Coronavirus (680) The Lancet: Has COVID-19 subverted global health?

29 May, 2020

This is a compelling perspective on the importance of context, social justice and equity in evidence-informed policymaking, from HIFA member Vikram Patel and Richard Cash.

Citation and selected extracts below.

CITATION: Has COVID-19 subverted global health?

Richard Cash, Vikram Patel

The Lancet; volume 395, issue 10238, p1687-1688, may 30, 2020

Published: May 05, 2020




The usual formula of dispensing guidance continues to be played out, with policies deemed necessary for the hardest-hit wealthy countries becoming a one-size-fits-all message for all countries. Two centrepieces of this approach are the use of widespread lockdowns... and a focus on sophisticated tertiary hospital care and technological solutions. We question the appropriateness of these particular strategies for less-resourced countries with distinct population structures, vastly different public health needs, immensely fewer health-care resources, less participatory governance, massive within-country inequities, and fragile economies. We argue that these strategies might subvert two core principles of global health: that context matters and that social justice and equity are paramount.

Lockdowns have been enforced with an increase in authoritarian behaviour of the police with the poor experiencing brutality and humiliation in countries such as India, Nigeria, Kenya, and South Africa.

What then should these countries do, especially as some of them begin to ease lockdown restrictions? Realistically, a community-based approach is needed that emphasises active case finding (through syndromic diagnosis where laboratory-confirmed diagnosis is not available) by community health workers and primary care providers, with contact tracing and home quarantining...

Central to our proposals are the engagement and participation of all sections of the community, especially the poor and marginalised, as a mature and responsible citizenry, invoking their solidarity to be part of a shared endeavour, rather than seeing the goal of containing COVID-19 as a purely technocratic or law-and-order problem...


Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: