The imperative of health equity
Effy Vayena, Professor of Bioethics at the Swiss Institute of Technology (ETH), Chair of the Greek National Bioethics and Technoethics Commission
The ongoing COVID19 pandemic revealed many weak links in several aspects of our society and the global order. The robustness of health care systems, equity of access to health services, health literacy and digital literacy, the relationship between science and politics, multilateralism and global coordination are amongst many that were put to the test and scored poorly. The result has been excess mortality and suffering and a prolonged pandemic with profound social and economic consequences. In the remainder of this pandemic and afterwards it is critically important to take stock of what happened and refocus our attention on how to rebuild our societies in ways that address those weaknesses. Experts maintain that more pandemics are on the horizon, along with other global crises resulting from climate change. Preparedness is urgently needed.
Amongst the most important learning from this pandemic should be the issue of equitable access to health care and equity more broadly. The pandemic disproportionately affected those in lower socio-economic groups. This is hardly a surprise. Although the right to health care is a universal human right, enshrined in law in most countries, we are still seeing a slow realization of this right in practice. It is well established that health has many social determinants and their effects can actually be measured. Just the zip code of one’s address can give a fairly good estimate of one’s life expectancy. Different zip codes represent differences in socio-economic status, levels of education, health literacy and access to care; such differences are then reflected clearly in one’s quality of health. With the powerful capabilities afforded by scientific and technological advances, we should aim at reducing these differences and ensuring that the right to health can be meaningfully exercised by all people. Strengthening health systems by investing in infrastructure and the people who make them perform has to be given a new priority. This includes emphasis on prevention and primary care, systemically neglected areas of the health systems in most countries.
Developments in digital health will certainly play a role in the delivery and quality of health care and in the strengthening of health systems. We have seen several signs of this already during the pandemic, along with the many ethical and policy questions that digitalization in health brings. Those challenges go far beyond the more familiar concerns about privacy and data protection, to issues of access, discrimination, and accountability. Digital health tools have to be developed and deployed with the aim of equitable access to health. Technological advances are not neutral. Therefore, they ought to be designed (and deployed) with what the human right to health demands. Digitalization can become a new determinant of health. In a utopian scenario those with digital access and digital literacy will enjoy better access to high quality health services, or in a dystopian scenario algorithmic decisions in health care will replicate existing biases, exacerbating health disparities.
On a positive note, we can opt for the realization of a more positive scenario. It’s a matter of political and civic choice. We need all stakeholders to help secure the right to health for all. We also need to ensure that health, although an individual right, is also understood as a common good. We’ve seen in this pandemic how connected we are, and how dependent each of us is on others’ health. We can collectively reimagine and achieve health for all.
Effy Vayena, participated in the discussion entitled "Health"