The Legacy of Kevany

By Key Correspondent, Libhan Collins

The lifetime work of John Kevany, Professor Emeritus of International Health at Trinity College Dublin who passed away in 2003, is celebrated through the John Kevany Memorial Lecture. At the 2019 Global Health Exchange Conference, this year’s lecture was given by Professor Diarmuid O’Donovan, who discussed health equity and rights on a local and global level.

In the 1990s and early 2000s, the foundation of global health in academia was being built. Prof. O’Donovan recalled Prof. Kevany asking questions surrounding the education of people in global health. There was a strong demand among their students for more learning and opportunities in this field. The loss of Prof. Kevany spurred a meeting of his peers which lead to the start of the Irish Forum for Global Health (now the Irish Global Health Network) and furthered the desire of professionals to promote research, education and advocacy in global health in Ireland.

Poverty stood out to Prof. Kevany as something upon which there was an obligation to act to reduce ill health, yet which was widely ignored as a cause of morbidity and mortality. Prof. O’Donovan expressed the extent to which poverty has an influence on disease and death. In less highly developed countries it is strikingly obvious, however it also has an impact in highly developed countries including Ireland.

The gap between poverty and wealth is ever increasing and despite improvements in health and human rights, many are still being left behind. Prof. O’ Donovan asked the audience to question how we as researchers present data. It has been reported that extreme poverty is in decline, the measure of extreme poverty being a living wage under $1.90. However, there are billions of people who may earn more than this and still be nutrient deficient or unable to access healthcare or education. Having a measure of extreme poverty does not necessarily reflect the reality of how extensive a challenge poverty in all its forms still represents.

We like to celebrate our progress in reducing preventable deaths but it is evident that much of the global health success to date has been among the least deprived, meaning the most disadvantaged are not always reached. The number of extremely poor people hasn’t changed, and marginalised groups of people have much higher rates of mortality than wealthier groups in society, across countries. This gap is true in Ireland as well as globally.

Structural inequalities are imbedded into health systems. Locally, we see this as one accessing healthcare publicly is expected to wait longer for care, whilst those who can pay for private insurance are seen much quicker. Healthy Ireland has a framework which includes addressing health inequalities, it is on the agenda but still much ground is to be made. The aim should ultimately be to remove structural barriers so that there is health for all. For this to be a possibility going forward, Prof. O’Donovan emphasised the need for community action and political will to come together.

“Health is not just healthcare” – sustainable systems are needed. For example, Safetynet is an organisation that focuses on inclusive health, offering primary care services to marginalised groups in Ireland such as the homeless and the Travelling community. While this service is a strong example of the efforts to reduce inequalities, it resides only in three cities and may not be sustainable. Systemic improvements in health determinants for these groups of marginalised people are also paramount. When living in poverty, these basic health infrastructures are lacking.

While the situation may not always be getting universally better, enthusiastic and motivated individuals like Prof. O’Donovan continue to work tirelessly within the framework of the SDGs to improve health outcomes and reduce inequalities in Ireland and overseas, helping to fulfil Prof. Kevany’s legacy of equity, fairness, and respect for all.

20 September 2019