Achieving and Maintaining Equitable Health Outcomes for all,Including for Future Generations

Abstract

Sustainable health equity means achieving and maintaining equitable health outcomes for all people, including for future generations. It encompasses realizing the right to health, setting the conditions for leading a healthy life, and fulfilling the full range of human rights. Achieving sustainable health equity requires that public services be designed and provided, and public policies be developed through empowering, inclusive, participatory, accountable, and democratic processes and mechanisms.

Sustainable health equity means achieving and maintaining equitable health outcomes for all people, including for future generations. ¹ It encompasses: (a) realizing the right to health so everyone can access a full range of health services regardless of their social and political position and that of their population group; (b) setting the conditions for leading a healthy life on the planet by simultaneously addressing the underlying social and environmental determinants of human health and the human-animal-environment interface ² ; and (c) fulfilling the full range of human rights, including economic, social, cultural, civil, and political rights. Achieving sustainable health equity requires that public services be designed and provided, and public policies be developed through empowering, inclusive, participatory, accountable, and democratic processes and mechanisms. ³

The COVID-19 pandemic highlighted the extreme inequity in access to diagnostics, treatments, and vaccines, resulting in a per capita death toll 31% higher in low-income countries compared to high-income countries. ⁴ The pandemic also featured stark within-country inequities, both in access to COVID-19 vaccines and mortality rates due to COVID-19,^5,6 reflecting long-existing health inequities and unequal access to quality health services and other necessities for a long and healthy life. In addition, the world is facing a syndemic of obesity, climate change, and undernutrition, with the worst outcomes experienced by populations in low- and middle-income countries, particularly those living in poverty and minoritized ethnic groups. ⁷

Sustainably attaining the highest possible level of health for all people everywhere requires addressing social and economic justice, including in the context of environmental sustainability. ¹ Nearly half the global population, 3.6 billion people, live in places highly vulnerable to the climate crisis, with deaths from floods, droughts, and storms 15 times higher compared to the least vulnerable regions. ⁸ Meanwhile, given the link between the ecosystem services upon which we depend, the destruction of habitats that is both a leading cause of the extinction of other species and the increased risk of outbreaks of novel and emerging infectious diseases, we must protect our planet's biodiversity and end our practices that are degrading it. Given that countries with the greatest GDP contribute the most to global carbon emissions, ⁹ those most responsible for the climate crisis must cancel external debt for countries most impacted and least responsible for our planet's climate peril and compensate them for their loss and damage for the harm experienced. Polluters—both at the corporate and the national level—must pay.

To create conditions for all people and future generations to attain the highest attainable standard of health, the Sustainable Health Equity Movement calls for public policies grounded in the understanding that intersectoral actions are fundamental for promoting health and recognizes that health policies play a crucial role in achieving the democratic and sustainable social, economic, and environmental forms of development we need. ¹⁰ In 1978, health leaders advocated for primary health care to achieve the ambitious goal of health for all by 2000. Yet, the debt crisis and subsequent global deregulatory economic policies soon sidelined health equity, universal access, intersectoral action, and participatory approaches. ¹¹ We urge governments to incorporate the right to health in all policies and practices—both domestically and in international agreements and policies and actions with extraterritorial impact—and to cut carbon emissions both at home and abroad, immediately, and protect biodiversity to avert the growing risk of massive social disruptions and accelerating the mass extinction already underway.