Unmasking Gender Inequities in Health: Research Findings & A Roadmap to Gender-Equitable UHC

IN A NUTSHELL
Editor's note In this article, the Author takes into account the results from a new study, published in The Lancet, funded by the Bill & Melinda Gates Foundation, which emphasizes the importance of considering sex and gender differences in health outcomes, while facing Health Inequity that weakens the value of Public Health.

As the Author maintains, ‘to dismantle the systemic barriers perpetuating gender inequities in health, we must adopt a multifaceted approach that includes sub-national analysis as a critical tool’. 

In such an endeavour, investing in data, empowering communities, building capacity, reforming policies and challenging norms must serve as not to be given up pillars.

By Philip J Gover BA MA MPH

Public Health Consultant, Cooperation Works

Unmasking Gender Inequities in Health: Research Findings & A Roadmap to Gender-Equitable UHC

 

Universal Health Coverage (UHC), a global health goal introduced by the World Health Organization (WHO), aims to ensure equitable access to essential health services without financial barriers. Its significance lies in its potential to enhance health outcomes, reduce inequalities, and foster economic development. UHC offers several benefits, including access to essential medical services, improved health outcomes, mitigation of health disparities, and promotion of economic growth.

Achieving UHC presents challenges across all economies, particularly in low-income countries. Structural barriers such as high healthcare costs, disparities in insurance coverage, and limited healthcare availability hinder access to care. However, recent research[1] published in The Lancet, funded by the Bill & Melinda Gates Foundation, highlights the importance of considering sex and gender differences in health outcomes, adding further complexity to the planning and delivery of UHC.

Key Insights from Research

The research article provides several key insights regarding health differences between females and males across different age groups and geographies. Key insights and conclusions from the research include:

Global Health Disparities: The study reveals substantial global health differences between females and males, with little progress in bridging these disparities from 1990 to 2021. Conditions such as depressive disorders, anxiety disorders, and road injuries disproportionately affect females or males, with disparities emerging as early as adolescence and continuing to grow over the life course.

Regional Patterns: The research highlights various regional patterns in the distribution of disease burden across age groups for females and males. Variations in the prevalence of different health conditions across regions underscore the complex and context-specific relationships between health and gender norms, economic conditions, and social practices.

Importance of Gender-Sensitive Interventions: The findings underscore the importance of developing gender-sensitive interventions and preventive measures from a young age to address growing health differences between females and males across life stages. Gender norms and attitudes intensify during adolescence, emphasizing the need for early interventions that consider social determinants of health.

In addition to gender, it is crucial to recognize the intersecting influences of race, ethnicity, socioeconomic status, and geographical location on health outcomes. Intersectionality underscores the complex interplay between various social determinants of health, magnifying disparities experienced by marginalized communities. For instance, women of colour may face compounded barriers to accessing healthcare due to systemic racism and economic inequality. Similarly, rural communities may encounter distinct health challenges stemming from limited healthcare infrastructure and resources. By adopting an intersectional lens, policymakers and healthcare providers can develop more targeted interventions that address the unique needs of diverse populations, thereby advancing health equity.

Need for Inclusive Health Data: The study highlights the need for inclusive health data that span the gender spectrum to support more comprehensive and equitable health research. Current data limitations, including the binary framework of female or male in data disaggregation, hinder the analysis of health differences for gender-diverse individuals.

Persistent Health Differences: Despite advancements in understanding sex and gender disparities in health, the research underscores the persistent nature of health differences between females and males. The study calls for continued innovation in analysing health data from a gender perspective to address the roots of health disparities and promote health equity.

Life Course Approach: The research emphasizes the importance of adopting a life course approach in strategic planning for health systems to address the diverse and evolving health needs of females and males across different life stages. Effective health system strategies should consider the interplay between sex, gender, and other social determinants of health.

[Figure 1 – Global rankings of the top 20 causes of DALYs globally for females and males, age-standardised (10 years and older), 2021]

The list of causes of disease burden represents the top 20 causes of age-standardised DALYs observed across females and males for the age group of 10 years and older globally in 2021. This same list of health conditions was ranked according to the DALY rates (per 100 000 population) for both females and males globally in 2021 for the same age group. The colours of the bars and lines denote whether DALY rates are higher for females (red) or males (blue) as established by whether the 95% uncertainty interval of the absolute difference in DALY rates includes zero. The degree of transparency reflects the composition of DALYs for each cause, split between mortality (YLL) and morbidity (YLD). DALY=disability-adjusted life-year. YLL=years of life lost. YLD=years lived with disability.

In conclusion, the research article highlights the ongoing health disparities between females and males globally, the regional variations in disease burden, the importance of gender-sensitive interventions, the need for inclusive health data, and the significance of adopting a life course approach in healthcare planning to promote health equity and address health differences across diverse populations.

