Equity, Diversity, Inclusion, and Justice
“Injustice anywhere is a threat to justice everywhere.” – Martin Luther King Jr.
The growing calls to decolonize global health have put into question the current model for global health, including the role of Canadian-led global health research and practice. Across the world, many groups, individuals, and countries have been a focus of study and practice without meaningful representation. An agenda that will re-envision approaches and practices that can amplify these perspectives and lived experiences must be renewed. Justice can only be achieved when principles of equity, diversity, and inclusion are met. These concepts are all intersected and must be considered collectively (not as stand-alone concepts).
The prioritization and commitment to work that advances equity, diversity, and inclusion stands to redress health inequities within and between populations, and advance meaningful progress on global health equity.
Movements such as Black Lives Matter, me too., and Idle No more, have prompted many to take pause and reflect on opportunities to address historical and contemporary wrongs and attitudes and progress towards a fairer, safer, and healthier world. The movement toward Universal Health Coverage (UHC) is an example within global health based on the principle that all individuals and communities should have access to the quality essential health services they require, without suffering financial hardship. Collectively, these movements have galvanized communities to live, interact and work differently. The lessons learned from these movements now need to be translated to guide new approaches for anti-colonial research and practice in global health.
In this sub-theme, we invite presentations that will interrogate what these dimensions mean more precisely. Consider: What is “decolonizing global health” and how can it be achieved? How can equity and inclusivity be operationalized and achieved in global health research and practice and what are the associated outcomes? What populations stand to benefit most and what are the potential trade-offs? How can equity and inclusivity be practiced meaningfully and positively as we move forward in diverse global health spheres? Do we have a clear understanding of the systemic barriers faced by individuals from underrepresented groups (e.g., women, persons with disabilities, Indigenous Peoples, racialized minorities, and individuals from the LGBTQ2+ community)? What measures need to be put in place to overcome these barriers?
Local and International Inequities
Local and international inequities are a major challenge that affect all spheres of individual, social and global well-being. Inequities can be an important source of social, political, and economic unrest, and this can result in impactful and long-lasting conflicts. Inequities between and within countries and a failure to identify and address inequities within and between populations complicate the identification and management of phenomena that negatively impact the health and well-being of populations and increase the gap of inequalities.
The COVID-19 pandemic has exposed significant health inequities that have existed in our societies for some time. In Canada, determinants of health are still characterized by a person’s color, religion, culture, or ethnic origin. This results in inequities in social inclusion, economic outcomes, personal health, as well as access to and quality use of quality health and social services. For example, during the second wave of the pandemic, cases from neighborhoods in Ontario, Canada, with the highest rates of ethnic diversity were four times more likely to be hospitalized, four times more likely to be admitted to an intensive care unit, and two times more likely to die from COVID-19 compared to Ontario’s least diverse neighborhoods. (www.opha.on.ca /April 221). The COVID-19 pandemic also brought to light huge disparities at the global level. Disruptions to essential services have been reported in 90% of countries (WHO 2022); however high-income countries reported fewer service disruptions compared to lower-income countries, and countries in the WHO Region of the Americas (dominated by Latin America) reported the highest average percentage of services disrupted compared with all other WHO regions.
Since these inequities increase over time, it is important to understand in depth the various issues relating to these inequities via research results to be able to develop effective strategies and policies to mitigate their negative effects. Achieving the granularity of data that exposes and interrogates health inequities is essential to understand the differential impact of programs and interventions (community effectiveness) on different communities. This subtheme will investigate the policies that lead to the inequities between and within countries and those that are succeeding in mitigating their impact. Consider: What actions can be taken by the global health community to build and support these initiatives? What is the evidence base that is needed for this – at the country level and at the community level? Is there a role for implementation science in identifying and redressing these inequities? What are the galvanizers and dampeners that contribute to or impede the evolution of these initiatives?
