5: Global Health Disparities

Global Health, Inequality, and Power

Two babies are born at almost exactly the same moment.

One enters the world in a place with clean drinking water, prenatal care, reliable electricity, functioning hospitals, vaccines, safe housing, and doctors who can prescribe medicines that will probably be available when they are needed.

The other does not.

Neither baby chose a country, an income level, a neighborhood, a health system, a passport, a climate, or a government. Yet those circumstances can shape what diseases they encounter, whether treatment exists, how quickly care reaches them, and ultimately how long they are likely to live.

That is where global health begins.

Health is biological, but it is never only biological. Viruses do not check passports, but health systems do have borders. Diseases may spread through bodies, yet vulnerability is shaped by housing, labor, income, gender, race, colonial history, environmental exposure, political decisions, access to technology, and the distribution of resources. Who becomes sick and who survives are therefore medical questions—but they are also economic, political, historical, cultural, and ethical ones.

In 2025, the World Health Organization reported that the difference in average life expectancy between the countries with the highest and lowest life expectancies was approximately 33 years. Within individual countries, health outcomes can also vary dramatically according to income, education, race and ethnicity, disability, gender, geography, housing, and working conditions (World Health Organization [WHO], 2025a).

Thirty-three years.

That is not a minor statistical variation.

It is nearly a generation.

Global health therefore asks us to look beyond hospitals and medicines toward what public-health scholars call the social determinants of health: the conditions in which people are born, grow, live, work, and age, along with the wider political and economic systems that distribute power, money, resources, risk, and opportunity (Solar & Irwin, 2010; WHO, 2025a).

It also forces us into some uncomfortable questions. Why do diseases that are preventable still kill millions of people? Why can a lifesaving medicine exist and still remain inaccessible? Why are some illnesses treated as global emergencies while others remain largely invisible? Who decides which diseases receive research funding? Why does where you are born have so much influence over how long you are likely to live? And when a health crisis crosses borders, who is responsible for protecting whom?

These questions became impossible to ignore during COVID-19. The same virus circulated through an interconnected world, yet people did not encounter the pandemic on equal terms. Some could work from home; others could not. Some countries purchased enormous vaccine supplies before others obtained first doses. Some workers were praised as “essential” while remaining poorly paid and heavily exposed. Technology accelerated vaccine development while misinformation traveled through many of the same global networks.

COVID-19 did not invent global health inequality. It made existing inequality unusually visible. Long before COVID-19, colonialism, trade, war, migration, urbanization, environmental change, labor systems, pharmaceutical markets, sanitation infrastructure, and global institutions had already shaped who was exposed to disease and who had access to protection. Anthropologist and physician Paul Farmer (2004) described this relationship through the idea of structural violence: suffering can be produced not only by direct acts of violence but also by political and economic arrangements that systematically expose some populations to greater risk while limiting their access to resources and care. This chapter therefore treats health as a Global Studies problem.

We will move from bodies to borders, from pathogens to politics, and from hospitals to history. We will examine epidemics, but also the quieter forces that determine health long before anyone enters a clinic. We will explore colonial medicine and global institutions; poverty and inequality; pharmaceutical markets and intellectual property; COVID-19 and vaccine distribution; chronic disease and maternal mortality; climate change, zoonotic disease, and planetary health. Most importantly, we will keep asking the question that sits underneath all of them: If health is shaped by global systems, who has the power and the responsibility to make those systems healthier?

The Global Studies Lens

Throughout this chapter, keep returning to the same lenses we have used elsewhere in the book. History asks how present health patterns developed. Economics asks who can afford prevention and treatment and who profits from health-related goods and services. Politics asks who sets priorities, allocates resources, and writes the rules. Culture asks how belief, stigma, trust, identity, and knowledge influence health behavior. Society asks which groups experience greater exposure, vulnerability, or barriers to care. The environment asks how climate, pollution, housing, water, food systems, and ecological change shape human bodies. A disease may begin in a body. Understanding why it spreads, who suffers most, and who survives usually requires looking much farther.