In recent weeks, the University of Ottawa’s Dr. Ronald Labonté and co-author Dr. Arne Ruckert - both members of the Faculty of Medicine - were lauded for their book providing a comprehensive view on key issues in global health equity. Their Health Equity in a Globalizing Era: Past Challenges, Future Prospects was chosen as the “Medical Book of the Year 2021” and public health category winner by the British Medical Association, one of the most influential medical bodies in the U.K.
As the world gradually emerges from the COVID-19 pandemic, Dr. Labonté, professor in the School of Epidemiology and Public Health at the Faculty of Medicine and a former Canada Research Chair, says new policies are urgently needed to address multiple health crises, accelerating inequalities and climate change. In the conversation below, Dr. Labonté shares his thoughts on these challenges and what’s next.
What are the most important things the ongoing pandemic has revealed about the structures of global health—and our vulnerabilities?
For the past two decades or more we’ve embraced the idea that the health of people in any one country is strongly connected to the health of others who may live in distant nations. The globalization of our economic interdependencies has made all of us more vulnerable to the rapid spread of pathogens and invasive species unfamiliar with the concept of borders, and of the socioeconomic disruptions they often precipitate, all bearing increased health risks.
We reiterated this idea in the pandemic’s early days with government leaders claiming repeatedly: “We’re all in this together,” and “No one is safe until everyone is safe.” But as soon as a remedy was at hand—vaccines—the rich world quickly hoarded almost all the supply for their own citizens. Any pretence of global cooperation was promptly sacrificed on the altar of nationalist self-interest.
You and your co-author draw attention to three health equity issues facing humanity. Can you briefly outline these three issues?
Prior to the pandemic, the world was already facing what we described in our book’s final chapter as “existential crises,” existential in the sense that our very survival rests upon resolving them. The first crisis was the explosive growth and scale of income and wealth inequalities. In relative terms there was some improvement in income growth for the world’s poorest over the past few decades, due largely to the outsourcing of manufacturing and some services from high- to lower-income countries. But in absolute terms it was the cliché 1 percent (more importantly, the 0.1 percent or fewer) of the world’s population that appropriated most of those income gains.
The second crisis was the imminent collapse of many of the fundamental ecosystems on which human life depends, climate change and biodiversity loss being the most immediate and obvious ones. Setting aside the enormous and long-term risks of toxic pollution, each year we—particularly those of us in the richer world—consume far more in ecological resources than the Earth can replenish. Those in the poorer world face the devastating consequences: drought, conflict, grinding poverty, increased infectious diseases as transmission vectors expand, and a rise in chronic diseases as transnational corporations shift diets away from traditional sources to ultra-processed and obesogenic “foods.”
The combination of these two twinned crises becomes fuel to the third: the mass movement of peoples in poorer regions of the world who flee poverty, conflict and ecosystem collapse only to be met by the increased and authoritarian militarization of the borders of those wealthier nations in which they seek refuge.
Are these inequities only accelerating?
Unfortunately, yes. Billionaire wealth almost tripled in the past year alone while 150 million more people are expected to fall back into extreme poverty—itself a woefully inadequate measure of what it actually means to be “poor.” That a few could become so much wealthier when so many more become much poorer is, ironically, partly a result of the huge infusion of government monies by a handful of wealthier countries, including Canada, into pandemic relief.
As for our planetary health, at the nadir of the pandemic many of us were in awe of the sudden clarity of our skies and the freshness of our air, as our industrial economies went into temporary lockdown. It was a short-lived reprieve, with greenhouse gas emissions on target to have increased in 2021 over 2020 and 2019 levels. We are now only a few years away from a climate change tipping point.
What’s one big change within the globalized economy that should be embraced urgently to significantly chip away at disease burdens and other stark global health inequities?
Living within our ecosystem limits and ensuring a just allocation of the material resources needed for a healthy life globally.
What do you think will it take for the aspirational goal of “health for all” to be achieved in the coming decades?
Fundamentally, we need to transform our centuries-old model of capitalism, whether we describe it as market-liberal, neo-liberal, state-capitalist or social democratic. Capitalism may have done us (or at least some of us) very well in the past, but it rests upon a fatal premise: that the only way for an economy to sustain itself is to grow endlessly.
The new economic bottom line is simply this: we must consume less.
Whatever hybrid or imperfect post-growth economy we do manage to create, it will be the one means that might actually achieve the aspirational goal of “health for all.”