Stories and History as Tools in Global Health

As she stared into the funeral pyre, she imagined what could have been if her village had a doctor readily available on the day of her mother’s death. But with no means to reach a doctor, her mother’s condition was left untreated, and she relied solely on prayers. To this day, she longs for closure in the knowledge of what health issue afflicted her mother and whether or not she could have been saved by a medical professional. This, and many other stories from communities around the world, invoke the idea of global health equity.

Global health equity is the idea that all humans, regardless of identity or location, deserve ready access to quality healthcare. According to the World Health Organization, this equity will be achieved when health disparities amongst populations are reduced and when health outcomes are maximized for each individual [2]. This affirms that health is a right, not a privilege for a selected few.

In order to understand the process of achieving equity, the root of health inequities need to be understood first. The burdens of improper access to health mainly come from systemic institutions and patterns that lead to discrimination or prejudice. These institutions can affect all facets of life, from where a person lives to their career outcomes [2]. BIPOC (black, :, and people of color), queer, and individuals living in rural areas are thus examples of groups that commonly experience inequities. To illustrate what inequity has looked like over time, we can consider black patients in the United States. In a discussion of critical race theory and health inequities, Washington University researcher Darrell Hudson states that the segregation of white and black communities has led to a lack of resources and access to health care for black communities in the United States [3]. Resources and care are not distributed equally; they are withheld from black patients and more heavily allocated towards white communities. These examples tie history with public health and medicine to highlight the exploitative patterns and practices that have amplified inequities for patients. One such exploitative pattern is depicted in health research. In an article regarding research in Africa, Kathryn Chu and her colleagues discuss research that developed countries such as the United States and United Kingdom have conducted throughout history to extract information from populations in developing countries. While these studies have developed medical knowledge, they have not contributed resources to the researched communities that can help improve their health or conduct their own research [4]. Researchers from developed areas do not share knowledge gained in their research or the methods used to conduct the research with the health professionals from developing countries. In response to this, a fairly new field of study has emerged that aims to address inequities at its core.

Global health aims to search for methods and interventions that can reform healthcare systems and better train professionals to deal with health inequities. One important realization that global health professionals have made is that examining history to inform policies and practices can help promote equity. As an example, professionals now recommend that partnerships in health and medical research between countries should be balanced. Research should be conducted by all partners with shared visions for the outcomes of the research [1]. It also means that if one partner lacks research or skills in research, the other researching institution should strive to help its partner build up those resources and skills.

The field of global health emphasizes the importance of patient voices in addressing inequities. Medical anthropologist Paul Farmer highlights this importance in an article where he discusses his work with Partners in Health, a non-profit organization dedicated to increasing access to healthcare to underserved populations across the world. In his experience, the health challenges faced by a rural village in Haiti were eased once medical and health professionals listened to patients and built a clinic [5]. These patients were surveyed by health professionals who went to every home in the village. The decision led to fruitful outcomes after years of denial that a clinic would be beneficial to the villagers. The concept of patient voices as a driver of change can be reinforced through the concept of co-creation, which holds that patients should be involved in the design of medical and health interventions [6]. In receiving patient needs and input, interventions and recommendations can be designed to eliminate barriers that prevent communities of patients from receiving proper health. Such input can also possibly act as a basis for advocacy for many populations of patients, such as women and members of the LGBTQIA+ community in an ongoing struggle to challenge health disparities. While there may seem no end in sight to the inequities we see, it is important to consider tools such as history and patient stories as drivers of health worldwide.

References:

1. Adams, L. V., Wagner, C. M., Nutt, C. T., & Binagwaho, A. (2016). The future of global health education: training for equity in global health. BMC medical education, 16(1), 296. https://doi.org/10.1186/s12909-016-0820-0

2. World Health Organization. (n.d.). Health equity -- global. World Health Organization. https://www.who.int/health-topics/health-equity#tab=tab_1.

3. Hudson, D. (2021). Achieving Health Equity by Addressing Legacies of Racial Violence in Public Health Practice. Annals of the American Academy of Political and Social Science, 694, 59–66. https://doi.org/http://ann.sagepub.com/content/by/year

4. Chu, Jayaraman, S., Kyamanywa, P., & Ntakiyiruta, G. (2014). Building research capacity in Africa: equity and global health collaborations. PLoS Medicine, 11(3), e1001612–e1001612. https://doi.org/10.1371/journal.pmed.1001612

5. Farmer, P. (2004, April 1). Global Health Equity. Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/global-health-equity/2004-04.

6. Lazo-Porras, Perez-Leon, S., Cardenas, M. K., Pesantes, M. A., Miranda, J. J., Suggs, L. S., Chappuis, F., Perel, P., & Beran, D. (2020). Lessons learned about co-creation: developing a complex intervention in rural Peru. Global Health Action, 13(1), 1754016–1754016. https://doi.org/10.1080/16549716.2020.1754016