How can health inequality be reduced?

This was the topic of the most recent episode of the Global Health Matters podcast with Dr. Garry Aslanyan.

Understanding Health Inequality

“Health inequity is produced by and within social relations that govern the production and exchange of concrete material things that we need to survive and flourish, to ensure well-being, like health,” explained guest Hani Kim, executive director of the Right Foundation in Seoul, Korea. “By material conditions, I mean how much we own and control various economic resources—resources that can produce things like money, land, credentials, and labour. What you own and how much of these resources you control critically determine what you have to do to get what you need to ensure your well-being.”

In other words, she explained, the relationships amongst different actors within global health—be it nations, non-governmental organisations, private philanthropies, or stakeholder groups within nations—are deeply embedded in a system that perpetuates inequalities of resources and power both amongst and within countries.

“These inequalities, along with material and power relations, have a profound impact on the strategies and directions that the field of global health employs to meet its goals,” Kim added.

The Role of Local Voices

Kim pointed out that global health efforts are often led by elites who impose solutions from above, assuming they have the best answers. This tendency normalises and universalises their perspectives at the cost of marginalising views that do not align with them.

She has made it a priority to invite and listen to partners from countries facing local health challenges. While she has seen some progress in this area, she emphasised that there is still a long way to go. Moreover, she cautioned that simply including local voices is not enough—it is essential to ensure they are truly representative, not just elites from their own communities.

“We live in a structure where inequalities of resources and power are so pervasive that even within these countries, the degree of inequality is immense. So, figuring out what the working classes and communities really want cannot be achieved simply by selecting a few so-called representatives,” Kim said. “The needs and wants of these communities are best expressed through movements and actions led by the members of those communities and working-class groups in their local context. This is inherently difficult to capture by simply selecting one or two representatives for forums, meetings, and conferences hosted by elites.”

Taking Action

Kim stressed that achieving change requires individuals to act within their own domains—whether as students, researchers, or professors—and to acknowledge their inherent limitations.

“Let us guard ourselves against the temptation to portray a world-view where what we can do, just because it is something we can do, is the most important or the best approach,” Kim added. “Solving health inequity is possible only when inequalities and material relations are addressed. And history teaches us that struggles for equality have been fought and won by the oppressed and exploited classes, not by elites.”

Building Sustainable Change

Another guest on the podcast, Seye Abimbola, an associate professor of health systems research at the University of Sydney’s School of Public Health, echoed much of what Kim said but added another critical perspective: many change efforts fail because people assume change will happen on its own.

“Change doesn’t just happen by accident or on autopilot,” Abimbola emphasised. “You have to build things, and be part of building structures that consistently do right by the people on whose behalf, with whom, and for whom we ought to be working.”

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Image Credits: TDR Global Health Matters.