The World Health Organization recognizes that the highest attainable standard of health is a fundamental human right. This includes access to timely, acceptable and affordable health care of suitable quality. Human right to health is influenced by health policies and programs which have the ability to either promote or violate them. Certain social criteria are also essential this right including the availability of health services, safe working conditions, adequate housing and nutritious foods. The right to health is similar to other human rights such as right to food, housing, work, education, non-discrimination, access to information, freedom, entitlements and participation. It constitutes the following:
- Right to control one’s health and body (sexual and reproductive rights)
- Right to be free from non-consensual or harmful medical treatment and experimentation
- Right to a health system of accessibility, availability, equality, equity, universality and quality
- Right to receive treatment or refuse treatment
Despite the fact that health is a basic human right… or should be, about 100 million people globally hit below the poverty line due to health care expenses yearly. Most vulnerable and marginalized groups within countries such as indigenous and minority groups bear a disproportionate amount of health problems, healthcare costs and limitations to accessing quality and affordable healthcare. This population experiences significantly higher mortality and morbidity rates than the general public. Some groups such as women, men who have sex with men and people who inject drugs also suffer poorer health outcomes due to social and economic disadvantage and discrimination. Moreover, the world’s most fatal communicable diseases – malaria, HIV/AIDS and tuberculosis – affect the world’s poorest countries, causing a burden on the economies of these countries.
Clearly, bigotry in the delivery of health services violates fundamental human rights and can have serious health consequences. Some examples include keeping people with mental health problems against their will, denying women access to sexual and reproductive health care and services, using people for experiments without informed consents or using them for harmful experiments, discharging unwell patients due to lack of hospital beds and forced procedures such as sterilization, abortions or virginity examinations in developing and developed countries. These violations create unequal health outcomes and can lead to ill health or death of the victims. Sometimes, it is often difficult to make fair decisions in the face of complicated and competing health priorities- however, researchers, health professionals and decision makers must be as fair as reasonably possible in policies and service delivery.
Reducing, and eventually closing the gaps in equality and access to health care and services require the effort of all individuals. More specifically, the responsibility of finding means to respect and protect human right to health is that of the health sector, government and international organizations that uphold human rights. In the last few years, there has been a growing acceptance for universal health coverage (UHC), a comprehensive means for strengthening health systems and improving health equity and access to health services. UHC has been identified as the third global health transition, following public health improvements like basic sanitation and epidemiological transition that decreased communicable diseases. International health and development organizations such as World Health Organization, World Bank, Rockefeller Foundation, Oxfam, Gates Foundation, International Labor Organization, and United Nations Children’s Fund support and promote UHC.
In the words of Dr. Margaret Chan, WHO’s director-general, “UHC is the single most powerful concept that public health has to offer and represents the ultimate expression of fairness.” Termed by many as a practical expression of the right to health, UHC was selected in September 2015 as one of the key targets to implement the health goal in the United Nations Sustainable Development Goals (SDGs). It is believed that through the continued worldwide adoption of UHC, the right to health will gradually be endorsed across all countries and social groups.
Access to comprehensive healthcare is fundamental to health and affects the overall physical, social, and mental health status. It is the ability of individuals or groups to obtain the services they seek, and is widely regarded as an important health determinant. Disparity in healthcare can be defined as differences or inequalities in accessing or receiving health care and services that help to achieve the best health outcomes. These differences and inequalities can be reflected in coverage, services, workforce, timeliness and quality of services received. Accessing healthcare requires 3 distinct steps which are: entry into the health care system, access to a health care location where needed services are provided and availability of health care provider with whom the patient can communicate and trust.
Research has shown inequalities in the distribution of health by race, income, education, neighborhood location, social class, gender and ethnicity. Health outcomes used to measure these include infant deaths and other preventable diseases and deaths, mortality rates, morbidity, disability, quality of life and life expectancy. Many individuals and families face barriers to health care and services including physical inaccessibility, socio-cultural issues or the cost of non-insured health services (e.g. eye and dental care, mental health services and prescription drugs). Other barriers include racism; language difficulties experienced by immigrants who cannot communicate in French or English; inadequacy of service providers available; lack of insurance; lack of cultural sensitivity, humility and understanding from health-care providers; location and the cost of transportation; extensive wait times; services not covered by benefits, a shortage of doctors/nurses in the area; low income and inability to create time from work and family responsibilities. To illustrate this, a study in Canada on immigrant women’s health showed that while immigrant women viewed health and prevention similarly to Canadian-born women, their ability to access the resources needed to stay healthy were different. At the same time, access to health care is also a challenge for Canadians in remote communities’ and Aboriginal populations who live off-reserve mostly due to location and the cost of transportation. Despite the fact that this population is more likely to report having unmet health care needs (20% compared to 13%), they are less likely than the overall population to regularly visit a physician.(77% compared to 70%). Barriers and challenges in accessing health care can lead to a deterioration of health, emotional distress and feelings of exclusion and isolation.
