Filling the breach: academia's opportunity to reduce disparities
Authors: Keith Martin, Zoë Mullan, Richard Horton
Journal: The Lancet Global Health (2018)

A destabilising force, and an anchor on our ability to achieve the Sustainable Development Goals, extreme inequality is tearing at the fabric of societies worldwide. The picture is staggering: the world's richest 85 people own as much wealth as the bottom half of the global population. According to a recent Credit Suisse Report,1Credit Suisse Research InstituteGlobal wealth report.https://www.credit-suisse.com/corporate/en/research/research-institute/global-wealth-report.htmlDate: 2017Google Scholar the richest 1% owns over 50% of the world's wealth (up from 42·5% in 2008), with the ultra-wealthy cohort (those with a net worth of US$50 million or more) growing the fastest. This concentration of wealth warps politics, conferring inordinate power on the affluent to influence public investments, tax, and regulatory policies to their advantage, worsening inequalities in access to quality education, health care, housing, child care, family planning, legal services, housing, sanitation, electricity, and more. Dangerously, it has created extreme inequalities in opportunity and economic mobility in most countries.2Stiglitz J Inequality and unearned income kills the economy.http://evonomics.com/joseph-stiglitz-inequality-unearned-income/Google Scholar Cutting across race, gender, region, and religion, this is a powerful economic and geopolitical force that, according to the World Inequality Report 2018, "has increased in nearly all world regions in recent decades", and particularly so in North America, China, India, and Russia.3World Inequality LabWorld inequality report 2018.http://wir2018.wid.worldGoogle Scholar Given its corrosive effects, one would think that governments would make gross inequality a top priority. Alas, such is not the case. Where inequality is highest, governments pay little attention to it, or at worst, exacerbate it. Witness the USA, site of the Consortium of Universities for Global Health's (CUGH) 2018 conference on health disparities. The world's richest nation, the USA has a Gini index of 0·48—the highest level of inequality it has faced since the Great Depression and the worst of any highly developed nation. It is on par with a list of deeply unstable countries, and the situation is getting worse.4The LancetAmerica: all things not being equal.Lancet. 2017; 389: 1369Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar The drivers of this deepening rift? According to the World Inequality Report, "income inequality observed in the US is largely due to massive educational inequalities, combined with a tax system that grew less progressive".3World Inequality LabWorld inequality report 2018.http://wir2018.wid.worldGoogle Scholar Witness the ruling Republican party's latest federal budget: a massive shift in wealth from the poor to the rich and a weakening of support for public goods such as the Affordable Care Act, food stamps, environmental protection, and more. Political inaction in the face of widening disparities in income inequality, opportunity, and social mobility has left an opportunity for academia to fill. Consistent with their tripartite mandate of research, education, and service, universities can address these challenges within their communities and internationally by addressing the social determinants of health. For example, final year students, graduate students, and residents could provide free services under faculty supervision to low-income communities across medicine, nursing, dentistry, law, education, and veterinary care. Graduate students and junior faculty could visit and share their work with primary and secondary schools. High school classes could be invited into universities to witness first-hand a world they may never have considered as a possibility in their lives. Internationally, many universities in high-income countries (HICs) have relationships with institutions in low-income countries (LICs) whereby (typically) HIC faculty and students gain extraordinary research and experiential training opportunities in LICs. Some benefits may accrue to the resource-poor institution, but, in practice, the high-income institution receives the lion's share of the benefits.5Mehanni S The one-way mirror of global health training.http://globalhealth.thelancet.com/2017/11/17/one-way-mirror-global-health-trainingGoogle Scholar This situation must change. HIC institutions should send faculty along with their students to supervise them and provide training and services as requested by the host institution. They should provide the LIC institution with free online access to their libraries, curricula, and courses. And they should offer LIC students and faculty context-relevant, hands-on experiences in return, with sponsored and facilitated travel and subsistence, while being mindful of the potential for such experiences to lure students away from countries that desperately need health workers. CUGH's annual conferences seek to educate, inform, inspire, and motivate the scientific community to be ever more impactful and politically active. In this age of a "substantial and growing amount of public disagreement about basic scientific facts",6van der Linden S Lewandowsky S How to combat distrust of science.https://www.scientificamerican.com/article/how-to-combat-distrust-of-science/Google Scholar where bogus ideas are gaining a frightening degree of traction and too many politicians foment social discord by manipulating people's fears for their own short-term political gain, a stronger public voice from academia is needed now more than ever. CUGH's 2018 conference in New York City will do this across eight subthemes, 600 abstracts, 17 satellite sessions (including a scientific writing workshop targeted at researchers from LICs by The Lancet Global Health's Editor, Zoë Mullan), and its annual global health film festival with the Pulitzer Center. This conference, like all, is a moment in time. But it is a challenge to the global health community to use its capabilities, assets, and voice to fill the breach left by dysfunctional political leaders and focus on improving the health of people and the planet to create a more equitable, sustainable world for all. Keith Martin is the Executive Director of the Consortium of Universities for Global Health. Zoë Mullan is Editor of The Lancet Global Health. Richard Horton is Editor of The Lancet.