Equity in Health

WHO Estimates Africa’s COVID-19 Caseload is Seven Times Higher Than Official Count
Cullinan K: Health Policy Watch, 2021

Africa is estimated to have seven times more COVID-19 cases and three times as many deaths as officially reported, according to the World Health Organization (WHO) Africa region. This means that the continent could have around 59 million cases and 634,500 deaths. “We’re using a model to estimate the degree of under-estimation. The analysis indicates that as few as one in seven cases is being detected, meaning that the true COVID-19 burden in Africa could be around 59 million people,” said Dr Matshidiso Moeti, WHO’s Africa executive director. WHO recommends that countries perform 10 tests per 10,000 people each week yet around 20 countries – more than a third of African countries – do not reach this benchmark, said Moeti. The WHO has thus decided to invest $1.8 million to roll out COVID-19 rapid tests in hot spots, starting with pilots in eight countries. Despite this undercount, WHO Africa officials observe lower deaths in Africa than other global regions.

10 Images that illustrate the shameful global vaccine inequity
Pai M: Microbiology online, August 2021

This series of 10 images tell the story behind the ‘great vaccine apartheid’ argued by the author to be the single biggest moral and scientific failure during this the COVID-19 pandemic.

Health Security and the COVID-19 Pandemic: Health and Security for Whom?
Almeida C: Think Global Health, August 2021

The concept of health security has long been prominent and controversial in global efforts to protect health. The author asserts that paradoxically, the COVID-19 pandemic has provided evidence of this concept's failure and reignited interest in it for the post-pandemic world. The article outlines how past shortcomings and present interest highlight the continued failure to address political and economic structural problems that generate inequities and produce neither health nor security for most of the world’s population. Thinking beyond the pandemic, she proposes that policymakers should reject health security and center policy on promoting human solidarity and protecting the human right to life.

Risk Factors, Mental Health and Psychosocial Needs, and Coping Among the Children Under the Care of Female Sex Workers and Adolescent Girls Surviving in Sex Work Settings
Kyomya M; Mukwaya R; Achan E; et al: PEAH – Policies for Equitable Access to Health, Geneva 2021

This assessment identified risk factors, mental health, psychosocial needs and mechanisms of coping by children under the care of female sex workers (FSWs) and adolescent girls surviving in sex work settings of Kampala, Gulu, Mbarara, Wakiso and Busia in Uganda. The study found stigma and discrimination, poor accommodation facilities, sexual abuse by clients of sex workers and substance abuse among children, adolescent girls and mothers, gender-based violence and low levels of literacy, with a high prevalence of mental health disorders, including depression, suicide, post traumatic stress symptoms and generalised anxiety disorder. Adolescent girls surviving in sex work settings, presented higher rates of common mental health disorders. particularly those aged 11-14 years. The study found that the risk factors are not addressed given that children under the care of FSWs and adolescent girls are often neglected by systems.

Which UHC? Features for Equity and Universalism
Loewenson R: International Journal of Health Policy and Management x(x), 104, doi:10.34172/ijhpm.2021.89, 2021

Equity and universality are implicit in universal health coverage (UHC), although ambiguity has led to differing interpretations and policy emphases that limit their achievement. Diverse country experiences indicate a policy focus on differences in service availability and costs of care, and neoliberal policies that have focused UHC on segmented financing and disease-focused benefit packages, ignoring evidence on financing, service, rights-based and social features that enable equity, continuity of care and improved population health. Public policies that do not confront these neoliberal pressures limit equity-promoting features in UHC. In raising the impetus for UHC and widening public awareness of the need for public health systems, COVID-19 presents an opportunity for challenging market driven approaches to UHC, but also a need to make clear the features that are essential for ensuring equity in the progression towards universal health systems.

End Inequalities. End AIDS. Global AIDS Strategy 2021-2026
UNAIDS:Geneva 2021

The new Global AIDS Strategy (2021–2026) uses an inequalities lens to identify, reduce and end inequalities that represent barriers to people living with and affected by HIV, countries and communities from ending AIDS. The Strategy outlines a comprehensive framework for transformative actions to confront these inequalities and to respect, protect human rights in the HIV response. It puts people at the centre to ensure that they benefit from optimal standards in service planning and delivery, to remove social and structural barriers that prevent people from accessing HIV services, to empower communities to lead the way, to strengthen and adapt systems so they work for the people who are most acutely affected by inequalities, and to fully mobilize the resources needed to end AIDS.

