Close the global healthcare gap: Solutions for a more equitable future

Mail & Guardian

15 hours ago

Newborn children in sub-Saharan Africa are 14 times more likely to die within the first month than those in high-income regions such as Australia and New Zealand.
Despite decades of advancements, healthcare disparities remain a pressing global concern. Established markets benefit from sophisticated health systems, yet billions of people in low- and middle-income countries still lack access to basic medical services and medical advancements. This inequality can be found in various areas, including access to medication and general healthcare.
Considered action must be taken by both public and private agencies to bridge this chasm and create sustainable, equitable healthcare systems that serve patients as effectively in emerging markets as they do in more established parts of the world.
In emerging markets, however, infectious diseases such as malaria, tuberculosis (TB) and HIV/Aids continue to be of the utmost concern and child mortality rates vary significantly between emerging and established countries. According to the World Health Organisation, the global under-five mortality rate dropped by 59% from 1990 to 2023, but the disparities remain. Newborn children in sub-Saharan Africa are 14 times more likely to die within the first month than those in high-income regions such as Australia and New Zealand.
Treatable diseases in emerging markets continue to claim higher mortality rates than should be expected, because of financial barriers, supply shortages and limited access to trained professionals, resulting from geographical and cost factors.
About half the world's population lacks essential health services, leaving billions of people vulnerable to preventable conditions. The World Health Organisation has predicted that, by 2035, there will be a shortage of 12.9 million health workers and this paucity could be most pronounced in lower-income countries because more attractive pay levels will attract medical personnel to higher-income countries. These countries would also be better placed to produce such graduates.
Aid organisations based in high-income countries are, however, making great strides in assisting emerging markets, by providing essential supplies, funding and expertise, to facilitate greater access to medication, and fortify the health infrastructure of these regions.
The Global Fund to Fight Aids, Tuberculosis and Malaria has, for example, has saved over 65 million lives since its inception in 2002, by achieving a 61% reduction in combined death rates from these diseases. In 2023 alone, the fund supported 25 million people by providing antiretroviral therapy for HIV. They also enabled treatment for 7.1 million TB patients and distributed 227 million mosquito nets, in their quest to reduce malaria infections.
Facilities in lower-income countries are fewer in number, poorly equipped and are not likely to exist in rural areas with lower population density. This leaves many patients having to travel long distances for treatment. In contrast, people in high-income countries are closer to hospitals, which are also better equipped. It's noteworthy that higher-income countries invest up to 60 times more per capita in healthcare than lower-income countries do.
These financial constraints often force individuals in emerging markets to pay for their care out of their own pockets, which can lead to economic hardship and perpetuate cycles of poverty. Expanding universal health coverage is therefore vital. Countries such as Thailand have successfully implemented universal health coverage policies and these have dramatically reduced financial burdens while improving public health outcomes.
Effective governance is critical to strengthening healthcare systems. Of the $7.5 trillion spent globally on health each year, it has been estimated that $500 billion is lost to corruption. In fact, the amount of healthcare funds stolen each year is more than enough to achieve health coverage for all. Tackling these issues through transparency and stronger policy frameworks, including stringent auditing, will significantly improve medical service delivery.
Innovative technology-driven solutions also offer us a promising avenue to narrow disparities. Telemedicine has revolutionised healthcare in underserved regions, allowing remote consultation and diagnosis, particularly in areas where medical professionals are scarce. And mobile health (or 'mHealth'), which uses smartphones, has enabled community health workers to track immunisations, disseminate health information and report and track outbreaks.
Portable, lower-cost diagnostics have proven to be a further gamechanger. Rapid diagnostic testing devices allow for the immediate diagnosis and treatment of malaria, HIV and TB, although desirable market penetration has yet to be achieved.
And then there's artificial intelligence, which is making its presence felt in all fields of human endeavour. AI-powered health-management information systems have different functions — operational, informational and decision-making — which sometimes conflict, but this reflects real-world conditions, where different sectors have to compete for resources.
It does, however, give a clear picture of the 'state of play' of a country's health system, which would allow its government to strengthen its healthcare strategy. There is the caveat, however, that internationally agreed recommendations be put in place to avoid possible innate AI bias.
Of course, at the foundation of all such progress is the need for infrastructural development. Expanding health worker education is vital and we need to develop initiatives which focus on task shifting, where lower-cadre workers are trained to handle medical tasks, enhancing healthcare delivery efficiency. Community health workers are proving particularly effective in preventative care, offering localised and accessible health support.
To make lasting improvements, public-private partnerships must also be used. Many countries have successfully engaged private firms to manage hospitals, expand telehealth networks and supply medication under government contracts. These partnerships inject essential energy, resources, innovation, efficiency and, importantly, accountability into public health systems.
Closing the healthcare gap requires a comprehensive, multi-sector approach — one which, fortunately, is already underway. Government investment in universal health coverage, healthcare infrastructure, trained professionals and technological advancements is essential.
With the right strategies and private-public commitment, a future where healthcare is accessible and equitable for all can become a reality. All interested parties must, however, exert and maintain the pressure and interest that's required to move all involved bureaucracies forward. Our plan for some imagined tomorrow needs to be replaced by viable action for a literal tomorrow.
Asgar Rangoonwala is the senior vice-president of Johnson & Johnson EMEA emerging markets.