Health Inequalities in Crisis Times: Questions for Global Health Governance.

Health inequalities continue to blight populations creating a global social justice challenge. Despite continued action by policy makers and practitioners, they are recurrent and stubborn, with evidence of exacerbation in many territories. Driven by extractive, capitalist economic and political logics that have organised societies with systemic power imbalances, inequalities are so entrenched they appear ahistorical. Recent global crisis of disease, finance and conflict have intensified challenges, with outcomes worst for those with the least power and resources. Impacts are compounded where inequalities are structural and systemic, for example the result of institutionalised racism, unevenly distributed wealth and employment opportunities, lack of availability of suitable housing and food or limited access to education. Understanding health inequalities as dynamic, the outcome of complex ecologies and interactions as well as their historical antecedents and determinants is vital for public health research and practice. The differential impact of COVID-19 on populations has illuminated this, leading researchers to reframe the pandemic as syndemic. Such analysis is imperative both for immediate crisis response and future health protection planning and strategy. Our discussion highlights how historic and systemic inequalities shape contemporary population health, constructing stubborn barriers to social justice, an effect heightened during times of crisis like the COVID-19 syndemic. What is to be done to ameliorate their impact on the most vulnerable remains a vital question.