Health Equity Is Everyone's Business

In the Summer of 2020, following George Floyd's death and data showing that mostly Black and brown people had died of Covid 19 in both the US and the UK, I began to take a closer look at health inequities in both countries. For most of my career, I had focused on addressing health inequities in low and middle-income countries in Africa, Asia, and South America. I knew that access to healthcare wasn't perfect in the US. I knew the UK's NHS wasn't perfect either, but little had I realized the extent to which these health inequities were the main reasons behind the much higher mortality of these populations during the pandemic.

My research opened my eyes to the glaring health disparities that these minorities face that often lie at the intersection of racism, sexism, ageism, and classicism. As a result, many people are either denied care or become disillusioned and fatalistic and don't even bother to engage with the health system anymore.

Health equities are linked to the social determinants of health. The World Health Organisation defines these as "the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, environmental and climate policies, and political systems".

According to the WHO, "social determinants of health have an important influence on health inequities - the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health, and illness follow a social gradient: the lower the socioeconomic position, the worse the health".

In December 2020, I joined Dr. Patrice Matchaba who was heading the US Novartis Foundation at the time. We started talking to people in Black and brown communities where there was a high prevalence of hypertension. We wanted to understand why. Did they not care about their health? Shortly after, we began to understand what was going on.

We discovered that in certain neighborhoods in Philadelphia for example, patients did not go to their doctor's appointments not because they didn't want to, but because they were too poor to be able to afford transportation. Others didn't go because their employers didn't give them time off and they had to prioritize employment over their health.

We began to realize that in order to address health equities, we needed to engage in alleviating social determinants that prevented individuals from seeking care when they were ill. So one of the solutions we looked into was providing transportation vouchers to low-income patients to ensure that they could go to their doctor's appointments. Another idea that I had in mind was equipping these households with the internet so that they could access care through teleconsultations. Other ideas were providing community gardens so that people that live in "food deserts" with no access to vegetables and fruits can grow their own. A healthier diet was a way of preventing the onset of cardiovascular conditions, diabetes, and other non-communicable diseases.

What I also learned is that while many expect healthcare and pharmaceutical companies to resolve health inequities issues, the reality is that, to be sustainable everyone has a role to play in trying to redress these inequalities, even a company like Uber can help with transportation. From the government to the private sector, to schools, to community organizations, to the patient, everyone must contribute.

Most importantly however is that all these efforts need to be coordinated to drive robust and sustainable impact. In the US, the Center for Disease Control launched a health equity program called Healthy People 2030 which sets data-driven national objectives to improve health and well-being over the next decade. That's a good place to start, but now after setting these goals, we need to build a robust and pragmatic multisectoral action plan about how to get there.

Thank you for reading my perspective.