wide responsibilities such as manufacturing or regulatory affairs.
This plan must be mirrored across each country and implemented at scale with basic resources always in place. At a clinic level, having water, sanitation, power, and internet connectivity are non-negotiables. Health facilities must transition to digital services and set up the right systems to intelligently inform and guide the next best actions. People who are educated about the future of medicine, not the past, are required.
Finally, whatever robust health equity plans we have in place must be guaranteed funding for 25-30 years, with the plan enshrined in law and insulated from party politics or regime changes.
I believe building a global health orchestra is possible now, with advanced technologies, new alliances, and unprecedented political and funding will at our disposal. I am enthusiastic that we can make tangible progress by 2030 – especially if all countries get behind their health-focused social entrepreneurs. This will give us the momentum we need to reach our goals by 2030. – Health-e News