How global is Global Health? Let’s talk about facts, by Antonio Jaén

A 2009 study conducted by researchers at Harvard Medical School and Cambridge Health Alliance found that 45,000 USA citizens had died every year, up to that date, as a direct result of not having any health insurance coverage. Three years later, the New England Journal of Medicine published a study stating that death rates are reduced considerably when Medicaid (free health insurance provided for the USA Government) is expanded. ​

In 2019, the U.S. Census Bureau announced in a report that the percentage of American citizens without health insurance was creeping upward. In the same year, Gallup, a well-known analytics firm, published 9 that 25% of USA citizens had delayed medical treatment for a serious illness due to the costs of care. In addition, another study conducted by the American Cancer Society in May of that very year found that 56% of adults in the USA reported having at least one medical financial hardship, also called “catastrophic illness” by economists, warning that this issue is likely to worsen unless action is taken.

Let’s now talk about Europe: the 2018 Access to Health report published by the European Union states that “several population groups have significant difficulties in accessing healthcare”, including women. And also says that access to healthcare can be “hindered by residence status and ethnicity.” The report concludes that “important inequalities in access to healthcare persist, both between and within countries; and large shares of the EU population, in particular vulnerable groups, face multiple hurdles and therefore do not obtain the care they need.”

Narrowing our focus to country-level within the EU; a research article on private health expenditure and the affordability of private financing of health care in Ireland warns that “reliance on private health expenditure as a funding mechanism undermines the fundamental goals of equity and appropriate access within the healthcare system.” 

Ireland “is the only Western European country that does not offer universal coverage of primary care”, states another research article, “with 60% of the population paying out of pocket on average €52 per GP visit and two thirds of the population paying up to €144 per month for drugs as well as paying for other primary care services.”

So, when we talk about Global Health, why is our focus on low and middle-income countries, systematically forgetting those with no or limited access to equal quality healthcare in the global Northern countries? Why are countries such as the United States and Ireland speaking about Global Health in Africa while not ensuring universal access to health for their respective communities?

In the North, we use Global referring to the world without including ourselves in the definition. As if the Global of Global Health refers to “the others”. Is not that a hypocritical approach to health and development?

Working for a project such as SURG-Africa and being part of the RCSI Institute of Global Surgery, I have witnessed the health-related needs of rural populations in some African countries. These are urgent needs that require first of all, political will; and global economic equity. It is essential to support Governments in their initiatives to improve their health systems and I reckon it is of paramount importance that we work in projects that share such aims.

I have been working from home for more than a year. I participated in many events, zoom meetings and virtual conferences about what everyone doesn’t doubt to denominate as Global Health-related issues. But I wonder: why I don’t then see presentations about, for example, Susan Finley from Colorado, who after having to call in sick –she was recovering from pneumonia– was fired. She lost her job because she had taken off one day beyond what is permitted by Walmart’s attendance policy -  The Guardian tells, therefore losing her health insurance. Finley was found dead in her apartment, a few months later, “after avoiding going to see a doctor for flu-like symptoms.” 
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Geography should be irrelevant when talking about health. But if we want to use the term Global Health, we need to learn that health is about making sure people receive the right healthcare, regardless of where they live. If Global Health can’t help the Susan Finleys of the world, let’s stop fooling ourselves, it is not Global; if people are left behind.