COVID-19 has unfairly affected some people more severely than others, exacerbating existing health and well-being inequalities within and between countries. For World Health Day, April 7, 2021, the WHO therefore makes five calls for urgent measures to improve the health of all people.
Within countries, illness and death from COVID-19 were higher among groups facing discrimination, poverty, social exclusion and poor daily living and working conditions – including humanitarian crises. It is estimated that the pandemic last year brought between 119 and 124 million more people into extreme poverty. There is also compelling evidence that this has increased gender disparities in employment, with women leaving the workforce in greater numbers than men in the last 12 months.
These inequalities in people’s living conditions, health services and access to power, money and resources are long-standing. Result: Mortality rates of children under the age of 5 among children from the poorest households are twice as high as the rates of children from the richest households. Life expectancy for people in low-income countries is 16 years lower than for people in high-income countries. For example, 9 out of 10 deaths globally from cervical cancer occur in low- and middle-income countries.
But as countries continue to fight the pandemic, there is a unique opportunity to better build a fairer and healthier world by implementing existing commitments, resolutions and agreements, while taking on new and courageous commitments.
“The COVID-19 pandemic has progressed amid inequalities in our societies and gaps in our health systems,” says Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “It is vital for all governments to invest in strengthening their health services and removing barriers that prevent so many people from using them so that more people have the opportunity to live healthy.”
The WHO is therefore publishing five calls for action:
Accelerate equitable access to COVID-19 technologies between and within countries
Safe and effective vaccines have been developed and approved at record rates. The challenge now is to make them available to everyone who needs them. Key here will be additional support for COVAX, the vaccine pillar in the ACT accelerator, which hopes to reach 100 countries and economies in the coming days.
But vaccines alone will not prevail over COVID-19. Goods such as medical oxygen and personal protective equipment (PPE) as well as reliable diagnostic tests and medications are also vital. As well as strong mechanisms for the fair distribution of all these products within national borders. The goal of the ACT accelerator is to establish testing and treatment for hundreds of millions of people in low- and middle-income countries who would otherwise miss out. But $ 22.1 billion is still needed to deliver these vital tools where they are desperately needed.
Invest in primary care
At least half of the world’s population still does not have access to basic health services; more than 800 million people spend at least 10% of household income on health care, and out of pocket every year nearly 100 million people are forced into poverty.
As countries move forward after COVID-19, it will be vital to avoid cuts in public spending on health and other social sectors. Such reductions are likely to increase difficulties among already vulnerable groups, weaken the performance of the health system, increase health risks, increase fiscal pressure in the future, and undermine development gains.
Instead, governments should meet the WHO recommended target of spending an additional 1% of GDP on primary health care (PHC). Evidence reveals that PHC-oriented health systems have consistently yielded better health outcomes, improved equity, and improved efficiency. Increasing PHC interventions in low- and middle-income countries could save 60 million lives and increase life expectancy by 3.7 years by 2030.
Governments also need to reduce the global shortage of 18 million health workers needed to achieve universal health coverage (UHC) by 2030. This includes creating at least 10 million additional full-time jobs globally and stepping up efforts on gender equality. Women provide most of the world’s health and social care, representing up to 70% of all health workers, but are denied equal opportunities to run it. Key solutions include equal pay to reduce the gender pay gap and recognize women’s unpaid health work.
Give priority to health and social protection
In many countries, the socio-economic impact of COVID-19, through job loss, increasing poverty, educational disruptions and dietary threats, has outweighed the impact of the virus on public health. Some countries have already established expanded social protection programs to mitigate these negative effects of wider social hardship and have started a dialogue on how to continue to support communities and people in the future. But many face challenges in finding resources for concrete action. It will be vital to ensure that these valuable investments have the greatest impact on those most in need and that disadvantaged communities are involved in the planning and implementation of the program.
Build safe, healthy and inclusive neighborhoods
City leaders have often been strong champions in improving health – for example, by improving transport systems and water and sanitation. But too often, the lack of basic social services for some communities traps them in a spiral of disease and insecurity. Access to healthy housing in safe neighborhoods, with appropriate educational and recreational facilities, is key to achieving health for all.
Meanwhile, 80 percent of the world’s population living in extreme poverty is in rural areas. Today, 8 out of 10 people who lack basic drinking water services live in rural areas, as well as 7 out of 10 people who lack basic sanitation. It will be important to intensify efforts to provide rural communities with access to health and other basic social services (including water and sanitation). These communities also urgently need increased economic investment in sustainable livelihoods and better access to digital technologies.
Strengthen data and health information systems
Increasing the availability of timely, high-quality data disaggregated by gender, wealth, education, ethnicity, race, gender, and place of residence is key to identifying where injustices exist and addressing them. Monitoring health inequalities should be an integral part of all national health information systems.
A recent WHO global assessment shows that only 51% of countries have included data classification in their published national health statistics reports. The health status of these different groups is often disguised when national averages are used. Moreover, it is often those who are vulnerable, poor, or discriminated against who are likely to be completely missing from the data.
“Now is the time to invest in health as a driver of development,” Dr. Tedros said. “We don’t have to choose between improving public health, building sustainable societies, ensuring food security and proper nutrition, fighting climate change and a thriving local economy. All of these vital outcomes go hand in hand. “
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