Limitations and Considerations

Acknowledging several limitations, including the inability to fully disentangle the influences of sex and gender on health outcomes, the study calls for more inclusive health research that considers intersectionality with other determinants of health.

The research emphasizes the necessity of adopting sex-informed and gender-informed strategies to address the distinct health challenges faced by men and women at different stages of life. This approach is crucial for achieving an equitable and healthy future for all individuals. Additionally, incorporating a sub-national perspective into these strategies can ensure that interventions are tailored to the specific needs of different regions and populations.

The research also hints at the need for sub-national analysis to understand how these disparities manifest at a local level.  By examining data at a sub-national level, researchers can identify localized health challenges, tailor interventions to specific regions, and allocate resources effectively to address disparities within different communities.

While national-level data provides a crucial overview of gender disparities in health, sub-national analysis offers a more granular understanding of these inequities. By examining health outcomes at the district or community level, policymakers and healthcare providers can identify localized challenges and tailor interventions to specific populations. This approach has proven successful in addressing other health disparities, such as maternal mortality and infectious disease outbreaks. For example, in India, sub-national analysis revealed significant variations in maternal mortality rates across states, prompting targeted interventions that led to a substantial decline in overall maternal deaths. Similarly, in Cambodia, sub-national data has been used to identify high-risk areas for malaria transmission, allowing for targeted distribution of bed nets and antimalarial medications. These examples demonstrate the potential of sub-national analysis to inform effective and equitable healthcare strategies, particularly in addressing the complex issue of gender disparities in health.

The Cambodian Context

In Cambodia, the unique burden of disease, that represents its top 20 causes of age-standardised DALYs will be slightly different from that of the global collection.  However, the underlying research illustrates that without assessment, gender-based access can be inhibited.  This is important for economies like Cambodia, as addressing its health inequities requires a nuanced understanding of various demographic factors and gender dynamics that play a crucial and influential role in the provision of healthcare.

The female population outnumbers males by 2-4%.  This demographic skew is further compounded by a pattern of rural to urban migration, whereby men predominantly leave provincial districts for city-based employment opportunities, leaving behind a disproportionately female rural population.  Beyond this, it is asserted that there are still a significant number of rural communities, within localities, still unmapped.[2]

[Figure 2 – Unmapped Villages and Towns in Cambodia, 2019]

Women, in general, also tend to outlive men both locally and globally, resulting in an aging and rural population, predominantly comprised of older women.  Adding further complexity is the consideration associated with the healthcare needs of prisoners, especially those of older incarcerated men and women, living out their lives in settings, where healthcare standards inside the prison gate fall way short of the limited standards that already exist outside the gate.

Sub-National Analysis: A Critical Tool for Action

Policymakers are increasingly recognizing the value of sub-national and sub-regional analysis in healthcare. By collecting and analysing health data within districts or communities, typically organized into cohorts of around 100,000 individuals (100k Analysis), we can identify regional and often sub-regional disparities in health outcomes, healthcare access, and resource allocation. This approach enables policymakers and healthcare providers to gain insights into localized health needs, prioritize interventions, and allocate resources more effectively.

The 100k Analysis approach can help facilitate a focus that examines and unmasks the granular detail of health outcomes, disparities, and healthcare utilization patterns within specific geographic areas.

While sub-national analysis offers a promising avenue for addressing gender inequities in health, it is important to acknowledge the potential challenges and limitations of this approach. Data availability and quality can vary significantly across regions, particularly in resource-limited settings. Additionally, financial and human resource constraints may hinder the implementation of comprehensive sub-national analysis. Strong political will and coordination among various stakeholders are essential for success, but can be challenging to achieve. Furthermore, the complexity of health systems and the interplay of multiple factors beyond gender may not be fully captured by sub-national analysis alone. Finally, equity considerations must be prioritized to ensure that resources and interventions are distributed fairly across all populations.

While challenges exist in capturing the complex nature of health needs within a fixed population size, the benefits of this approach outweigh the drawbacks. By complementing population-based analyses with localized evaluations, we can develop targeted interventions that address the diverse and evolving health needs of rural and urban populations across different age groups.

A Roadmap to Gender-Equitable UHC

To dismantle the systemic barriers perpetuating gender inequities in health, we must adopt a multifaceted approach that includes sub-national analysis as a critical tool:

  1. Invest in Data: We need robust, sex-disaggregated data at both national and sub-national levels. This data must inform targeted interventions and policies addressing the specific health needs of different populations in different regions.
  2. Empower Communities: Engage with communities at all levels, especially marginalized groups, to raise awareness of gender disparities and empower them to advocate for their health rights.
  3. Build Capacity: Provide healthcare professionals with training and resources to deliver gender-sensitive care free from bias and discrimination, ensuring that this capacity is distributed equitably across regions.
  4. Reform Policies: Advocate for policies promoting gender equity in all aspects of health, from access to services to research funding, with consideration for regional variations in health needs.
  5. Challenge Norms: Confront harmful social norms and power dynamics that drive gender disparities in health, recognizing that these norms can vary across different communities and regions.