Few programs attempt to close the gaps in accessing health services by the undeserved population and reduce disparities in healthcare. They include West Prince TeleHomeCare, which provides another option for people deciding to live in their own homes while dealing with health issues and Toronto’s Mobile Health Unit which provides sexual health services onsite to the many immigrant women working in garment factories in Toronto’s downtown core.
The World Health Organization’s recommendation to address inequities and disparities in healthcare is that countries must address the systemic and structural stratification of their societies as a national priority. This means reducing the gap and inequalities in healthcare between those at the highest and lowest income levels through actions that will eradicate poverty and increase opportunities for employment, education and early child development among the entire population.
Social class is a function of socioeconomic status, a root cause and health determinant, which accounts for most of the health disparities seen in the world today. It is reflected in racial, gender and income differences between population groups both within and between countries. For example, the higher disease rates of African Americans in the United States when compared to Caucasians, have remained consistent despite many attempts to address them. This gap in morbidity among racial groups is widening in recent years for several causes of death. Specific minority populations have also shown higher rates for some health conditions just by being in their group, even when their social status is somewhat “equivalent” when compared to other groups. Factors that contribute to the differences in social status and negatively affect health by restricting socioeconomic opportunities include income, education, power, individual and institutional discrimination, gender, residence in poor neighborhoods, employment, bias in medical care, racism, and inferiority stigma. These factors, and their combinations constitute an individual’s social class.
Research has consistently proved that health is not only a function of genes and habits but is also influenced by class and status. The unequal distribution of power, money and resources also creates health inequities through a systematic and unequal distribution of opportunities to be healthy. Analyses of data from the German National Health Interview and Examination Survey showed that in the last decade, the proportion of people belonging to lower social class has decreased while middle and upper social classes have increased. Some risk factors attributed to the differences in social class were smoking, obesity and inactivity, which were mostly associated with people belonging to lower social class. Concurrently, hypertension and hypercholesterolemia were more often observed in men of the upper social class compared to those belonging to lower class. Regarding morbidity, diseases such as chronic bronchitis and gastric and duodenal ulcer were found to have higher prevalence in the lower social class while allergic rhinitis were observed more often in the higher class. Differences in social class are clear and many attributes are unique to people depending on which of the classes they belong. The contentment about life and health status was higher in the upper class while the level of complains and dissatisfaction about life and health status was higher in the lower class. Additionally, a study in Australia showed that the richest 20% of the population can expect to live an average of six years longer than the poorest 20%, just by belonging to then richer social class.
The British Epidemiologist, Michael Marmot, is a pioneer in this field of research. He studied English civil servants over some decades and found that irrespective of universal healthcare and race, people higher up the ladder (richer and upper status) lived longer and were less sick than those lower down (poorer and lower status)- even when behavior is accounted for. This effect or “social gradient” was consistent throughout the ladder as people just below the highest statuses tended to have shorter lives and be sicker than those just above them all the way down. Marmot discovered two variables that seemed to have a great impact on health and well being: a sense of autonomy or control over one’s life and work, and the ability to fully participate in the society. Naturally, people with higher incomes and education levels tend to have more control and power and contribute more to the society than those with fewer resources- a plausible explanation for the health differences. For example, a job loss may not really affect a rich educated man with multiple investments like Dr. K, but can trigger a disastrous chain of events including ill health for a low-wage worker.
Marketing is the promotion and selling of products or services and includes activities such as market research and advertising. It is also the process of creating, communicating, delivering, and exchanging valuable materials to customers, clients, partners, and the society at large. Marketing can be commercial, which is strictly business for profit, or social, which is used in promoting healthy behaviors for public health. Communication is an essential part of marketing and health promotion, this makes the media a popular option amongst marketers and health promoters. The media in this context includes all non-personal channels of communication, from pamphlets to television commercials to education. These channels can be employed directly using consciously designed media materials or indirectly by stimulating interest and opinion on particular topics.
