At the 20th Extraordinary Session of the Assembly of the African Union in Accra this month, heads of state took up a question that the continent's health debate has circled for years without settling: why does Africa keep spending on disease and still lose ground on health?
The answer is not primarily clinical. It is structural.
Health equity is not achieved by the health sector alone. It is shaped by the conditions in which people are born, grow, learn, work, live and age - and by the public choices that determine whether those conditions protect life or reproduce vulnerability. The evidence on this is no longer contested. Social determinants can shorten healthy life expectancy by decades. The gap in life expectancy between countries runs as wide as 33 years. Children born in poorer countries are 13 times more likely to die before their fifth birthday than children in wealthier ones. Eliminating wealth-related inequality within low- and middle-income countries could save an estimated 1.8 million children every year.
Those figures describe a produced outcome, not an accident. Health inequity emerges where access to quality education is limited, literacy is low, nutrition is inadequate, housing is unsafe, water and sanitation are unreliable, livelihoods are insecure, transport is unavailable, and essential services are too distant or too costly.
Originally published by African Business.