Global Health Advancing Diversity And Inclusion

Global health is a high priority agenda in achieving sustainable human development. Considering transnational health issues, global health largely aims to improve health and achieve health equity for all people worldwide. More specifically, it is about achieving better health outcomes for poor, socially marginalised and vulnerable populations around the world. In low-income countries, existing health disparities across different populations are key challenges to reach the social goal of health for all. 

Therefore, global health underscores the critical need to consider a broad and multi-sector approach to better understand emerging health challenges with a focus on social, cultural, economic, political and environment factors that underlie health inequities. This approach will help promote basic health rights of people by upholding values of equity, inclusivity and mutual respect regardless of age, ethnicity, gender identity, religion, socio-economic status.  

New challenges

Globally, while we observe unprecedented increases in life expectancy, this indicates a significant progress in terms of social development. However, the persistent differences in health and mortality between low and high socio-economic groups are still large. While the world is facing new challenges of pandemics such as COVID-19 and few others, there needs a better understanding of the present and future dynamics of global health systems where inequality within socioeconomic groups is a key challenge. 

Over the decades, we have experienced the crucial nexus between gender and health inequalities. This can be viewed from a broader social and anthropological perspective that how human sex and gender can be considered as determinants of diseases. Equally important is to examine how health systems respond to various health needs and expectations of diverse genders in different contexts. Therefore, improving the health and well-being of all genders requires gender-transformative, human rights-driven, and intersectional policy approaches that directly address the underlying causes of gender inequities. 

In many low-income countries, the context of culture and global health are rarely mainstreamed in terms of community-based public health interventions. Therefore, meanings and understanding of health, illness, and well-being are likely to reflect a marked cultural influence. Moreover, ethnomedicine and folk healing system, as well as the role of religion in health and healing have been interesting social history to better understand various facets of traditional health care delivery systems in diverse societies. This also necessitates health policy makers, planners and researchers to look at cultural determinants of global health more closely in order to address the health needs, priorities and choices of different ethnic, indigenous and cultural groups for equity and social justice.   

On the other hand, migration is entirely socio-economic phenomena in the context of globalisation. Despite commitments to sustainable development goals, universal health coverage, equity in health, and other health related international conventions, global health policies are still not migrant inclusive. Similarly, the health care needs of socially excluded and marginalised groups are still not adequately addressed in national health policies and strategic interventions in many low-income countries.   

In the recent years, commercial determinants of health are increasing priorities in global health policy agenda for action. These are primarily concerned with private sector activities such as supply chains, labour conditions, product design and packaging which influence the social, physical and cultural environments through business actions and societal engagements. More importantly, these determinants have profound impacts on a wide range of risk factors, including smoking, air pollution, alcohol use, obesity and physical inactivity, and health outcomes, such as non-communicable diseases, communicable diseases and epidemics. 

Additionally, there is still lack of participation in health-promoting behaviors among poor and socially disadvantaged communities. As a result, this contributes to health risks and further widens health disparities. Socio-cultural characteristics such as socio-economic status, education, health literacy, ethnicity, and religiosity have enormous influences on beliefs and cognitions that determine people’s health seeking behavior and impact on health outcomes. On the other side, global health needs to adopt an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems. One health approach should be promoted to consider health of humans, domestic and wild animals, plants and the ecosystems at large. 

Again, from anthropological perspective, global health is not only a bio-medical concept but also involves political economy and culture. This approach critically reveals the most profound social cause of health sufferings and the way to global health security. Experiences suggest that cultural diversity and cultural adaptation meticulously embraces the role of local context in addressing health care needs of diverse socio-cultural groups for appropriate health solutions. 

Equitable access

Nepal’s health policy and new strategic plan aim to ensure health for all by ensuring access to equitable quality health services. Apart from the government, development partners and civil society in health sector have been consistently working together to reach out their consistent technical assistance in those areas where local health system is relatively poor and the complex issues of   cultural diversity, health equity and social inclusion are prominently visible. 

Reaching the unreached is one of the ambitious strategic actions to ensure no one is left behind.   The emerging issues of diversity, equity and social inclusion in federal health systems need more discussions for better understanding among policy makers, political parties, health workers, civil society, academia and private sector to ensure intersectionality in health care delivery and right to health for all. 

(PhD in global health, Bhandari writes on health and development issues)