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Health Equity accelerates Humanity Equity
Health Equity accelerates Humanity Equity

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Close to 15% of the population has received at least one dose of vaccine in low-income countries, vis-à-vis 80% in high-income countries.1

Of the 4 billion doses of the Pfizer-BioNTech vaccine planned for 2021, high-income countries purchased nearly 70% of the doses.2

As I start collecting my thoughts and writing this piece, I am reminded of a simple and provocative quote from Nelson Mandela that fits apt - Health cannot be a question of income; it is a fundamental human right.

For a world fighting a raging health crisis, never did the conversation around health equity hold more meaning. Even before the pandemic hit, more than half the world’s population already lacked access to essential health services.3 The inequity has been further exposed in the last 2 years. When we all are aware that this virus can be fully contained only when EVERYONE is vaccinated, the glaring difference in vaccine distribution and administration poses even deeper questions on the basic human right to live a healthy life.

The SDG 3 (Sustainable Development Goal) defined by the UN is ‘ensure healthy lives and promote well-being for all at all ages; under this, SDG 3.8 is specific to the topic in question - achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Health Equality vs Health Equity

When we talk about improving health outcomes through enhanced healthcare infrastructure, we may assume the words ‘health equality’ and ‘health equity’ to be similar and invariably use one for the other. However, there lies a great deal of difference between the two which we need to bridge to make healthcare a basic, fundamental human right.

While health equality means we all get the same access to the same healthcare systems, health equity is that of the healthcare system being modified and personalized for everyone.

Consider a few instances:

• A doctor’s clinic or a healthcare facility is accessible only on weekdays, automatically excluding those who cannot leave their jobs and go for the appointment. The same facility may be in an area that can only be accessed through a private mode of transportation, automatically excluding those who don’t own a car.

• A health plan designed to cover physical ailments automatically excludes mental wellbeing.

• A pharma company’s R&D wing brings out a new product extrapolating the results of a survey conducted on a relatively homogeneous group, automatically excluding those who are sitting at the fence waiting to be counted and heard.

Social drivers of healthcare

There are many social drivers that have an impact on accessing healthcare and achieving health equity. It is not just financial status or income, there are also factors such as race, region, religion, caste, class, sexual orientation, gender, unconscious biases, and disability amongst others.

Now if you observe, while we can bring equality in all these scenarios by say, providing telehealth, we are still excluding those who don’t have a phone or internet, or those with hearing or visual disabilities. That equity happens when we accept that no one size fits all, and we meet everyone where they are and start from that point on their healthcare journey.

So, who owns Health Equity?

Making health equity mainstream is not one individual’s or organization’s or even a government’s job alone. It is a cohesive exercise to be undertaken by each of the stakeholders in the healthcare ecosystem to ensure no one is left behind, and everyone is empowered to live their best, healthier lives.

Health equity will be making a healthcare ecosystem that is inclusive in terms of:

Economic status – Governments have a huge role to play in this simply because of the sheer scale and reach they can offer and manage. There are several government health insurance schemes currently in India, run by both center and various state governments, that are providing health insurance available to the underprivileged people of the society. Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat Yojana is one of the biggest healthcare schemes in the world, with a goal to cover over 50 crore Indians4. There are also schemes that specifically cover certain vocations and occupations.

Education – Illiteracy is one of the biggest impediments towards accessing healthcare. Opening easy channels of communication for a large segment of the audience who otherwise feels left behind will help bridge a huge gap.

Digital immaturity – Access to a phone, smartphone, or even the internet is a privilege. For low-income countries or rural pockets of high-income nations, instead of putting vulnerable people through a chain of IVR calls or paperwork, bring telehealth to the remotest corners even through a simple feature phone, and structure customer support in such a way that healthcare can be accessed through a voice call.

Gender – Single working mothers and households run by women can have a lot going on. The healthcare ecosystem can make them feel inclusive by designing facilities for them that can be accessed at their convenience, or plans that are flexible, affordable, and can be accessed without getting overwhelmed with paperwork or follow-up.

Marginalized community representation – Plans, services, and solutions designed to include everyone from every community have a better chance to accelerate better health outcomes for all.

Geographical roadblocks – We cannot change the zip code of a person, but we can ensure that every zip code is serviced with the best possible healthcare infrastructure that can help communities in that area, and not exclude them from accessing care in the first place.

The world is fast-changing and so are the expectations from healthcare. What used to be just providing care is now about ensuring value-based care that delivers better health outcomes and accelerates health equity. There is a renewed commitment in the healthcare ecosystem to become an inclusive partner that improves lives and communities. Hence, it is on to the entire ecosystem to address inequities and make the customer the center of every policy, change, and decision; to ensure every person has the best chance to live a healthy life.

Only when every one of us has unbiased access to the type of healthcare we need, can we make it a level-playing field for all to thrive. Only when there is health equity, can we claim to champion humanity equity.

Sources:

1. Hannah Ritchie, Edouard Mathieu, Lucas Rodés-Guirao, Cameron Appel, Charlie Giattino, Esteban Ortiz-Ospina, Joe Hasell, Bobbie Macdonald, Diana Beltekian and Max Roser (2020) - “Coronavirus Pandemic (COVID-19)”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/coronavirus’ [Online Resource]

2. https://www.brookings.edu/blog/future-development/2022/02/11/why-global-vaccine-equity-is-theprescription-for-a-full-recovery/

3. https://www.globalcitizen.org/en/content/unequal-health-care-access-covid19/

4. https://www.acko.com/health-insurance/ayushman-bharat-yojana-scheme/

 

About the author:

Shantha Maheswari

Shantha Maheswari

Chief Strategy and Planning Officer, Legato Health Technologies

Shantha Maheswari comes with more than 25 years of diverse business and technology leadership experience and has been responsible for leading innovation, talent, and growth with a deep focus on client value, profitability, and people. Prior to joining Legato, Shantha was the Industry and Functions Business Group Managing Director at Accenture India.

Shantha is a Certified Leadership Coach from Wharton School, Leadership in Innovation from MIT, C-Suite Cloud Advisor from Carnegie Mellon, and a recipient of CEO awards for high performance. She also holds an Executive MBA from Symbiosis, Pune, and a B.E. from PSG College, Coimbatore, India.


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