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Tackling Health Inequity: Where to Begin?

Photo credit: Patrick de Noirmont

From vaccines that prevent childhood diseases to antiretroviral drugs that treat HIV, we’re better equipped than ever to take on the world’s greatest public health challenges. In the past two decades, these tools have already saved millions of lives and dramatically improved the well-being of communities around the world.

But the benefits of this progress have not reached everyone equally. In many marginalized communities, gains in health have simply stagnated – or worse, declined – fueling a cycle of poverty and holding entire economies back from reaching their full potential.

We may have the science and solutions at our disposal, but we’re missing the strong health systems that bring these resources to all who need them. Ebola has exposed the enormous gaps left by existing health systems. And, for too many, the price of health is just too high: each year, approximately 100 million people fall into poverty paying for essential services.

“Each year, approximately 100 million people fall into poverty paying for essential services.”

As the world sets new global Sustainable Development Goals at the UN this year, the next great health challenge will be to create policies and infrastructure that bring affordable health services to everyone, everywhere. But where do we begin? Last month, global health leaders gathered in Bangkok for the annual Prince Mahidol Award Conference to chart a path toward health equity. Three takeaways stood out as crucial elements for success: universality, cross-country learning and increased accountability. 

First, health equity starts with policies that promote universality, meaning that everyone – rich and poor, men and women, city-dwellers and rural communities – can access the quality health services they need regardless of their ability to pay. This is easier said than done, but a growing number of countries – from Thailand to Rwanda – have embraced universal health coverage (UHC) to build resilient health systems that reach everyone with essential services and protect all communities, especially the poorest, from crippling health costs.The results have been remarkable. By 2009, Thailand achieved nearly 99 percent coverage of pre-natal care and more than 99 percent coverage of skilled birth attendants, with virtually no differences in access to care across geographic areas, education levels, or socioeconomic classes.

Second, we’re seeing that the experiences of countries pioneering UHC offer important lessons for other countries. In Rwanda and Ethiopia, for example, clear government leadership and increased domestic resources were critical for successful health reforms.

The Joint Learning Network is a powerful example of a knowledge-sharing platform for countries and practitioners to build on each other’s successes and lessons learned as they explore UHC together.

Finally, tackling the health equity gap hinges on strong governance and accountability. We need systems, at both the global and country level, that hold governments, private sector actors, multilateral agencies, and non-profit organizations accountable to health goals. The UHC monitoring framework developed by the World Health Organization and the World Bank Group, which The Rockefeller Foundation proudly supported, is a critical step in this direction, but it will take robust information systems and institutional capacities to ensure that all stakeholders are doing their part.

The Sustainable Development Goals are our chance to be bold, and to build on what we’ve already accomplished to create a fairer and healthier world for the next generation. By ensuring that our tremendous advances in medicine and public health reach everyone, by learning from different countries’ triumphs and challenges on the road to UHC, and by holding each other accountable, we will be able to bridge the gaps and make universal health coverage a reality.


The 2015 Prince Mahidol Awards Conference was hosted by the Thai Ministry of Public Health, The Prince Mahidol Awards Foundation, Mahidol University, The Rockefeller Foundation, and other global partners. The conference also marked the 100th anniversary of an innovative partnership between Thailand and The Rockefeller Foundation. 

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