Since 1954, the WHO has commemorated its founding with the World Health Day, highlighting a different subject connected to health each year. This year, they are focusing on “Building a fairer, healthier world”. Although health is a human right, not everyone has the same opportunities for a healthy life and good medical care. On the contrary, almost half of the people still do not have access to vital health services or cannot afford them, as reported by the United Nations. In this blog post, we’d like to take a closer look at the issue of health inequality and, of course, take a look at Ghana and the health care system that prevails there.
The right to health is enshrined in Article 12 of the United Nations „International Covenant on Economic, Social and Cultural Rights“ (ICESCR), which came into force in 1976. By signing the Covenant, member states not only recognized that everyone has a right to mental and physical health, but also committed to promoting certain measures to improve the overall health situation. These include, for example, ensuring the availability of medical care, improving environmental and workplace hygiene regulations, and reducing the number of child mortality through cost coverage and preventive examinations.
In Germany, these measures have been implemented for the most part. The infant mortality rate in this country is now only 0.3 percent, average life expectancy is above 80 years and around 99.9 percent of Germans have health insurance. From a global perspective, this puts Germany in a pretty good position. Unfortunately, “universal healthcare” – which means essential medical care for little or no money – is still far from being available everywhere. As the WHO reported only recently, there are still around 100 million people worldwide who are forced into extreme poverty due to healthcare expenses for sometimes the most basic treatments. This means that they are left with less than 1.9 US dollars a day to live on.
Marginalized groups are particularly at risk
The situation is not quite as drastic in Germany. However, there are still many people in our country who are severely disadvantaged in terms of health and medical care. For example, people in Germany who are affected by poverty,have a life expectancy that is up to ten years shorter and a risk of illness that is twice as high. Around one fifth of Germans were affected by these factors before the Corona pandemic. With the poor economic situation due to Covid-19 these numbers are likely to increase.
Marginalized groups in Germany – and thus often disadvantaged in terms of health – also include Sinti and Roma, refugees, people without a permanent residence or migrant workers. Poor housing conditions, poverty, language barriers or unsanitary working conditions are just some of the many factors that these groups have to contend with. According to the Robert Koch Institute, many of these people are particularly hard hit by the Corona pandemic. In 2020, for example, an increased outbreak of Corona could be recorded among people of these groups. In addition, many hospitals reported extremely high numbers of migrants in intensive care units in relation to people without a migration background.
In other countries in the Global North, marginalized groups are also affected by inequalities and even discrimination in health care. For example, in the U.S., African Americans, Hispanic Americans, and Native Americans more often lack health insurance, suffer more chronic diseases, and have much higher infant mortality rates compared to white Americans. Many disparities are also evident with respect to Covid-19. While vaccination rates are much lower among marginalized groups, mortality rates are much higher. Specifically: Black Americans are on average 3.6 times more likely to die of Covid-19 than white people, and in some age groups even up to nine times more likely!
As we can see, health and medical care are unfortunately not a given for everyone, even in Germany and other relatively rich countries like the United States. Often people who are already affected by discrimination are excluded from our health care systems or at least disadvantaged by them.
What is the situation in Ghana?
Finally, we want to take a look at the health care situation in Ghana, the home country of our chocolate production. We asked our colleague Karen from Accra how the health system works there, and she told us: “In general, health care in Ghana is not accessible for many people, especially in rural areas, as most health care facilities are located in the cities. In addition, there used to be only the “cash and carry” system, which meant that you could only get the treatment you needed after paying for it.”
In 2003, therefore, the National Health Insurance Scheme (NHIS) was introduced in Ghana to ensure access to basic health care for all residents. This includes treatment for common diseases such as malaria or appendicitis, prenatal care, emergency care in the event of accidents and the supply of common medicines. However, many medical services, such as organ transplants, prostheses, HIV medications or even simple visual aids in the form of glasses, are not covered by this.
29 million Ghanaians depend on only 55 ambulances across all ten regions, which means that 1 ambulance has to take care of 50,000 persons. In addition, many people are still not registered in the system or are unable to receive treatment due to overburdened health facilities. As Karen tells us, public hospitals in particular are under immense pressure. “Unfortunately, most of the clinics do not have enough doctors to take care of everyone. Patients often have to wait in lines for hours for their turn, enduring their pain for so long without any medication.” Private facilities would be a different story, but most people in Ghana cannot afford them, and they are not covered by the NHIS either.
What about health care at fairafric?
In order to offer our employees in Ghana a safe and healthy working environment, they all receive free health care. Necessary treatments do not have to be postponed due to financial worries, and our employees can also visit private facilities. As one of our co-workers says: “Before I worked at fairafric, I always had to wait in long lines at the hospital to get the treatment I needed, and sometimes I didn’t get treated at all. Working at fairafric has given me the convenience and ease of receiving medical care whenever I am sick. I get the prescribed treatment and don’t have to worry about spending hours in front of doctors’ offices or risk my health for money reasons.”
Easy and, more importantly, free access to health care is still not a given for many people. They either live in countries where there is no universal health care at all, are disadvantaged when it comes to treatment because of their origin, religion or skin color, or cannot afford the treatments they need in the first place. The reasons for health inequality are countless. This is the case despite the fact that health is actually a human right and should be equally available to all.
Therefore it is all the more important for companies and each one of us to work together to ensure that health is no longer a privilege. Through proper health insurance, policy reform and systematic action against discrimination and exclusion, we can make a big difference – and actually build a fairer, healthier world.