The time for action is now. By working together, we can create a world where all individuals, regardless of gender or geography, have the opportunity to live healthy, fulfilling lives. This is not just a matter of justice; it is an investment in the future of our societies. When we prioritize gender equity and sub-national analysis in health, we create a ripple effect of positive change that extends to all aspects of life.

Author profile

Philip J Gover BA MA MPH

Public Health Consultant based in Cambodia with Cooperation.Works Mobile and open to program and research management opportunities that address inequalities in Public Health, Social Justice and Sustainable Development. 

I solve complex development challenges, designing innovative programs and securing funding through strategic partnerships.  With a proven track record in Community Development, Public Health, and Business Enterprise, I like to drive projects from concept to implementation. Passionate about the UN SDGs, I aim to support and empower communities to create sustainable solutions. I enjoy coaching teams and mentoring talent and I take calculated risks to achieve transformative change.

Let's connect if you seek a change-maker with vision and execution. 

philip.gover@cooperation.works

https://www.linkedin.com/in/pjgover

 

References

[1]     Patwardhan, V., Gil, G. F., Arrieta, A., Cagney, J., DeGraw, E., Herbert, M. E., … & Flor, L. S. (2024). Differences across the lifespan between females and males in the top 20 causes of disease burden globally: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Public Health9(5), e282-e294.  Available here

[2]     See here

 

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Stroke Awareness and Africa

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Editor's note Stroke risk awareness should increase in Africa where this disease is the third leading cause of death, accounting for about 9% of all deaths on the continent, due to factors including high blood pressure, diabetes, obesity, smoking, and lack of access to healthcare services

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                                     Addis Ababa, Ethiopia                                       

Stroke Awareness and Africa

 

Stroke is a medical condition that affects millions of people around the world, including the African population. It is a serious and potentially life-threatening condition that occurs when the blood supply to the brain is disrupted(1).

May is Stroke Awareness Month, a time dedicated to increasing awareness about stroke, its causes, and its impact on individuals and families(2).

African countries are facing a growing burden of stroke cases. According to the World Health Organization (WHO), stroke is the third leading cause of death in Africa, accounting for about 9% of all deaths on the continent. The prevalence of stroke in Africa is higher compared to other regions, and it affects individuals at a younger age. This can be attributed to various factors such as high blood pressure, diabetes, obesity, smoking, and lack of access to healthcare services(3).

One of the major challenges in addressing stroke in Africa is the lack of awareness and knowledge about the condition. Many people are unaware of the risk factors and warning signs of stroke, which delays the timely recognition and treatment of the condition. It is crucial to educate the population about stroke, its symptoms, and the importance of seeking immediate medical attention.

Many individuals may not recognize the symptoms of a stroke or may delay seeking medical help, resulting in delayed treatment and poorer outcomes. Therefore, it is crucial to educate the public about the signs and symptoms of a stroke and emphasize the importance of seeking immediate medical attention.

Recognizing the warning signs of stroke is crucial for getting prompt medical attention and preventing long-term damage.

The acronym “BE FAST” is an easy way to remember the signs of stroke:

  • Balance: sudden loss of balance or headache
  • Eyes: Is vision blurry
  • Face drooping: Does one side of the face droop or feel numb?
  • Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
  • Speech difficulty: Is speech slurred or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.”
  • Time to call: If someone shows any of these symptoms, call to hospital immediately.

Prevention plays a vital role in reducing the burden of stroke in the population. Adopting a healthy lifestyle can significantly lower the risk of stroke. This includes maintaining a balanced diet, engaging in regular physical activity, avoiding tobacco and excessive alcohol consumption, and managing underlying conditions such as high blood pressure and diabetes(4). Access to quality healthcare services and medications for risk factor control is also crucial in preventing strokes. In conclusion, stroke has a significant impact on the African population, with higher prevalence and younger age of onset compared to other regions. Raising awareness about stroke, recognizing its symptoms, and promoting preventive measures are essential to reduce the burden of stroke in Africa. By working together to educate communities and improve access to healthcare services, we can make a difference in the lives of millions affected by stroke in Africa. Remember, timely action can save lives. Stay informed, stay healthy(5).

Stroke Awareness Month is an opportunity to spread the word about stroke prevention, recognition, and treatment. By raising awareness, we can help more people understand the risk factors, warning signs, and actions to take in the event of a stroke(6).

 

References

  1. World Stroke Day | American Stroke Association [Internet]. [cited 2024 May 11]. Available from: https://www.stroke.org/en/about-the-american-stroke-association/world-stroke-day
  2. Stroke – Society for Public Health Education – SOPHE [Internet]. [cited 2024 May 11]. Available from: https://www.sophe.org/focus-areas/chronic-conditions/may-national-stroke-awareness-month/
  3. World Stroke Day 2022 [Internet]. [cited 2024 May 11]. Available from: https://www.who.int/srilanka/news/detail/29-10-2022-world-stroke-day-2022
  4. strokeawareness [Internet]. [cited 2024 May 11]. Help Spread Stroke Awareness | Stroke Awareness. Available from: https://www.strokeawareness.com/patient/spread-the-word.html
  5. Elshebiny A, Almuhanna M, AlRamadan M, Aldawood M, Aljomeah Z. Awareness of Stroke Risk Factors, Warning Signs, and Preventive Behaviour Among Diabetic Patients in Al-Ahsa, Saudi Arabia. Cureus. 15(2):e35337.
  6. Stroke Awareness Foundation: Improving Stroke Outcomes [Internet]. [cited 2024 May 11]. Available from: https://www.strokeinfo.org/

 

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Interview: Joan Kembabazi, Gufasha Girls Foundation, Uganda

Gufasha Girls Foundation (GGF) is a non-profit community-based organization whose primary work is to advocate against child marriage and promote girls’ education.  Founded in 2016 and headquartered at the Kayunga District, Uganda, the Foundation is committed to reaching the most vulnerable girl children to change their lives, give them hope and build a generation of empowered girls and women. 

In this connection, PEAH had the pleasure to interview Joan Kembabazi as Gender Equality Activist and Founder & Team Leader of Gufasha Girls Foundation 

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Joan Kembabazi 

Gender Equality Activist and Founder & Team Leader of Gufasha Girls Foundation (GGF)

…I dream of a world where every girl attains the opportunity to access quality education to be able to be whoever and whatever they want to be, finds and owns her voice and uses it to stand against any form of violence and discrimination… 

(Joan Kembabazi) 

PEAH: As a non-profit organization whose primary work is to advocate against child marriage and promote girls’ education, Gufasha Girls Foundation strives to ensure that all girls in Uganda can stay in school, stay healthy and have the futures they dream of. Can you tell us more about? 

Kembabazi: Gufasha Girls Foundation is a grassroot community–based organization in Uganda dedicated to ending child marriage and promoting girls’ education through a holistic approach that challenges and dismantles barriers, negative social and cultural norms and all challenges facing girls and ensures that they have the opportunity to thrive and build a better future for themselves and their communities. Our approach includes girls’ education advocacy, community engagements, child marriage prevention and intervention and capacity building.

PEAH: Now, let us in on the plight of child marriage, as part of the history of the Foundation and the origin of its name

Kembabazi: The origin of the name of “Gufasha Girls Foundation” traces back on my personal story of the loss of my childhood best friend, Gufasha Moureen who was married off at the age of 13 to a 62 year old man. Gufasha  was denied her right to education and her parents insisted that she was old enough to get married. While in marriage, she lived a life filled with violence, rape, abuse and most times food. At time of child birth, she couldn’t make it and lost her life and the baby too. This hurt me so deep.  And with time, I realized there were so many girls like Gufasha who were being married off even as young as 11 years in my community. This inspired me to start off my advocacy work to raise awareness on the devastating effects of child marriage  and founded a grassroot coomunity-based organization that I named in memory of my best friend. This is how and where Gufasha Girls Foundation originates from.

 PEAHHow many girls is Gufasha Girls Foundation currently looking after? 

Kembabazi: Gufasha Girls Foundation is currently supporting more than 2000 adolescent girls through our grassroot initiatives including Leadership and Empowerment training actvities, Menstrual health and Management products and awareness, Education Sponsorships and SRHR education and services.

PEAHWhat about Gufasha Girls Foundation mission, vision and values?

Kembabazi: Our Mission is to end child marriage and empower girls and young women in Uganda through Advocacy, Capacity building and Education support.

Our Vision is a world in which every girl achieves her fullest potential and contributes to all aspects of life.

Our values are: Community transformation, Passion, Accountability and Transparency.

PEAHYour programs include ‘End Child Marriage, Girl Child Education, Menstrual Health & Hygiene Management’. Can you please detail in depth?

Kembabazi: We work to end Child Marriage because it is a violation of girls’ rights and we believe that girls should and must enjoy their rights including a right to just be a girl/child. We work closely with communities to challenge and change negative traditional and cultural norms and beliefs that force girls into marriage before 18 Years. We do this through community dialogues, collaborating with local, traditional and religious leaders, health workers, social media advocacy, safe spaces and school clubs and various advocacy campaigns.

We advocate for advocating for gender transformative education in schools and communities to break stereotypes around girls’ education.Through our #SheThrives Education Sponsorship program, we currently support education of 13 girls.

Proper Menstrual Health and Management is a fundamental right for girls and we educate girls about MHM and support  them with sanitary products to enable them stay in school and menstruate with pride and dignity.

PEAHAs for the results achieved by Gufasha so far?

Kembabazi: Gufasha Girls Foundation has successfully raised awareness about the harmful effects of child marriage within local communities of Uganda leading to a shift in attitudes and perceptions towards the practice.

We have been able to implement child marriage prevention and response programs in communities which has led to the decline in the practice rates.

Our Leadership and Empowerment sessions for adolescent girls  has enabled girls to assert their rights, resist pressure to marry early, and pursue their educational and career aspirations.

We have provided age-appropriate Sexual Reproductive Health Rights information and services to adolescent girls which has recorded a decline in teenage pregnancies, HIV/AIDs contraction, STIs and school dropouts among girls.

PEAHDoes Gufasha work together with national and/or international partners? 

Kembabazi: Yes, we work with both national and international partners that we share the same vision with. Our partners include: Partnership for Maternal, Newborn and Child Health (PMNCH) which is hosted by the World Health Organization, Tranform Education (TE) which is hosted by the UN Girls Education Intitiative; and grassroot partners that share the same vision of transforming communities include Joy for Children, Raising Teenagers and Tard Foundation.

PEAHWhat are your own duties and tasks in Gufasha Girls Foundation?

Kembabazi: – I lead the Team at Gufasha Girls Foundation.

I work with the team to set goals and strategies for the organisation, ensuring they align with the needs of the communities we work for and with.

I represent the organisation in public forums and media.

I secure funding and resources to sustain and expand the organisations programs and initiatives

I build networks, partnerships and collaborations with different organizations and stakeholders for the organization.

PEAHThanks to you and the Gufasha team for the excellent, very commendable work

 

 

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UK passes law to send asylum seekers to Rwanda after months of wrangling

Afghan Women’s Voices Stifled as Taliban Tightens Media Controls

EU adopts first directive combatting violence against women

Commission’s recommendation calls for better protection of children from violence

It’s all connected: Gender Justice for Planetary Health – including at national and local level

European Medicines Agency makes recommendations to improve supply of critical medicines

As Danaher reports quarterly earnings and increased market share for Cepheid’s GeneXpert medical tests, MSF calls on corporation to drop all test prices to $5 for low- and middle-income countries

Colombia issues first-ever compulsory license, a landmark step for expanding access to affordable HIV treatment

The Kissing Bug Doctors of Florida

WHO prequalifies new oral simplified vaccine for cholera

Study Finds Adult Vaccination Programs Deliver 19x Returns

The response to substandard and falsified medical products in francophone sub-Saharan African countries: weaknesses and opportunities

Reviving use of local seeds in African farming

Microplastics are everywhere — we need to understand how they affect human health

Negotiations on global plastic treaty to resume in Canada

Urgent Global Action Is Essential To Stop Wave of Plastic Pollution

To Protect Human Health, We Must Protect the Earth’s Health

Climate change to wreck global income by 2050, study shows

Asia Is Warming Faster Than the Global Average, Warns WMO

Rich Nation Hypocrisy Accelerating Global Heating

Climate change: A driver of increasing vector-borne disease transmission in non-endemic areas

Quakes do not kill people, bad buildings do

 

 

 

 

 

 

Restoring Broken Human Deal

IN A NUTSHELL
Editor's Note

How can the present ‘broken deal’ within humanity and with nature be restored? With this in mind, this far-reaching reflection piece takes into most account the global political and economic governance failure, increasingly evident during the first two decades of the 21st century, as the root, driven by greed, cause of global human injustice and nature destruction. And this occurs at a time when unempathetic (between humans and much lower with other forms of life), maniputaled and/or passive societies continue to play a negative role.

Against this backdrop, aside from implicitly advocating for decision makers worldwide to overturn the evidence that public interest almost regularly succumbs to the interest of the powerful, this analysis also suggests that a potential solution “lies in fostering a new societal paradigm rooted in empathetic local governance, ecosystem-friendly production and consumption of essential needs, and collaborative digital innovation to advance human knowledge and create global benefits”

By Juan Garay

Professor of Global Health Equity Ethics and Metrics in Spain (ENS), Mexico (UNAChiapas), and Cuba (ELAM, UCLV, and UNAH)

Co-founder of the Sustainable Health Equity movement

 Restoring Broken Human Deal

 

It appeared that the ending of the wars of the 20th century, referred to in China as “European” wars, led to a collective effort in establishing the United Nations, despite the devastating US nuclear bombing of Japan. However, one might argue that it was more of an arrangement among the victorious powers, centered around the Security Council’s authority, with the human rights charter serving as a superficial facade lacking enforceability. Historical evidence seems to support this perspective.