1 Ontario Public Health Agency
Indigenous Health
Most international studies on indigenous health policies focus on anglo-settler democracies (Canada, Australia, New Zealand, and the United States) despite these countries representing a small fraction of Indigenous populations worldwide LAMBERT et al. However, Indigenous peoples around the world experience different histories, cultures, realities, and health considerations. There are various approaches to how countries address the needs of Indigenous populations, and to what extent the indigenous wealth of knowledge and experience is reflected in health systems and population health policies. Furthermore, local, national, and international communities have much to learn from each other. Thus, a call for global collaboration, led by Indigenous leaders, for the sharing of knowledge is essential. Through traditional knowledge systems, Indigenous peoples globally know and understand their health and wellness. Colonial policies worldwide created ongoing system structures that are the foundation of inequitable power structures, actions, and values that negatively impact Indigenous peoples today and in the past.
This subtheme invites contributions that interrogate questions such as: What do we need to address and overcome these gaps in health equity for Indigenous peoples globally? How can our inquiries and practices address the historical and ongoing traumas associated with colonization and colonialism? How can we learn from anti-colonial approaches used in Indigenous health research and practice globally to further an agenda for inclusive global health? How can evidence on Indigenous ways of knowing inform a greater emphasis on equity, diversity, and inclusion in global health?
Local Implementation as Key to Inclusivity
There have been increasing calls for greater autonomy and local ownership and participation of people in need in global health research. At the same time, there remain significant legal, social, and political barriers that pose challenges to local implementation. Through frameworks and approaches such as implementation science, there are opportunities to optimize, and scale-up if needed, localized work and solutions. The very principles of “local level engagement” would require that the needs of communities are addressed, and from the start, provide a mechanism to ensure the application of equity, diversity and inclusion principles as well as inclusive global health.
This subtheme asks you to consider: How can local empowerment make a difference and align with district and national efforts and policies? How is empowerment linked to local and district capacity to develop evidence-based planning and equity-oriented resource allocation? How can local implementation serve to operationalize equity, diversity, and inclusion principles, and progress an inclusion agenda in global health? How does local implementation empower researchers and practitioners in diverse settings?
To partially answer these questions, it is important to share experiences from local implementation. For example, a reproductive health project uses an innovative approach to integrate research findings into health policy. This project can show how local implementation has tremendous potential to bring the concern of vulnerable populations into the decisions made by health authorities at the national level.
Global Health in Times of Crisis
Conflict and fragility impact health systems both directly and indirectly: insecurity and conflict result in direct deaths from violence, but the indirect effects on population health and health systems are often far more significant. Contemporary crises have furthered the strain on already fragile health systems in many parts of the world where vulnerable groups like women, children, the elderly, ethnic and racialized minorities, migrants, refugees, and displaced populations, continue to disproportionately suffer. Often a crisis also causes an inappropriate and inequitable focus on a particular issue, shifting focus away from what the evidence says should be done, to what can be done, within regional political and economic realities/imperatives.
Further, persistent levels of poverty, food insecurity, and housing and sanitation issues impact the determinants of health, resulting in a higher burden of morbidity and mortality related to non-communicable diseases and even other infectious diseases like HIV/AIDS, measles, malaria, and tuberculosis. The COVID-19 pandemic has added an additional source of complexity in fragile and conflict-affected states. The response to the pandemic in fragile regions has been characterized by resource shortages, coordination challenges, the spread of inaccurate information, and untimely risk communication at various levels. In other fragile settings, political considerations led to downplaying the COVID-19 risk leading to increased infection and death.
In this subtheme, we invite presentations that will delve deeper into the impact of crisis on global health. Consider: Why do certain crises draw more attention than others? Are populations who are experiencing marginalization less visible than others who have a voice and power on the global stage? How can we highlight and give fair attention to these “other” global crises? What are the inter-relationships between global crisis and the consequences for global health? How can we maintain or ‘shock proof’ global health systems and global health priorities from ongoing and destabilizing crises? What has been learned from previous crises and how can such learning support planning and recovery efforts?