In health promotion, social marketing is often employed to inspire behavior change, especially because human beings are social beings. Social marketing is defined as the application of known concepts and methods obtained from the commercial sector (behavioral theory, persuasion psychology, and marketing science) to promote changes in socially important and health related behaviors. Behaviors such as drug use, smoking, family planning, recruiting blood donors and sexual attitudes can be influenced or changed using this type of marketing. The “marketing mix” or “four Ps” of marketing are factors that are involved in marketing and must be present for marketing to occur, they include, place, price, product, and promotion. Social marketing must be voluntary and should underscore the benefit of the consumer. It involves the following:
Activities that use behavioral theory to influence behavior that affects health
Assessing factors that influence the way individuals receive, understand and use messages such as the credibility of the subject matter and
Strategic marketing of messages that are aimed to change the behavior of target audiences using the four Ps
To put all these in perspective, we can use a health behavior such as physical activity to illustrate how a heath product can be socially marketed with the four Ps:
Product: Physical activity, being our product is what we have to market and sell to our audience. We need to use the benefits associated with physical activity to effectively market our product and attract our audience. Benefits may include weight loss, meeting people, recreation and beauty from toned muscles.
Price: These are all the costs and barriers that our audience will overcome to be able to perform the physical activity. Individuals weigh the benefits and costs/barriers of physical activity and will be more likely to participate if the benefits outweigh the costs. Barriers may include competing activities, transportation, interest and cost,
Place: This represents the location or facility the physical activity will take place. It must be close enough, available at convenient times and easily accessible so that individuals will be more encouraged to participate in the physical activity.
Promotion: These are communication strategies and adverts used to reach the target audience and show them the benefits of the health behavior. Promotion goes a long way in determining if our audience will buy the product by choosing physical activity or not.
Unity is simply defined as the state of being united or joined as one, usually towards achieving a common goal. It is a crucial feature for every venture in order to achieve set goals and objectives. Words like teamwork, group, affiliation, alliance, association, partnership, and collaboration buttress unity. Most times, nothing can succeed without unity because in its absence, disorientation and disorganization are not lacking. Be in it in our homes, schools, workplaces, churches, and the world at large, unity is essential to peace, progress and good health.
Given the relevance of unity, organizations such as United Nations (UN), World Health Organization (WHO), Economic Community of West African States (ECOWAS), International Monetary Fund (IMF), World Bank (WB), Universal Postal Union (UPU) and so much more exist. These organizations attempt to bring oneness and unity to our world today in various areas of life including social, health and economy. As huge and diverse as the world is, we are somehow connected through the internet, business, transportation… and this connection makes us vulnerable to one another by promoting the rapid transfer of health risks internationally. Many health issues are global in nature in that they transcend the boundaries and borders of countries… affecting continents and the world at large. In response to these global issues such as HIV/AIDS and other infectious diseases, climate change and health equality, solidarity is needed to help countries tackle health problems. Unity increases strength and empowers less developed countries through the assistance of more developed ones and large international donors.
The need for oneness and centralization in health provision is not new. The global community reached an agreement on the importance of providing holistic sexual and reproductive health services as far back as 1994. Increased unity is naturally beneficial because it increases coverage and access at lower cost as well as improves the quality of care and acceptance for stigma. Current priorities for Joint United Nations Programme on HIV/AIDS (UNAIDS) include sexual transmission of HIV, violence against women and girls, punitive laws and human rights and youth empowerment. These factors mostly affect developing countries and have spurred an increase in the number of global health initiatives (GHIs).
For almost two decades, the appearance of several disease-specific GHIs has modified the way international donors provide assistance for global health. WHO’s collaborative group on maximizing positive synergies reviewed and analyzed existing data, and 15 studies and described the complex nature of the interaction between country health systems and GHIs. Sometimes, the health systems and structures of individual countries do not align or integrate with GHIs, causing misunderstandings and frictions between countries and donors on the global scale. They concluded however, that if the necessary adjustments to the interactions between countries’ health systems and GHI are made by fostering unity, it will improve efficiency, equity, value for money, and outcomes in global public health. Hence, health systems and GHIs can complement each other and work together in order to mutually and positively strengthen global health.