The post-war era saw a surge in global cooperation, centered on the US Marshall Plan and the interlinking of Western market economies. It also witnessed the formation of alliances among former adversaries in Europe and the emergence of independence movements in African nations, which were still under colonial subjugation. However, alongside these developments, the United States supported fascist regimes in the Americas and engaged in unsuccessful conflicts against communism in Asia and elsewhere. The Cold War intensified nuclear threats and polarized the world until the fall of the Berlin Wall. Meanwhile, China quietly pursued a strategy of combining global trade with communist single-party national development plans, resulting in the fastest GDP and life expectancy growth rates recorded (1). This approach represents one of the most successful blends of market and centralized economies in terms of human lifespan, albeit at the cost of restrictions on freedom and environmental degradation.

During the first two decades of the 21st century, the Cold War appeared to transition into a multipolar landscape, notably with the decline of Russia and the economic and geopolitical ascendance of China.

Meanwhile, humanity witnessed the diminishing impact of two major death tolls by the close of the 20th century: the AIDS pandemic (2) and the aftermath of the Soviet Union’s collapse (3). Globally, under-five and adult mortality rates decreased, and life expectancy continued its upward trajectory (4), increasing by approximately 0.5% annually. Concurrently, advancements in digital technology, particularly in understanding the human genome (5), as well as in applied technologies, nanotechnologies (6), and 3D protein mapping and engineering (7), pushed the boundaries of knowledge.

However, despite these advancements, the two primary global health challenges since the 1980s persisted: intra- and inter-generational inequities (sustainable equity) (8). The World Health Organization (WHO) continued to grapple with the elusive task of estimating inequities through inequalities across relevant stratifying variables (9), failing, even after 75 years, to adequately measure the only common health objective among nations (best feasible level of health) (10). Consequently, the burden of health inequity (11), representing the gap to the universality of the right to health, remained unmeasured.

Efforts to identify such a target faced challenges from UN development models (12) (with the best Human Development Indexes largely unreplicable and unsustainable), World Bank poverty thresholds (13) (falling short of enabling the aforementioned feasible health levels), and the OECD-DAC cooperation target of 0.7% from 1970, which stood at only 0.37% over 50 years later, in any case significantly below the redistribution rates necessary for economic equity and thus global health equity (14).

Why does such persistent reluctance exist to measure global health progress and challenge the persistence of anachronistic development, economic, and cooperation concepts?

While the transition from MDGs to SDGs aimed to standardize targets across all countries, bridging the gap between intra (MDGs and SDGs 1-11) and inter (SDGs 12-16, COP, and Biodiversity targets), and overcoming north-south polarization (15), it fell short of fully translating rhetoric into action, to put it diplomatically.

Meanwhile, global political and economic governance remained entrenched in the hands of the Security Council, dominated by World War II victors, and international financial institutions revolving around the US dollar, thus perpetuating US economic supremacy (16).

The low commitment to global fair governance does reflect the meager overall UN regular budget (17): less than 0.00002% of the world’s GDP. It is supplemented by ad hoc and earmarked funding primarily from Western development agencies and “philanthropy” linked to economic powers and vested interests. In the case of global health governance, under the World Health Assembly and the World Health Organization, regular contributions to the WHO’s budget do not reach 20% (18), with a growing influence of ad hoc contributions of mainly Western development agencies, philanthropic endowments or direct influence from pharmaceutical companies (19) whose profits primarily stem from patent monopolies (20).

Against this backdrop, Humanity grappled with three intertwined challenges: the economic speculative crisis of 2008-2010, the COVID-19 pandemic of 2020-2022, and ongoing conflicts in Ukraine and Gaza. Though seemingly disparate, these challenges share common roots that have hindered sustainable health equity progress since the 1980s and also contribute to the escalating existential threat of anthropogenic global warming:

