Data is power. In health care, most of that power comes from research, who is studied, and which questions we ask. Globally, the under-representation of specific populations in medical research — particularly those from low- and middle-income countries like South Africa — is driving inequities in health and holding back progress.
Today, 84% of the world’s population live in low- and middle-income countries and most of those people — nine out of 10 people — don’t have access to safe, affordable and timely surgical care. We are facing a global shortage of 15 million healthcare workers by 2030, which represents a shortfall of nearly 143 million surgeries a year.
Even non-surgical interventions, such as the Covid-19 vaccine, a great triumph of modern medicine, have followed the well-trod pattern of deep global inequality — the African continent is just 16.9% fully vaccinated.
Without an intentional shift in how we do research and approach health care needs, this inequity will continue to persist and put those in low- and middle-income countries at a deeper disadvantage.
Developing contextually appropriate solutions
It is imperative to develop contextually appropriate solutions to ensure everyone has equal access to healthcare. With health infrastructure, technology and genetic studies based almost entirely in wealthy nations, today’s researchers and clinicians are given incentives to focus on problems and diseases prevalent in high-income areas.
This means research is focused disproportionately on people with European ancestry. From a research and clinical standpoint, the lack of genetic diversity in databases has severe implications in patient care globally, because genetic advancements are based on such a small subset of the world’s population.
Researchers with the nonprofit medical organisation Operation Smile have created the most diverse database of genetic samples of patients with cleft conditions and matched controls in low- and middle-income countries, which is unearthing breakthrough risk factors of disease. The aim is that these findings will be used to prevent congenital conditions before they develop in the womb and in children who are at high risk of living with the disease. Progress is made when research and resources are directed to areas that need them most.
There are more ways to narrow these inequities in research and surgical care around the world.
First, let’s drive research and development to develop fast, affordable, and reliable digital health solutions that are functional in low-resource settings. Telemedicine has saved millions of lives worldwide.
Second, we need to expand genetic research to vulnerable populations so that they are part of our understanding of human genetics and not an afterthought.
This is more complex because of the expensive high-tech machines and resources required, and collaboration is also needed between the public and private sectors, as well as the robust support of the philanthropic, academic, tech and venture sectors.
Third, we need to expand educational opportunities to build the next generation of surgeons, nurses, doctors, researchers and medical assistants worldwide. With a global shortage of nearly 2.2 million surgeons, anaesthetists and obstetricians, this is a critical step to achieving global health equity. This will require the development of context-appropriate and innovative education methods — we cannot simply use the model and scale of high-income countries.
Empowering women to revolutionise health innovation
Last, let’s make this the decade that women rise in global health. Although women form the majority in medical schools, particularly in South Africa, and make up 70% of health sector workers, this does not translate to the surgical specialties or to leadership positions in the healthcare sector, which are still male-dominated. Women hold just 25% of senior roles in health institutions.
More women in medicine — particularly in positions of leadership — will create prosperity, empower women, and close the surgeon shortage.
To empower women, we need more initiatives that offer opportunities for leadership and career development.
This inclusion could launch a revolution in health innovation. When you have well-represented communities at the table, you make decisions and cultivate ideas that will serve a wider variety of settings, individuals, and realities. In Morocco, a local researcher shared with us a potential cause of cleft conditions that is rarely studied but potentially affects thousands. This is something that is only present in certain regions of the world, and we only know because she had a seat at the table.
Health equity then isn’t just a boon for the nations lacking access. It’s how we expand our understanding of health, genetics and risks globally — and solve them together.
Digital technology. Medical innovation. Education and opportunities. Understanding those in need through quality and diversity in research. This is the model for a global health system that is equitable, dynamic and, most of all, effective.
Dr Allyn Auslander is the associate vice-president of research for Operation Smile, an international NGO that provides free cleft lip and palate surgery. Dr Priyanka Naidu is a global surgery fellow at Operation Smile, a doctor and an aspiring paediatric reconstructive surgeon from Cape Town