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    ID-19 and its economic and socia

    COVID-19 and its economic and social consequences, which include an estimated additional 119-24 million people pushed into extreme poverty (Lanker et al., 2021), and more generally trends in greater unemployment and poorer education outcomes among lower-income workers (ILO, 2021), risk worsening health gaps between countries long into the future. 2018; 10(2): 6365. Therefore, we define global health equity as mutually beneficial and power-balanced partnerships and processes leading to equitable human and environmental health products on a global scale (see Figure 1). 3. Equality and poverty: views from managers and professionals from public services and household heads in the Belo Horizonte Metropolitan Area, Brazil. PLoS Med, 15(6):e1002590. DOI:, Hommes F, Monz HB, Ferrand RA, et al. The authors have no competing interests to declare. represent the views or recommendations of their related institutions. DOI:, August, E., Tadesse, L., ONeill, M. S., Eisenberg, J. N. S., Wong, R., Kolars, J. C., & Bekele, A. 2020; 67(8): 924935. Koplan et al.s widely cited definition mentions equity: global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide [4]. They specify that global health involves a multidisciplinary approach, stating that it emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual-level clinical care. More recently, the shift to the term global health includes a greater awareness about the environment and climate change as global health concerns. Trade Policies and their Impact on Inequalities. Annals of Global Health, 88(1), 50. Engaging in practices and reflection that lead toward global health equity in the current moment will move us closer to these goals [13]. By continuing to read our website, we assume you agree to this. 2015; 81(1): 151152. What should equity in global health research look like? This means that some groups, already in poorer health and less able to weather unexpected crises, may fear engagement with authorities or health providers in the context of testing or vaccination. Ann Glob Heal. 2013; 4(1): 1218. Early on, tropical medicine focused on maintaining a labor force in the colonial tropics. Develop systems of global accountability for health equity. UPSTREAM CHALLENGE: ECONOMIC CONSEQUENCES OF THE COVID-19 PANDEMIC. How COVID vaccines are being divvied up around the world. This means the relationship between equity and vaccine distribution is dynamic, and builds on previous actual and perceived treatment of different groups. First, partnerships are a key launch point for global health equity. 2022; 6736(22): 1820. Failing to take a global approach is resulting in the prolongation of the pandemic and the likely exacerbation of socio-economic divides between countries. International health largely replaced the term tropical medicine with a focus on high-income countries helping low and middle-income countries; this highlighted the power disparity between the two regions [2, 3]. Prev Vet Med. As the COVID-19 pandemic has shown, social divides determine our health outcomes to a large degree and are as deadly as any external pathogen (Bambra et al., 2020; Maani and Galea, 2020). Research across a range of lowand middle-income countries has shown the extent to which these long-standing divides pose more than merely technocratic, quantitative challenges to healthcare access.

    Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Current metrics of health inequalities focus primarily on healthcare-related outcomes, rather than encompassing the foundational drivers of ill health. Such partnerships also involve collaborations within low-income countries and within high-income countries without the involvement of foreign actors. A lack of focus on the causes of inequitable distributions. The urgency of the moment must be balanced with addressing the causes of the moment. Vaccination rates within countries may also vary depending on the levels of trust in institutions and historical experience with them. Mental health and substance abuse,, accessed 19 April 2021, WHO (World Health Organization) (2021b). Such partnerships foster processes with these same dynamics; for example, sharing lead authorship responsibilities with meaningful roles for host country researchers to frame relevant questions and to provide context and interpretation for the research findings. While medical innovation has played a role, particularly in the context of vaccine distribution, at the global level improvements in population health been largely due to improvements in living conditions, employment and education associated with economic development. Ultimately, a commitment to all three components of our definition is necessary to move toward health equity for all. Again, this vulnerability to the longer-term consequences of the pandemic is a manifestation of inequity in terms of living conditions, resources and rights that predated the pandemic, as is the case for inequities in vaccine distribution. Failing to understand the causes of health has led to a lack of focus on the upstream power and economic imbalances that prevent a more equitable distribution of resources; this is necessary to reduce global health inequity. In order to best understand critical vulnerabilities, and to track progress made in addressing health inequities within and between countries, we propose the establishment of a global health equity forum that combines data on within-country and between-country health inequity, and the underlying drivers of this inequity. Towards a common definition of global health. Mainstreaming Sustainability and Global Cooperation will Need Reforms on the Global Financial System JAKARTA, 21 FEBRUARY 2022. September 23, 2021 | Last updated: October 11, 2021, Global Solutions Initiative Foundation gemeinntzige GmbH|. Annals of Global Health. Global perspectives require a lens through which the outcomes for all are equally valued, regardless of national borders, gender, age, race or ethnicity, ability or income. pmed.1002590, Barlow P, Stuckler D. (2021). The equivalent gap for women was 10.1 years (Chetty et al., 2016). 2021; 6(6): 47. Lancet. 2022;88(1):50. Keeping girls in the picture. The Lancet, 386(10010):2257-2274. doi: 10.1016/ S0140-6736(15)00195-6, Nicola M, et al. ), Reimagining global health: An introduction. We can think of a technical solution for a single dimension of health equity in a single context, or we can grapple with international and intranational equity priorities.