  1. Economic speculation, primarily driven by bargaining economic interests rather than creativity or production, has evolved into increasingly complex layers and holds greater power, particularly in the hands of massive asset managers (21). This system has been hoarding roughly 20-30% of GDP (22) and a significant portion of GDP growth over the past four decades, diverting resources away from global human justice and decoupling from global human wellbeing (23). Such speculative economy is a major part of what we earlier called “hoarding threshold” (24) and has been recently called “wasted GDP” (25). Furthermore, it exacerbates both economic intra (correlated with increasing GINI) and inter-generational (linked to climate change through global-scale production, trade, and consumption) inequity (26). Therefore, a more appropriate term for it would be “toxic GDP,” behaving akin to a cancer in the global economy and human harmony with nature. This dynamic continues to propel and dominate not only the global economy and lifestyles but also, linked to power-driven mass media and artificial intelligence, global human thinking. It perpetuates a biased economic governance that shields the primary speculative powers, often resulting in diminished or even nonexistent fiscal revenues (27). Western positions have opposed the development of a UN Tax Treaty aimed at addressing the unmentioned undermining effects of financial speculation (28).
  2. The COVID pandemic exposed how global governance prioritizes capital over humanity. Despite significant scientific and economic investments in urgent global goods such as effective vaccines, the response was heavily biased in favor of big pharma, accelerating the rollout of their new patent-protected technologies, such as mRNA, (with remaining mid-long germ safety uncertainty) (29) primarily benefiting high-income countries and communities. This unequal access to vaccines exacerbated disparities and polarized humanity, reminiscent of the AIDS gap in the 1990s (30). In this instance, the disparity between those protected from the pandemic and those exposed correlates with individuals “working” behind screens, often closely associated with a speculative or toxic economy, versus those fulfilling essential needs such as food, water, energy, transportation, and vital public services. Global governance failed to establish binding frameworks for global goods, and exemptions to patent laws for public health purposes proved slow and ineffective, prioritizing profits over the health and lives of the majority (31).
  3. Ongoing wars are related to a growing West-East and North-South divide and tension. The “north and west” has approximately one sixth of the world population, yet two thirds of the world’s GDP, of the military spending, of global carbon and ecological footprint and also two thirds of the veto power in the security council. Their oligarchic role in global economy and politics, as mentioned above, is progressively challenged (32). The most recent wars on Ucraine and Gaza, reflect reactions to the rupture of fragile balances of a NATO vs. Russia and its growing alliances with China, and the Arab league vs. Israel and its US Big brother. Western double standards (33) confronting Russia’s invasion while being supportive or complacent with Israel alleged genocide (34) undermine its former -at least intentional-multilateralism and human rights discourse. Meanwhile, the tension grows between the two major powers, the US and China, over the sovereignty of Taiwan (35), where also most chips (the neurons of global economy and communication) come from. Global political and military governance proved weak and biased as anachronic security council permanent members’ veto power (36) overruled the global cry to stop bombing innocent civilians, notably in Gaza.

The abovementioned crisis revealed an enhanced Humanity’s “broken deal”, unable to collectively limit toxic GDP and its impact on nature, develop global goods to confront increasing natural disasters and pandemics due to human’s destruction of nature and to prevent military, including nuclear threats, abuse by some. Economic, ecologic, knowledge, political and military global governance are either biased, void and/or broken.

As a result, human wellbeing, as gauged by life expectancy, dropped for the first time after the post war humankind (rhetoric?) deal (37) and is not picking up after the pandemic in many regions (38). Intragenerational health inequity, with a burden of some 16 million excess and unfair and preventable deaths per year remained high (39) while we expect comparable international demographic data to assess the post-pandemic trend in the present 2020-2025 period. The prospects of excess intergenerational mortality surpass 220 million excess deaths in the remains of the century, mainly in low polluting countries, communities and age groups (40).

These root causes of global human injustice and nature destruction have a common root: unempathetic (between humans and much lower with other forms of life), maniputaled and/or passive societies (41). The combination of economic, knowledge and military powers driven by greed, with passive and submissive societies fuels speculative and ecologically destructive global economic powers through blind consumption and savings, selfish protection of unfair individual, corporate and national privileges, unequitable access to what should be global public goods, and power market and media-driven voting, forced tax contributions to maintains the status quo and even military recruitment to kill unknown-others mandates by power greed far from the battlefields.

How can the present broken deal within Humanity and with nature, be restored?

If governments have proven incapable or unwilling to build human justice for the last 75 years, can individuals and societies roll back the rising intra and intergenerational gaps and restore the “broken deal”?

Interestingly, as biased governance frameworks interrelate so do the counter dynamics societies may put in motion. Enhanced conscience of our present largely collective blind consumption, savings, taxes and votes may trigger a new philosophy beyond anthroposophism towards biosophism, of simplicity, solidarity and respect for human and nature biodiversity (42).

Digital means can help know the individual (43) and collective economic (preventing toxic GDP/consumption) and ecological (preventing excess carbon and ecological footprint) ethical thresholds.

If “toxic GDP” shrinks and eventually collapses, political and military powers may follow.

A growing number, particularly among younger generations, seeks to break free from the relentless global urban rat race of excessive production and consumption (44, 45). A potential solution lies in fostering a new societal paradigm rooted in empathetic local governance, ecosystem-friendly production and consumption of essential needs, and collaborative digital innovation to advance human knowledge and create global benefits.

