Equitable access to care: a global challenge

One group that has suffered from inadequate access to care during the pandemic is young pregnant women, as examples from several places around the world show.

There are many examples of how pandemics, both the present one and those in the past, hit already vulnerable groups hard. Access to care is unfairly distributed, not only internationally but also at national level.

Mats Målqvist, Professor of Global Health, and Hannah Bradby, Professor of Sociology, are both associated with the interdisciplinary UUSI (Uppsala University Sustainability Initiatives) platform, established to strengthen the University’s research on sustainability issues. They are working in the UUSI Social Justice initiative – in one of the five focus areas – and define health as not only the absence of illness, but the universal right to reach one’s full potential.

Målqvist and Bradby are both investigating how we can achieve social justice in terms of health care and health.

“My primary research concern is how various types of inequality combined affect access to equitable care and care of the proper quality. Specifically, I’m looking at the implications of gender, ethnicity and migration status – including undocumented migrants,” Bradby says.

Målqvist’s research is along the same lines, but with more of a focus on how health care systems can work better.

“How can we do what we know is good? How are we to increase breastfeeding rates, for example? It’s all very much a matter of improving vulnerable groups’ scope for good health by giving them access to care, but also for health in terms of developing their potential,” he says.

Sharing our insights

Scientists from various fields, like Bradby and Målqvist, are getting together in the UUSI initiative.

“Every discipline has its own distinct insights, and we’ve got to share them. That’s why we need multi- and interdisciplinary research,” Bradby says.

In sociology, people discuss “sociological imagination”, the ability to visualise the society we want, so that we can build it. This involves researchers explaining their own work to other experts and sceptics, to arrive at a solution.

“Sitting alone in your office and writing the world’s best research article doesn’t cut it. What’s important is the process of working with others,” Bradby explains.

Målqvist agrees: “If I only speak to doctors and medical students, we’ll share the same opinion. The gain is bringing in outsiders and getting a different way of looking at things.”

Another vital means of making a difference with our research is reaching out with our knowledge to a wider audience.

“We’re working hard on having an ongoing dialogue with various stakeholders. In concrete terms, it can be about writing for non-experts,” Bradby says.

Research as an educational tool

Målqvist views research as an educational instrument, especially in undergraduate studies.

“Gathering ideas about global perspectives on medical and nursing education, for instance – that’s probably my contribution,” he says.

Having scope for reaching one’s full potential through equitable care is essential for several different reasons. One reason is so that we can create a sustainable society. When the health of all its members is as good as it can be, we also get a society that reaches its full potential.

“Given the gigantic challenges we face today in terms of the climate, we need a socially functional and efficient society capable of taking on this challenge as well,” he says.

It is easy to believe that here in egalitarian Sweden, we have a just system of health care that gives everyone the same chances. But here, too, the care sector is governed by the values and hierarchy characterising our society.

“Even with universal care, which we have in Sweden, there’s discrimination and invisible processes at various levels – not only individual, but structural. To have a sustainable society, we need to find out how these invisible processes work,” Bradby says.

Local best practice shows the way

One group that has suffered from inadequate access to care during the pandemic is young pregnant women, as examples from several places around the world show. One survey, in Nepal, reveals that pandemic-related restrictions have caused a rise in child mortality. Another study, conducted in Sierra Leone, shows that this group stayed away from health care facilities during the Ebola pandemic.

But can global conclusions be drawn from local best practice? Both Målqvist and Bradby answer in the affirmative.

“It depends on the research, of course, but to generate a meaningful discussion our research has got to identify examples of best practice,” Bradby says.

“What’s more, examples can show the future consequences of going in a specific direction. So they indicate major lessons for the global conversation,” Målqvist says.

To prevent the repercussions of pandemics from hitting young expectant mothers or other vulnerable groups in society hard, we need to transform the system from the bottom up.

“The COVID-19 pandemic has shown up the inequalities that already exist. These groups were disadvantaged before the pandemic too, so we can learn from this,” Bradby says.