Our global public health system is only as good as its weakest link

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I have always thought that if there is a god, she must have a deep sense of irony.

COVID-19 showcases that. We know that as individuals we must “shelter in place” and step back to keep ourselves safe. Yet at the same time, we as a community need to step forward to keep others safe, including people who we do not know and may never meet. Science tells us that. Economics tell us that. And values, ethics and morality tell us that.

But will we?

The health of someone working in a food market in a faraway place can devastate the whole world. A stranger’s health risk is our health risk. It was always so – and is now on display clearly. Our global public health system is only as good as the weakest link.

And the weakest links are shockingly weak. More than 50 per cent of the world’s rural population and 20 per cent of the urban population lack institutional healthcare. More than 2.2 billion people lack access to safely managed drinking water and 4.2 billion lack access to safely managed sanitation – the first lines of defence against disease.

One million people live in the catchment area pooling into Kiwoko Hospital in rural Uganda, where Adara has been working for more than two decades. Close to 10 per cent are HIV positive. An incredible army of 400 clinicians and health workers are preparing for COVID-19 with no mechanical ventilation, limited supplemental oxygen, limited personal protective equipment (PPE), and no proper isolation facilities.

They step forward to face the firestorm that is coming armed with soap and courage, and a lifetime of commitment to serving the poor. In Uganda, there is one intensive care bed per million people – compared with 89 beds per million in Australia.

We find ourselves in a world not just with enormous wealth and income inequality, but with even greater disparities in access to healthcare. When COVID-19 came, the mighty door of the global economy slammed shut, almost without notice. The music stopped. Our neglect of the vulnerable now amplifies the risks of COVID-19 to all of us. If we’re going to stitch back together global supply chains, we need to address growing inequality.