Confronting the realities of health inequities in our world today

This special series of JPHE focuses on health equity. Health equity means that everyone has the ability to achieve the highest possible level of health and well-being, no matter where they were born or where they live now. Achieving health equity necessitates recognizing and addressing the vulnerabilities and inequities in our societies that contribute to unfair and avoidable differences in health status across populations.

The root causes of health inequities are pervasive and result from beliefs and values firmly entrenched in our societies. For example, racism, ableism, and sexism are systemic and disadvantage certain populations over others, leading to bias, discrimination, and unequal distribution of power and resources. Other characteristics that may be associated with health inequities include religion, socioeconomic status, age, sexual orientation or gender identity, geographical location, among others.

Health inequities contribute to incredible disparities in terms of life expectancy, and overall health and well-being. For example, we know that certain populations such as low-income and/or racial/ethnic minorities, are disproportionately burdened by chronic diseases in many countries. Children born in disadvantaged neighborhoods have a much greater chance of dying before they reach age 5 years than other groups. And we know incredible differences in life expectancy exist—both across countries and within populations in the same country, such as Indigenous groups. While accepting this may be an uncomfortable reality, we cannot ignore these facts.

The articles included in this series were all invited papers presented at the 2023 APRU Global Health Conference, which was hosted by Tecnológico de Monterrey in Mexico City in October 2023. The Association of Pacific Rim Universities (APRU) was created in 1997 and the Secretariat is based in Hong Kong. As a network of leading universities linking the Americas, Asia, and Australasia, APRU brings together thought leaders, researchers, and policy-makers to exchange ideas and collaborate on practical solutions to the challenges of the 21^st century. The APRU Global Health Program, housed at the University of Southern California, organizes an annual conference to bring together experts from around the region to exchange ideas and knowledge relating to global health. A range of topics were discussed at the conference, including migration, Indigenous health, and global access to surgery.

Latin America is the ideal place to bring together academics, clinicians, government officials, and other global health practitioners to discuss health equity. Latin America has some of the most persistent health inequities in the world, including a wide range of life expectancies at birth (1). Latin America is culturally and ethnically diverse, with dramatic levels of socio-economic inequality often divided along racial, gender, and ethnic lines (2). As Yamin et al. (3) have noted, “health is an acute reflection of overall patterns of inequality and discrimination and, as elsewhere, social determinants contribute more to patterns and burdens of disease than medical care in the region.”

This special series provides specific examples of health inequities from Ecuador, Mexico, New Zealand, and the US covering a wide range of topics and populations. Yet, in all of the papers, it is clear that health inequities do not occur randomly but are instead attributable to long-standing beliefs and values embedded in our societies.

For example, in the article “A view from Aotearoa regarding Indigenous health equity—looking back to move forward” (4), Māori researchers from New Zealand call on us to recognize the importance of Indigenous self-determination and Indigenous knowledge. They provide specific examples of Indigenous-led health solutions, including during the coronavirus disease 2019 (COVID-19) pandemic. They remind us that it is important to confront the ways in which colonialism has continued to shape health status for Indigenous populations.

The article by Gonzalez-Amarante and Romero-Padron titled “Perception and role of physicians in the midst of the air quality crisis in Nuevo León, México” (5) highlights the fact that Mexico is the most air-polluted country in the Americas. Air pollution is a leading contributor to the global burden of disease and disproportionately impacts vulnerable populations. In fact, lower-middle- and low-income countries have been shown to be much more vulnerable to health risks of air pollutions compared to populations in high-income countries (6). The authors remind us that medical professionals have a role to play in terms of advocacy and proactive engagement in environmental issues to promote public health.

The article by Garzon-Villalba titled “We all deserve to live in a clean environment: undernutrition and pollution in Ecuador” (7), draws attention to environmental pollution and food insecurity, which remain significant public health concerns in Ecuador. Once again, nutritional problems such as stunting and anemia are widespread among marginalized populations such as Indigenous populations in rural areas, where every eight out of ten Indigenous children lack access to clear water and sanitation. She recommends robust policies and joint collaboration from multiple sectors to alleviate the social and economic burdens to address these challenges in Ecuador.

In the article titled “Disparities in healthcare: Spanish-speakers at a pediatric clinic in Houston, Texas” (8), Hinojosa-Barrera and González-Amarante explore the barriers to care that Spanish monolingual speakers in Texas face in the US. They demonstrate that the lack of effective patient-provider communication due to limited English fluency and other structural barriers that Hispanic populations face create disadvantages that lead to health inequities in this population.

Palma and colleagues (9) describe the diagnostic options for leishmaniasis in Ecuador in another article included in this special edition. Neglected tropical diseases (NTDs), like leishmaniasis, primarily impact communities where water, sanitation, and access to health care are inadequate (10). The negative, long-term physical and mental health impacts of these disease are vast and include stigma, social isolation, disability, and disfigurement. Despite their tremendous toll and the fact that are largely preventable and treatable, historically these diseases have not received the same attention and resources as other infectious diseases, which may be linked to the fact that they are primarily found in poor, rural communities (11).

Finally, in the article by Alarcón Rebollar et al. titled “Successful twin pregnancy in rural Chiapas: providing quality care and comprehensive support to overcome barriers in health access—a case report” (12), the authors describe the barriers that pregnant women face in accessing adequate maternal care in a rural state of Mexico. Underutilization of healthcare services is tied to both sociocultural factors, such as ethnicity, language ability, poverty, and decision-making control, as well as structural barriers such as cost of services and location of health facilities. They emphasize that the social determinants of health play a crucial role in health outcomes and comprehensive strategies to reduce health inequities are crucial to improving maternal health outcomes in high-risk populations.

Together, these papers remind us to consider how social determinants of health, such as access to education and healthcare, and neighborhood and physical environment, influence health status. They also challenge us to consider how the legacy of colonialism has impacted health status among populations across the globe, and how structural racism continues to negatively impact key populations in our societies.

In order to reach the goal of health equity on a global scale, we as global health practitioners must all use our knowledge, skills, and assets to take action. Health systems strengthening and enhanced international governance and cooperation are needed. Clearly, more research is needed to measure health disparities and test possible solutions. We must also strive to give a voice to those who have been traditionally marginalized or excluded in research. We can advance health equity around the world through collective work in global health research, practice, and education. Above all, we must always promote values of mutual respect and cooperation in our global health work, valuing all populations equally.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Public Health and Emergency for the series “Equity in Health: Findings from the APRU Global Health Conference 2023”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-91/coif). The series “Equity in Health: Findings from the APRU Global Health Conference 2023” was commissioned by the editorial office without any funding or sponsorship. M.W. served as an unpaid Guest Editor of the series and serves as an unpaid Editor-in-Chief of Journal of Public Health and Emergency. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Mellissa Withers