What exactly is meant by ‘global health equity’? What does the phrase encompass and what should it entail? Is defining it important, or merely an academic exercise?
A group of prominent researchers from U-M, together with longtime collaborators in Ethiopia and Rwanda, offer their thoughts in a viewpoint published recently in Annals of Global Health.
“Terminology describing global health activities has changed and expanded over past decades as our values in this space have changed. The term global health equity has increasingly appeared in the literature,” writes the team. “Some have argued that the term is simply a rebranding of global health to distance it from its colonial roots and power disparities. We argue here that adding the word equity is important, as our language has the power to shape our future discourse and actions.”
Authors include clinical associate professor of epidemiology Ella August and other colleagues from the School of Public Health, U-M Center for Global Health Equity Joseph Kolars, as well as Rex Wong and Abebe Bekele, from the University of Global Health Equity, in Rwanda, and Lia Tadesse, Ethiopia’s Minister of Health and an adjunct professor of obstetrics and gynecology at UMMS. Collectively, the group has decades of experience building and maintaining equitable collaborations – the kinds of partnerships that too often are left out of any ‘global health’ definition, they assert.
The group also emphasizes that in-country partnerships—without any partners from high-income countries—are vital to advancing health in low-income countries and often provide insights that impact health in positive ways in high-income countries. They note specifically their deviation from existing models that define global health partnerships as necessarily between low-income and high-income countries: “Such partnerships also involve collaborations within low-income countries and within high-income countries without the involvement of foreign actors.”
“In building our definition, we move beyond the sole focus on (health outcomes) to emphasize partnerships and processes,” they write. “Regardless of where the collaborators are from, engaging in partnerships that are equal in power and benefit, and equitable in sharing resources, is critical to the success of global health activities.”
Their proposed definition focuses on three principles – partnership, process, and products (i.e., health outcomes) – to comprise a holistic description and approach to global health equity. Partnerships should be mutually beneficial, with equitable resource sharing, and agreed-upon roles and responsibilities. Built-in processes that ensure equity in areas like goal-setting and publication authorship are vital. Finally, the team notes, that products to emerge from such foundational partnerships and processes are likely to be equitable by design.
“Although many existing definitions of global health mention one of the three, few mention them all, and their presence in our proposed definition reinforces the idea that global health equity requires all three to be in place,” they write. “Ultimately, a commitment to all three components of our definition is necessary to move toward health."