A Long-Growing Concern

By Alexander Nassar, Associate Editor

Research in the field of healthcare, including clinical, biomedical and caregiving research, is a major driver in the improvement of quality of life for all people. Considering the universality of disease susceptibility, of which the world was reminded during the COVID-19 pandemic, it is more important than ever to ensure that this (literally) vital field of study encompasses the entire breadth of human populations.

         The title of a 2017 report “World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses” says it all. Not everyone has access to proper health care, by far. In light of such staggeringly disproportionate access, it is important to identify what is lacking in order to achieve Universal Health Coverage (UHC), the proposed solution in the UN’s report.

The Canadian Perspective

         In Canada, the Pan-Canadian Health Inequalities Reporting Initiative, established by several governmental agencies, published a list of the main conditions underlying health inequity in the country. These include infant mortality, suicide and tuberculosis. Analysis of health outcomes of these conditions revealed that Indigenous peoples (First Nations, Inuit and Métis), as well as people living in socio-economically challenged areas, suffered the most inequity in health outcomes. The Public Health Agency of Canada mentions adopting the “Health in All Policies” framework developed by the WHO to tackle these issues.

         Tuberculosis stands out as a particularly concerning disease because of its contagious nature. According to an article published in The Lancet in 2019, the initiative to eradicate this deadly disease is at risk because of its high incidence among the Inuit Indigenous people in Canada. A study earlier that year had found that overcrowded accommodations in Iqaluit, Nunavut territory in the Canadian arctic, were hotspots for Tuberculosis. Indeed, Anna Banerji, one of our own faculty leaders here at UoT’s Faculty of Medicine, outlined the flaws in the government’s approach to tackling this epidemic. The lower level of education among this population disempowers the very few Inuit researchers and medical professionals, whose first-hand expertise must be translated towards effective community-based treatment and health care provision.

The American Perspective

         This clear outline is an example of how the social determinants of health are manifested in vulnerable populations. The Kaiser Family Foundation (KFF) in the U.S., a prominent healthcare journal, explains that these social determinants of health have been found to be “primary drivers of health outcomes and that social and economic factors shape individuals’ health behaviours”. This is the proposed basis for why racialized, low-income people, and members of the LGBTQ+ community, are more likely to suffer from health challenges. The epidemiological study of COVID-19 revealed that Black people were more likely to contract the virus and that LGBTQ+ people were more likely to suffer from mental health issues caused by the COVID-19 pandemic.

Recent years have also seen the Affordable Health Act in the U.S. suffer drawbacks under the Trump administration, leaving many, especially immigrants and Hispanic people unable or even afraid to seek proper health care. Inequity in health care, however, is currently being addressed as a priority by the Biden administration, which has seen the establishment of the UNITE Initiative by the National Institute of Health (NIH). UNITE aims to challenge the structural racism that exists in the field of biomedical research and promote diversity to better serve the advancement of science.

         In total this brief on the inequities in the healthcare sector has considered Indigenous people, BIPOC, and the LGBTQ+ community, three populations that have been increasingly leading the push for an inclusive and just world. Health care inequities, then, are yet another aspect to consider when tackling the multifaceted issue of inequality in today’s world.

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