This transformative system could result in a significant reduction (around 40%) in GDP (considered as toxic share), while simultaneously narrowing the gap in inequality from the current international GINI coefficient of 0.6 and average national coefficient of 0.45 to a more equitable range between the thresholds of dignity and excess (below 0.15 GINI); while keeping carbon emissions and ecological footprints below ethical thresholds (approximately 1 metric ton and 1 hectare annually per capita, respectively). (39)

By ensuring that living standards exceed the dignity threshold (greater than $10 per person per day) (39) for all individuals and providing universal access to preventive and treatment services, as well as essential global goods such as life-saving knowledge, products, and devices, this approach could help achieve the elusive and often overlooked global health objective of attaining the best feasible level of health for all, thereby averting an estimated 16 million unjust deaths annually.

This global, peaceful revolution aimed at restoring sustainable equity has the potential to reverse the current troubling trends and steer humanity toward brighter horizons.

 

References

1)https://www.statista.com/statistics/1041350/life-expectancy-china-all-time/

2)https://www.unaids.org/en/resources/fact-sheet

3)https://academic.oup.com/book/10210/chapter/157873288

4)https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31833-0/fulltext

5)https://pubmed.ncbi.nlm.nih.gov/23284016/

6)https://www.iinano.org/frontiers/

7)https://deepmind.google/technologies/alphafold/

8)http://www.peah.it/2021/04/9658/

9)https://health-inequalities.eu/jwddb/who-health-equity-monitor/#:~:text=The%20WHO%20Health%20Equity%20Monitor,resources%20for%20health%20inequality%20monitoring.

10)https://treaties.un.org/doc/Treaties/1948/04/19480407%2010-51%20PM/Ch_IX_01p.pdf

11)https://www.peah.it/2015/10/understanding-measuring-and-acting-on-health-equity/

12)http://scielo.sld.cu/pdf/rnp/v18n36/1817-4078-rnp-18-36-87.pdf

13)https://www.binasss.sa.cr/eng.pdf

14)https://sdgpulse.unctad.org/development-financing/

15)https://www.undp.org/publications/transitioning-mdgs-sdgs

16)https://scholar.google.com/scholar?hl=fr&as_sdt=0%2C5&q=us+dollar+global.economic+governance+biased&btnG=#d=gs_qabs&t=1713263714000&u=%23p%3DK7uNOI1zKk8J

17)https://betterworldcampaign.org/resources/briefing-book-2022/united-nations-budget

18)https://www.who.int/about/funding

19)https://www.europarl.europa.eu/doceo/document/E-9-2020-002335_EN.html

20)https://www.sciencedirect.com/science/article/pii/S0954349X23000048

21)https://www.afr.com/companies/financial-services/how-asset-managers-came-to-rule-the-world-20230428-p5d3zk

22)https://www.investopedia.com/ask/answers/030515/what-percentage-global-economy-comprised-financial-services-sector.asp

23)https://www.epi.org/publication/charting-wage-stagnation/

24)https://www.sciencedirect.com/science/article/pii/S0033350617301610

25)https://www.nature.com/articles/s41599-023-02210-y

26)https://earth.org/gdp-climate-change/

27)https://www.cristianismeijusticia.net/sites/default/files/pdf/en170.pdf

28)https://taxjustice.net/press/un-adopts-plans-for-historic-tax-reform/

29)https://www.mdpi.com/1422-0067/24/2/1404

30)https://www.peah.it/2022/01/10563/

31)https://www.hrw.org/news/2023/04/19/proper-pandemic-treaty-would-value-universal-access-over-profit

32)https://geopoliticaleconomy.com/2024/02/26/western-dominance-ended-eu-josep-borrell/

33)https://mondediplo.com/2024/01/01editorial

34)https://news.un.org/en/story/2024/01/1145937

35)https://www.researchgate.net/publication/375000050_Will_the_US_and_China_Go_to_War_over_Taiwan

36)https://press.un.org/en/2022/ga12473.doc.htm

37)https://www.thinkglobalhealth.org/article/global-life-expectancy-declines-first-time-30-years

38)https://www.scientificamerican.com/article/why-life-expectancy-keeps-dropping-in-the-u-s-as-other-countries-bounce-back1/

39)http://www.peah.it/2021/04/9658/

40)https://www.peah.it/2018/07/5498/

41)https://journals.sagepub.com/doi/full/10.1177/0169796X211068451

42)https://www.peah.it/2023/12/12800/

43) https://g.co/kgs/MoYB7vQ

44)https://www.pas.va/content/dam/casinapioiv/pas/pdf-volumi/extra-series/es41pas-acta19pass.pdf

45)https://apnews.com/article/china-youth-lifestyle-nomad-thailand-086c064470a11365acfafbd4457ba166

 

By the same Author on PEAH

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