COVID-19 and the global movement to confront systemic racism have thrown in stark relief the need for the public health community to confront inequity. The cost of systemic bias on health is striking and quantifiable: When public health systems have fewer resources and embedded structural inequalities, it damages health and keeps people from living healthy lives. This is an affront to our mission of building a healthier, fairer world for all.
At Vital Strategies, we work toward a world where people have equitable access to health, and where they are protected from the leading drivers of death and disease no matter their race, gender, or sex, or where they live. Our work contributes to a more equitable world where a child in Peru can live in an environment protected from lead poisoning; where parents in Rwanda can easily obtain birth certificates for their children; and where people living in cities around the world can travel safely on roads with enforced speed limits and pedestrian crosswalks.
This World Health Day, we’re highlighting the ways Vital Strategies is working alongside partner organizations and governments to reimagine public health and prioritize equity.
Unlocking Access to Registration Systems
While every life counts, millions of people around the world remain uncounted. Registration and identification documents—birth, marriage, and death certificates—provide a host of social benefits and protections including access to health care and education.
Globally, trans people face a multitude of challenges obtaining official documents that match their gender identity, with some countries enforcing invasive requirements including psychiatric diagnoses, hormone therapy, or forced sterilization.
In Peru, Vital Strategies is providing technical assistance to civil society groups to remove legal and administrative barriers that prevent lesbian, gay, bisexual, transgender and intersex (LGBTI) people from obtaining accurate identity documents or registering vital events such as marriages. The project aims to ensure that the country’s LGBTI people have straightforward access to registration and identity documents along with the associated benefits, including access to health care, and even improved mental health, that are essential to health and well-being.
Promoting Food Nutrient Labels
Almost one-third of the world’s population is overweight or obese, including more than 41 million children under the age of 5. Obesity is a driver of noncommunicable diseases (NCDs), including diabetes and heart disease, which are responsible for 70% of global deaths. Recently the COVID-19 pandemic has further revealed deep structural inequities in food environments. Many people in low- and middle-income communities struggle to obtain affordable healthy foods and rely instead on processed and low-nutrient foods.
At the point of purchase, consumers typically spend less than 10 seconds selecting food and beverage items, and the food and beverage industry benefits from those quick choices by using marketing tactics that make unhealthy foods seem more appealing, often targeting children. Front-of-package warning labels can help. Our guidebook “What’s in Our Food? A guide to introducing effective front-of-package nutrient labels” aims to help governments take on these cost-effective and high-impact strategies.
Once the world’s leading consumer of sugary drinks, Chile’s adoption of front-of-package labels on sugar-sweetened beverages reduced consumption by nearly 25% in 18 months. Mexico has also recently adopted front-of-package warning labels accompanied by mass media campaigns about the harms of sugary drinks.
Uncovering Financial Incentives to the Alcohol Industry
Alcohol consumption leads to one death every 10 seconds, resulting in 3 million deaths per year globally. Despite this global burden, the alcohol industry receives billions in financial incentives through tax breaks and marketing subsidies. Incentives are often disbursed from high-income countries to transnational alcohol corporations in low- and middle-income countries. The effects of alcohol incentives are greater on countries with weaker public health systems and where there is already a high burden of alcohol use.
A first-of-its-kind report from Vital Strategies, The Sobering Truth: Incentivizing Alcohol Death and Disability, uncovers these incentives and proposes key recommendations for countries to strengthen their health systems against the harmful use of alcohol.
For example, over several decades, the European Bank for Reconstruction and Development provided more than US $422 million in development assistance to breweries in Central and Eastern Europe, including a US $13 million loan to a brewery in Uzbekistan—even though the World Health Organization has identified NCDs and their risk factors, including alcohol, as obstacles to development.
Governments and development agencies must reexamine current economic incentives to the alcohol industry and advocate for consistent policies that protect the health and welfare of people globally.
Harnessing A Harm Reduction Approach
Overdose deaths increased drastically during the pandemic, claiming more than 80,000 lives in the United States last year.
It’s been 50 years since the United States started it’s so-called war on drugs—a racialized and discriminatory set of drug criminalization policies and practices resulting in the mass incarceration of Black people. Despite similar rates of drug use across racial-ethnic lines, Black and Latinx people are jailed at far higher rates for drug use.
To undo harm, we must invest in a public health response focused on racial equity. Instead of punishing drug use, we can implement harm reduction-oriented services offering safer drug use supplies and supportive engagement.
Vital Strategies’ Overdose Prevention team is providing technical assistance to governments and affected communities and assisting local partners in building innovative science-backed solutions focused on sustainable reductions in overdose death. Recently, in partnership with the Michigan Department of Health and Human Services, we launched a media campaign promoting Michigan’s harm reduction services including the availability of naloxone and access to syringe service programs.
In March 2021, public health, faith, harm reduction, and criminal justice leaders were featured during South by Southwest (SXSW) for a panel discussion, “Decriminalize Drugs to Reduce Harm and Build Justice.” This provided an influential platform to urge policymakers and advocates to end the criminalization of drugs and invest in a public health response to save lives.
Collaborating With City Leaders
Cities are home to over half of the world’s population, and they are places where health can be produced or compromised.
Many cities found themselves at the epicenter of the COVID-19 outbreak, which further exacerbated inequities. Through the Partnership for Healthy Cities, a collaboration between Bloomberg Philanthropies, WHO and Vital Strategies to prevent NCDs and injuries in its global network of 70 cities, mayors quickly mobilized to respond to COVID-19, supporting hard-to-reach populations and protecting lives and livelihoods.
The city of Athens rolled out a program to provide temporary housing for people affected by homelessness and a specialized support center for people who inject drugs. In response to rising poverty levels that accompanied lockdowns, Bogotá provided cash assistance to its residents while increasing health care capacity and access. And throughout the pandemic, the Partnership has supported COVID-19 communication campaigns to promote healthy behaviors including the 3 W’s: wear a mask, wash your hands and watch your distance.
You can hear from mayors who spoke at our VitalTalks event on Oct. 29, 2020: COVID-19 and Beyond: Cities on the Front Lines of a Healthier Future.
Be sure to join us On April 15, for our next VitalTalks event: Cities Hold The Key: Prioritizing Equity in the COVID-19 Recovery featuring Lori Lightfoot, Mayor of Chicago, Illinois and Carolina Cosse, Intendant of Montevideo, Uruguay. Register for the event here.
While our world is an unequal one, it does not have to be. Governments, policymakers and public health professionals have the power to develop, implement and enforce policies that address inequalities and make a difference in people’s lives. Working together, we have the opportunity to build back better after COVID-19.
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