    (2018). The association between income and life expectancy in the, United States, 2001-2014. DOI:, Johnson SB. This focus on allocation between countries should not distract from the inequity in vaccination within countries, which is also a pressing concern owing to urban-rural divides and to racial, ethnic, tribal and class differences in health status, ability to access healthcare and exposure to the virus owing to housing, employment or educational conditions. University of California Press; 2013. 2022. The COVID-19pandemic has led to global reverberations far beyond the millions of lives lost or altered as a direct result of infection. DOI:, August, E, et al.. What is Global Health Equity? BMJ Glob Heal. DOI:, Hedt-Gauthier B, Amoroso C, Warugaba C, et al. A narrow emphasis on what shapes health, available to a few.


    UNESCO,, accessed 22 April 2021, Viner R, et al. Taking full definitions of health and well-being beyond longevity, being female is associated with greater exposure to mental illness and gender-based violence (WHO, 2021). A lack of focus on the foundational causes of health, which are highly inequitable in their distribution. Nature. For example, in the United States in 2016, men aged 40 in the highest 1 per cent of earners had an expected age of death of 87.3 years, 14.6 years longer than those in the bottom 1 per cent of earners. Health Research Policy and Systems, 16(1):58. doi: 10.1186/ s12961-018-0338-5, Newton JN, et al. Rich countries should tithe their vaccines. Drs.

    COVID-19 has demonstrated that no amount of biomedical capacity can overcome these societal failures. This will allow funders, non-governmental organizations and governments a clearer view of the longer-term projections for health inequity, their implications for policy, health and prosperity, and the likely impact of future shocks and changes in policy. Ella August & Lia Tadesse are co-first authors. DOI: The implementation of social distancing itself is likely to have significant repercussions for global health equity, owing to the consequences of economic shutdown that are being faced by vulnerable or marginalized groups.

    We propose the development of global metrics of health inequity, emerging from the broadest definition of health and linking to the social determinants of health. (2020). In the context of a future pandemic, each of these components would identify critical weak links in the global population that involve a lack of access to social protections, labour standards, public health and healthcare services. Although many existing definitions of global health mention one of the three, few mention them all, and their presence in our proposed definition reinforces the idea that global health equity requires all three to be in place. In the context of health, it refers to the allocation of resources according to need, in such a way that preventable differences in health outcomes are minimized and access is fair (Culyer and Wagstaff, 1993). When considering between-country or within-country differences, it is clear that health inequities arise owing to wider inequalities in the allocation of power, resources and opportunity, and it is through this lens that we must examine and overcome barriers to global health equity. Finally, we should consider the immediate challenges that health inequities pose, and also the long-tail consequences of our decisions to reduce global health inequities over the longer term. DOI:, Zinsstag J, Schelling E, Waltner-Toews D, Tanner M. From one medicine to one health and systemic approaches to health and well-being. DOI:, Mullard A. DOI:, August, Ella, Lia Tadesse, Marie S. ONeill, Joseph N. S. Eisenberg, Rex Wong, Joseph C. Kolars, and Abebe Bekele. 2021; 9(7): e897e898. Global vaccine equity demands reparative justice-not charity. ILO Monitor: COVID-19 and the World of Work. Taking a truly global view of health equity requires us to consider the inequitable distribution of health not only across countries, but also within countries, regions, cities and neighbourhoods. Reducing health inequity necessitates that we reduce underlying inequities, rather than just extremes of poverty. What Is Global Health Equity? 2011; 101(34): 148156. Measuring health gaps between the rich and the poor: A review of the literature and its implications for health research in Africa.

