The Role of Advocacy in Addressing Health Inequities

The COVID-19 pandemic has both exposed and exacerbated inequities in public health. Locally-led advocacy, by individuals and communities affected by the policies under consideration, is the only way to ensure that health systems are strong, sustainable and accountable to the people they are meant to serve and represent.

On November 4, the Global Health Advocacy Incubator (GHAI) hosted a panel of international experts at the Triangle Global Health Annual Conference to discuss challenges, successes and lessons learned in advocating for equitable health systems. The panel was moderated by Vandana Shah, Regional Director for South Asia Programs at GHAI.

Vanessa Manfre Garcia de Souza, a Technical Advisor at FIAN Brazil and a partner of GHAI’s food policy program, spoke about childhood nutrition as an issue of equity – all children deserve access to healthy, nutritious foods in order to reduce their risk of chronic health diseases later in life. The number of school-aged children and adolescents with obesity increased 1000% over the past four decades. In Brazil, more than a fifth of children are overweight or obese. In order to achieve health equity in school environments in Brazil, advocates are working to strengthen the national school feeding program to limit ultra-processed food, and to include locally grown products, which also supports efforts by small and local farmers to reduce the creation of food deserts that negatively impact low-income populations.

Radhika Khajuria, a Senior Policy Consultant at GHAI’s parent organization, the Campaign for Tobacco-Free Kids, spoke about how she works directly with a group of people in India who are suffering health inequalities at the hands of the tobacco industry. Radhika works with Bidi workers across five populous states of India. Bidi is hand-rolled tobacco that is the most widely smoked tobacco product in India. Bidi workers are largely women who come from the most marginalized and impoverished groups in India. Tobacco companies often uses bidi workers as a front group to humanize their industry. Through an empowerment-based model, bidi workers across five populous states of India have been systematically sensitized about the health harms of bidi—harms that have been exacerbated by the COVID- 19 pandemic, which has worsened their existing health vulnerability. The bidi workers who received this support have conducted their own advocacy to governments for safer and healthier alternate livelihoods.

In Ecuador, Paola Carvajal, Director of Fundación Ciudadana and a partner of GHAI’s road safety program, is fighting for a key equity issue: road safety. Many of the victims of crashes are not the drivers—they include pedestrians and passengers, such as infants without car seats or children walking to school. Road traffic crashes are a leading cause of death for young people worldwide, and the leading cause of death for young people 15–29 years old. Tariffs on imported child restraint systems and motorcycle helmets impede affordability and access to life-saving equipment. Paola spoke about the importance of applying research to training and awareness courses for road safety and mobility. The efforts of Fundación Ciudadana and their coalition paid off when Ecuador’s National Assembly passed a new national Transit Bill in April containing key road safety measures, including speed reduction and helmet use—measures demonstrated to reduce injuries and save lives. This will also have a far reaching impact on reducing disparities from road safety accidents.

The global health response to the inequities exacerbated by the COVID-19 pandemic must focus on equity, and equity requires advocacy: ensuring that people affected by policies, including those impacted by being excluded in the first place, are able to make their voices heard effectively and in places where they will make an impact.

Watch the full panel discussion: