Health for All: How Do We Get There?

Líbhan Collins, Key Correspondent for the Irish Forum for Global Health

In thinking about global health, it can be difficult to grasp how truly complex and vast the area is. At the recent Global Health Exchange Conference, run by the Irish Forum for Global Health, I listened, along with over 100 other attendees from various different backgrounds and specialties, to over 40 speakers. For me, It really hit home the life encompassing subject that we call ‘global health’. Each speaker brought their experiences and knowledge to the table and offered a thorough understanding of what it means to leave no-one behind. This article offers a glimpse into the brim-filled event.

To make sure the needs of all people are addressed in health policy, a focus on inclusive health is vital; in seeking ‘health for all’ we must leave no one behind.  Aiden Fitzpatrick of Irish Aid referred to this as helping “the furthest behind first.” Sustainable health systems must be inclusive of those in poverty and in marginalised groups. Israel Balogun of CBM emphasised that including people with disabilities in international development and actively engaging them effective policies will ensure they are not left behind. Giving voice to the marginalised can benefit society as a whole and ensure they are not exluded. At the conference we saw an example of this with the ‘bypass fees’ in Malawi. These allow those who can afford it to skip queues for treatment, despite free healthcare access available to all. High income countries can also have high inequalities and ineffective healthcare systems. In Ireland, for example, there is no universal healthcare provision. Here, 15% of the population pay for voluntary health insurance and 15% pay out of pocket. Government funding is not being effectively spent, but with the introduction of Sláintecare there are hopes for improvements. We still have a lot to learn from what works and what doesn’t work in this country, and globally.

There is a real push to work together for sustainable changes and improvements. Time and time again in the conference it was emphasised that in Ireland, and globally, there is a need for health systems to be resilient and have capacity to cope with emergencies and changes in health trends. David Weakliam, representing the HSE, shared an African proverb:

“If you want to go fast go alone; if you want to go far go together.”

This event gave vent to many ideas and allowed knowledge exchange between passionate people willing to do their part in the hope that they will add a piece to the bigger picture of a future with universal health care.

There is a hint of rivalry between development and humanitarian work. Which is more important? Bridging this gap was discussed in a  number of sessions. Humanitarian work is vital in emergent crisis situations, yet international development is needed for sustainable health systems. Working with WHO preparedness and response to emergencies, Michael Ryan, with a wealth of field experience, offered his opinion that education and training would allow for a strong health system and in turn epidemic preparedness. Community based approaches and engagement are also key to development. There is also a need for evidence, research, and data sharing, applying research to development and humanitarian settings, such as is done by Evidence Aid. Yet, standards need to be locally adapted. When running a clinical trial, or introducing any type of community intervention, the local culture and social norms must be considered and respected. As an example, EBODAC tackled the ethical challenge of introducing evidence that a new vaccine works while attempting to control an Ebola epidemic, all the while ensuring participants were considered a priority. The role of social scientists in global health is clear in this instance, displaying a balance between collaboration with important local figures and research. This idea of working together and truly leaving no-one behind by inclusion and engagement is a major step forward in how we approach these issues. This is in contrast to the failure to tackle Malaria through use of insecticide treated nets due to not considering local contexts in developing areas.

Caitlin Walker (Cambridge Uni), Nadine Ferris-France (The Work for Change), and Breda Gahan (Concern Worldwide) share a common goal to overcome barriers to treatment and stigma. Caitlin considered the prevention of depression in young people using eHealth through the use of apps. Self stigma proves a major barrier in TB treatment, and as shared by Nadine the Work for Change has developed a toolkit, which is currently being evaluated, to reduce self stigma through practical exercises and discussions. It is paramount that health care providers are also trained in stigma awareness to eliminate it, and transmission of HIV is preventable, yet we still have new cases every day. Stigma here not only resides around the illness itself but that transmission is associated with men who have sex with men, sex workers, or drug use. For Breda, engaging with local people is a major component in the success of any intervention.

We’ve seen at this meeting that where cost of access is one barrier to universal health, stigma is just as powerful. Emergencies can be more difficult to consider under the umbrella of health for all, but here too there are methods of  prevention and planning to allow for efficient emergency responses. Where Ireland can offer resources and knowledge for both aid and development projects we must not forget to learn from these partnerships. Without undermining the enormity of the challenges ahead, a focus on local issues, root causes, and context specific efforts are likley to maximise long term health improvements. While we have global collective goals such as the SDGs, local action is needed to achieve health for all.

8th November 2018