Global Health and Inequities: Alternatives to Tilting at Windmills

(Photo credit: Group of windmills at Campo de Criptana in La Mancha, by Lourdes Cardenal.)

Last week, we saw why social and economic inequities are so important for global health and why global health professionals cannot afford to ignore them. I ended up with a difficult question: what can we do about them? Should we charge at full tilt at any inequity that seems to be related to adverse health results? Many of us being idealists, the temptation to do so is considerable. However, playing Don Quixote will probably not lead to appreciable progress, or at least not to the best results possible; to get results, we should ignore windmills and concentrate on targets that are more worthwhile.

As many social determinants of health lie firmly outside our fields of expertise, it will be necessary to forge links with other professions, many of which have come to similar conclusions. ‘Even' economists have concluded that inequities are as bad for a nation's wealth as they are for its health. Engaging in alliances will be necessary to arrive at any meaningful result, and (as a positive side effect) could lead to better inter-disciplinary cooperation on other subjects too.

Furthermore, an intensive information campaign will be necessary. Many non-health professionals are at best only vaguely aware of the impact of inequities on health: for many people, health is a highly technical subject, with hardly if any links to issues of social justice. We need to be relentless in informing (or indoctrinating) a wider audience about these links, and what they can do about it. In other words: this blog is in many ways a necessity.

This also means that we should be constantly on the lookout for non-health actions with important health consequences: not an easy task (how could public health professionals in the 1980s have known that the World Bank's new position papers would ultimately impact so much on public health?), but one that will be ultimately rewarding in its results.

Over the last couple of weeks, we have seen how not every inequality is an inequity: justice is what defines inequities, i.e. the fact that we can and should do something about them, but choose (for whatever reason) not to do so. We have also explored the relationship between (social) inequities and health, and found out that they are closely linked. Finally, we have had a look what health professionals can and should do about inequities; cooperation, alliances, partnerships, and information are keywords here.

Public health professionals can and should act meaningfully about social inequities; and in the process, we might actually learn something about what we in turn can do to help foster better economies, build better buildings, or grow better crops.