The Department of Internal Medicine recently hosted a global health public lecture on Equity and Social Medicine, featuring the world-renowned global health expert, Professor Louise C. Ivers. She is a Professor of Medicine at Massachusetts General Hospital, a Professor of Global Health and Social Medicine at Harvard Medical School, and the Director of the Harvard Global Health Institute at Harvard University.
The lecture was attended by notable researchers, faculty members, undergraduate and postgraduate students. Among the attendees were the Dean of the Faculty of Medicine, Associate Professor Joseph Ngonzi, the Director of Global Health Uganda, Dr. Stephen Asiimwe and the Head of the Department of Internal Medicine, Dr. Grace Kansiime, among others.
During the lecture, Professor Louise C. Ivers focused on critical issues such as non-communicable diseases (NCDs), neonatal disorders, water and sanitation, food security, social structure, and structural violence.
While non-communicable diseases are on the rise and causing deaths, infectious diseases and neonatal disorders continue to claim many lives in resource-limited settings. Even when solutions are known, the lack of resources remains a significant barrier. For instance, cholera outbreaks have increased in Haiti despite knowing how to prevent them, largely due to an under-resourced healthcare system compared to the rest of the Americas. Poor families are more likely to experience food insecurity and are at higher risk of cholera, often resorting to scavenging for food. Currently, 2 billion people worldwide lack access to safe water, while 2.6 billion lack proper sanitation.
Structural violence, whether direct or indirect, leads to inequities in health and social injustice. Individuals may be unaware of these injustices as they become normalized within society. For example, the shortage of oxygen in hospitals and the burden of antimicrobial resistance is exacerbated in areas without strong regulations regarding antimicrobial use.
Violence fuels the resurgence and spread of diseases. In Haiti, gang violence in 2022 obstructed water tankers from reaching communities, forcing residents to rely on unsafe water sources. Climate change, including storms and floods, disrupts access to healthcare and facilitates the spread of diseases. Poverty contributes to inequity, compounded by a lack of political will—all manifestations of structural violence.
Pneumonia and other respiratory diseases rarely cause deaths in affluent countries, yet they rank among the top five causes of death in poorer nations. Most of these deaths could be prevented through vaccination and timely interventions with drugs and oxygen as needed.
Addressing intersectional issues and social determinants of health—such as the circumstances in which individuals are born, raised, and age—requires a focus on the political structures influencing these factors. While the emphasis has often been on changing individual behavior, it is crucial to address the underlying forces driving these behaviors, such as the choice between purchasing soap for handwashing or food.
Should doctors engage in social medicine? This raises questions about whether it dilutes technical training or increases political involvement in medicine. When engaging with individuals, it is essential to provide not just information but also resources, such as soap and clean water, rather than merely advising them to wash their hands.
To improve global health issues, we must:
- Address health system gaps
- Enhance community health
- Engage with affected populations
We must reject the status quo; this work is our responsibility. Health policies should address social determinants of ill health, prioritize community health systems, invest in research, and demand accountability from all stakeholders, including ourselves. New models of service delivery must be created.
Equity means not providing the same resources to everyone, but rather giving each individual what they need. For instance, consider the example of bicycles for those who need them.
Global health is not about voluntarism; knowledge and talent are distributed globally, but power and resources are not. Partnerships and programs in global health should seek to harness talent wherever it exists, sharing knowledge, resources, and power. Global health initiatives should transcend national boundaries, be multidisciplinary, and foster a sense of global solidarity.
Dying from inequality is both unnecessary and preventable.
The Head of the Department, Dr. Grace Kansiime, expressed gratitude to Professor Louise C. Ivers for her insightful lecture, emphasizing the importance of recognizing social structures and structural violence. “We sometimes forget what our community members go through, and it is our responsibility as health professionals to acknowledge these social structures, ensuring that our patients feel appreciated regardless of their conditions,” she stated.
The Dean of the Faculty of Medicine, Associate Professor Joseph Ngonzi, thanked Professor Ivers for her support and commitment to the faculty. He stated that her lecture was yet another demonstration of her dedication to serving the Faculty of Medicine and MUST. “Words cannot express our gratitude as a Faculty and a University. Thank you, thank you, thank you!”