    Reimagining Global Health: An Introduction. Understanding health inequities is therefore key to preparing for future pandemics. Early efforts at containing COVID, one of the worst pandemics in history, highlighted extreme disparities in vaccine coverage between high- and low-income countries. But over 100 countries had yet to administer a single vaccine dose. The World Health Organization (WHO, 1948) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. It is imperative that one of the first tasks for such a forum would be developing metrics that can adequately catalogue and seek to rectify inequalities that have arisen as a result of COVID-19. A focus on the downstream and biomedical solutions to global health equity has also led to a lack of focus on the social determinants of health, the physical and social environments in which we live, even though these are highly inequitable in their distribution and contribute disproportionately to health inequity within and between countries. (2020b). Is the term global health equity meaningfully different than global health? Accessibility to health and health services is a core aspect of health equity [22]. Accountability as a Driver of Health Equity. We assert that global health equity is inextricably linked to power-balanced and mutually beneficial partnerships and processes. Kaiser Family Foundation,, accessed 12 July 2021, UNCTAD (United Nations Conference on Trade and Development Secretariat) (2019). DOI:, Kumar M, Atwoli L, Burgess RA, et al. DOI:, Wollner E, Law T, Sullivan K, Lipnick MS. Why every anesthesia trainee should receive global health equity education. What is Global Health Equity? It is important, however, to understand differences in within and between-country health inequalities, as their causes, measurement and solutions vary, and there may be trade-offs when focusing on one factor or another. The Hastings Center Studies, 1(3):77-87. doi: 10.2307/3527467, Chetty R, et al. Epidemic illusions: On the coloniality of global public health. Contribute your expertise by sharing your Policy Brief. All authors had a role in writing the manuscript. Please leave this field empty.Please leave this field empty.Please leave this field empty. The use of policies such as requiring author teams to submit reflexivity statements with their journal submissions describing the ways in which equity has been promoted in their partnership can help make these practices more standard [13, 17]. 2016; 94(1): 57. One of the most prominent examples of a barrier to global health equity has been the misallocation of COVID-19 vaccines within and between countries. Our Viewpoint addresses this gap by offering a discussion of this need and proposing a definition. Equitable products, such as access to technology and tailored delivery of interventions effective in the specific context, are the fruits of these partnerships and processes. DOI:, Adams LV, Wagner CM, Nutt CT, Binagwaho A. In reality, upstream factors such as a lack of investment in wider social protections and widening socio-economic divides along racial and ethnic divides, together with the longer term defunding of public health infrastructure, greatly undermined the response to the pandemic in countries such as the United States and worsened its impact (Bambra et al., 2020; Maani and Galea, 2020). More broadly, regional differences reflecting resource and opportunity gaps can lead to significant within-country variance. A forum could help to predict those subpopulations within countries that are most likely to require additional support in times of natural or manmade disasters, and identify groups that are likely to be disproportionately affected by global policy goals, such as reducing CO2 emissions. Eventually, the term global health came into favor, reflecting new emphases. A Proposed Definition. In other words, income inequality is more extreme. As Abimbola and Pai discuss, concern for global and international health was originally in service of colonization, and global health efforts and organizations today are characterized by supremacist structures and leadership [12]. Published online November 2020.

    Annals of Global Health, 88(1), p.50. DOI:, Richardson ET. The term global health equity has increasingly appeared in the literature, and the organizations, centers, fellowships, and degree programs with global health equity in their name are much more visible than even five years ago.

    The COVID-19 pandemic and health inequalities. Annals of Global Health, vol. J Public Health Africa. BMJ Glob Heal. Annals of Global Health 88 (1): 50. These are disparities that have both immediate and long-tail consequences. Int Health. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. In the United Kingdom, life expectancy in the most deprived regions in 2013 was comparable to the life expectancy in 1990 for least deprived regions (Newton et al., 2015). (2020). doi: 10.1136/bmjgh-2020-002884, Asaria M, et al. Pan American Health Organization. DOI:, Abimbola S. On the meaning of global health and the role of global health journals.

    The socio-economic implications of the coronavirus and COVID-19 pandemic: a review.

    BMC Med Educ. A recent meta-knowledge analysis found that global health research tended to focus on infectious diseases in lowand middle-income settings and on healthcare systems (Abdalla et al., 2020). COVID-19 has had an unprecedented impact on global health but the inequitable consequences have been as expected. Berkeley: University of California Press, Hammonds R, Hanefeld J, Ooms G (2019). Decolonization and the eradication of racism are ultimate goals that will transform the way global health activities are practiced. This is of particular note at a time when decision-makers are grappling with global measures such as those aimed at lowering emissions. (2018). While a fuller embrace of COVAX, or more equitable guidelines for the distribution of vaccines within countries, might reduce health inequities in the context of COVID-19, the conditions that drive those health inequities in the first place, the vast differences in underlying health status, access to healthcare, infrastructure for storing and transporting medicines, access to safe working and housing conditions, and imbalances in ability to influence trade agreements or patent protections would remain. Geneva: United Nations, UNESCO (United Nations Educational Scientific and Cultural Organization) (2021). Disability-adjusted life years per 100,000 population by region, Source: Adapted from the World Health Organization Global Health Observatory (WHO-GHO, 2021). This means that even in high-income countries, there are significant proportions of the population that are left behind, experiencing shorter lives in poorer health than the wealthiest minorities in many lowand middle-income countries, often along racial and ethnic divides (Wrigley-Field, 2020).

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