« All News

“Health For All” Blog Post by ISID Emerging Leader, Esmita Charani

Health For All

April 7th is World Health Day. The focus of this day is Health For All. The premise of this day is to emphasise the need for equity in health access and use globally, recognising that good health and healthcare is a human right and not a privilege of only those who can afford it. The reality of course is that we need a world health day because of the persisting inequities which hinder access to good health and health care to many across the world. Socioeconomic and demographic divisions in societies everywhere and lack of political investment continue to hinder the vision of universal healthcare for all, everywhere. In this space of inequities and inaccessibility to effective healthcare, many initiatives are born that aim to do well. Including the concept of global health. Infectious diseases is a field within global health that is acutely driven by poverty, lack of access to clean water, sanitation and hygiene (WASH), and lack of access to effective vaccine programmes. Most importantly infectious diseases can be spread across populations and therefore are a public health concern. The need to provide the minimum level of access to effective prevention programmes in all populations everywhere for effective health is most acute in infectious diseases. Furthermore, managing infectious diseases also has implications for healthcare workers as being at risk of acquiring diseases themselves, being a vehicle for their spread through inadequate training and lack of correct preventative interventions in place, and through behavioural factors. This is acutely plain in the emergence and spread of antibiotic resistance which is driven by not only ecological factors but also human related behaviours including hygiene, inappropriate use of antibiotic (be it under,- over-, or mis-use).

Access to the preventative and management interventions for infectious diseases, including access to WASH, and antibiotics together with interventions for their appropriate use are essential to good health to all people, everywhere. It is futile to try and address the problem of infectious diseases and antibiotic resistance in one country or one specific population, there needs to be a concerted global effort. Despite this, lack of access to these basic health interventions remains one of the major barriers to good health globally. Many people continue to die for the lack of access to effective vaccines and antibiotics increasing the burden of infectious diseases globally and the emergence and spread of drug resistant infections. We cannot therefore talk about good health without considering the need to manage the threat of drug resistant infections and the drivers for their emergence and spread globally.

Power asymmetries continue to shape the world we live and work in. This includes the health industry and global health. Many practices and norms continue to perpetuate and sustain inequality and inequity, including for example how we decide what should be priority areas for research in health, who we include or more importantly exclude from clinical trials, and how we represent people in our work. To disrupt and change the status quo in health delivery and research we need to: 1) understanding what good health looks like and means to different people across cultures and societies 2) identify and deliver a minimum common denominator set of interventions to people everywhere, including access to WASH, vaccines, lifesaving interventions, 3) include the voices and narratives of those thus far excluded from decision making, including people marginalised based on their social and cultural identities including race, gender, ethnicities, sexuality, education and economic status. This is needed not only for when we seek healthcare but also for when we provide healthcare.

Most of the healthcare workforce is female, whilst most of healthcare leadership remains dominated by men. Additionally, most healthcare related roles within society and the family is the burden of female family members and evidence from different countries and cultures demonstrates the negative socioeconomic consequences of this unequal burden of care that is placed on women to the individual and also to the family and society. Whilst power dynamics in healthcare have been described, solutions to addressing them are lacking. Intersectional research is needed to broaden the understanding of the axes of power, and social constructs as predictors of health-related behaviours, specifically infection-related behaviours. Intersectionality hinges on understanding human beings as shaped by the interaction of different social constructs and conditions (e.g., race, caste, gender identity, class, geography, religion, migration status) which interact within connected systems and structures of power e.g. healthcare systems.

Infectious diseases and antibiotic resistance are multifaceted global health challenges, the drivers and consequences of which are socially manifested. Single interventions e.g., evidence-based guidelines, better diagnostics, and new antibiotic agents do not account for the structural and social determinants of health. To optimise care, we must look at collective and individual behaviours. Socioeconomic and cultural inequities influence health-seeking and health-providing behaviours, impacting health outcomes. To deliver effective health for all we need to understand and address these inequities and their consequences. We need to identify communities and populations regardless of geography, who are most affected by infectious diseases and antibiotic resistance because: 1) their burden of infection is highest placing them at greatest risk of untreatable infections; 2) they do not have equitable access to disease prevention programmes vaccination and WASH; 3) they are often exposed to conditions that promote the emergence and spread of drug resistant infections and antibiotic resistance, including interrupted, inadequate, or inappropriate treatment, and dependence on antibiotics through informal routes without the need for a prescription. Critically we need to include both health-providing and health-seeking perspectives based on gender, race and other sources of marginalisation. The WHO report on tackling antibiotic resistance posed the following questions: Is the impact of antibiotic resistance the same for everyone? Do any groups in society face greater or different risks of exposure to antibiotic resistance or more challenges in accessing, providing, using and benefiting from the information, services and solutions to tackle AMR, including IPC? Leaving behind the siloed visions considering each inequality and its relationship with antibiotic resistance and drug resistant infections, we need to study how the multitude of social constructs, hierarchies and inequalities create axes of power which influence behaviours. World Health Day is about health for all. Much work is needed to understand how healthcare systems disempower those less advantaged due to their socioeconomic status, from seeking and providing optimised care. New strategies are needed to provide a mechanism for dismantling and reframing the structures (within political, societal, and healthcare systems) which obstruct those less privileged to have equitable access to health and healthcare.

By Esmita Charani, ISID Emerging Leader, United Kingdom

News Feed Archives


©2024 International Society for Infectious Diseases