Engaging globally with how to achieve healthy societies: insights from India, Latin America and East and Southern Africa
Loewenson R; Villar E; Baru R; Marten R: BMJ Global Health 6(4), e005257, 1-13, 2021

This paper explores the features and drivers of frameworks for healthy societies that had wide or sustained policy influence post-1978, globally and in selected southern regions, in India, Latin America and East and Southern Africa. The authors implemented a thematic analysis of 150 online documents and reviewed the findings with expertise from the regions covered. Globally, comprehensive primary healthcare, whole-of-government and rights-based approaches have focused on social determinants and social agency to improve health as a basis for development. Biomedical, selective and disease-focused technology-driven approaches have, however, generally dominated, positioning health improvements as subsequent to macroeconomic growth. Historical approaches in the three southern regions that integrated reciprocity and harmony with nature were suppressed by biomedical models during colonialism and by postcolonial neoliberal economic reforms. With widening differences between biosecurity approaches on the one hand and holistic, ecological approaches on the other, economic, the context in the 2000s of ecological, pandemic crises and social inequality is argued to imply that which ideas dominate will be critical for health futures. The authors point to what this implies for building approaches to healthy societies, including for a more equitable circulation of ideas between regions in framing global ideas.

Covid-19 deaths in Africa: prospective systematic postmortem surveillance study
Mwananyanda L; Gill C; MacLeod W et al., :BMJ 372 :n334, 2021

The authors measured the fatalities from Covid-19 in Lusaka. PCR tests were done post mortem on 372 deceased people of all ages at the University Teaching Hospital morgue in Lusaka, Zambia, enrolled within 48 hours of death between June and September 2020; PCR results were available for 364 (97.8%). SARS-CoV-2 was detected in 58/364 (15.9%). Most deaths in people positive for covid-19 (51/70; 73%) occurred in the community and none had been tested for Covid-19 before death. Among the 19/70 people who died in hospital, six were tested before death, while for the 52/70 people with data on Covid-19 related symptoms, only five were tested before death. Covid-19 was identified in seven children, only one of whom had been tested before death. While the proportion of deaths with covid-19 increased with age, 76% were aged under 60 years. The authors conclude that deaths with covid-19 were more common in Lusaka than indicated in official reports, with most occurring in the community, where testing capacity is lacking, but also due to lower levels of testing in facilities and in those presenting with typical symptoms of covid-19.

Prevalence and Factors Associated with Mental and Emotional Health Outcomes among Africans during the COVID-19 Lockdown Period—A Web-based Cross-Sectional Study
Langsi R; Osuagwu U; Goson P; Abu E; et al: International Journal of Environmental Research and Public Health 18(3), 899, 2021

This online study assessed the prevalence of mental health symptoms as well as emotional reactions among 2005 respondents aged 18 years and older in seven African countries between 17 April and 17 May 2020 corresponding to the lockdown period in these countries. Respondents self-reported feeling anxious, worried, angry, bored and frustrated. Multivariate analysis revealed that males, those aged >28 years, those who lived in Central and Southern Africa, those who were not married, the unemployed, those living with more than six persons in a household, had higher odds of mental health and emotional symptoms. Health care workers were less likely to report feeling angry than other types of workers.

The Inequality Virus: Bringing together a world torn apart by coronavirus through a fair, just and sustainable economy
Berkhout E; Galasso N; Lawson M; Morales P; et al: Oxfam Briefing Paper, Oxfam International, 2021

This report highlights the ways that the coronavirus pandemic has the potential to lead to an increase in inequality in almost every country at once, the first time this has happened since records began. The virus has exposed, fed off and increased existing inequalities of wealth, gender and race. Over two million people have died, and hundreds of millions of people are being forced into poverty while many of the richest – individuals and corporations – are thriving. Billionaire fortunes returned to their pre-pandemic highs in just nine months, while recovery for the world’s poorest people could take over a decade. While the pandemic has exposed a collective frailty and the inability of a deeply unequal economy to work for all, it has also shown the vital importance of government action to protect health and livelihoods. Transformative policies that seemed unthinkable before the crisis have suddenly been shown to be possible.