Inequity in Low- and Middle-Income Countries and the Colonial History of Public Health

  • Mbuso Precious Mabuza


The political power and influence of the medical model and issues of ethnicity and socio-economic status continue to influence current attitudes to and practices in public health programmes and contribute to continuing health inequalities and inequities in low- and middle-income countries. Poverty is a major public health issue in many low- and middle-income countries and the inequalities and inequities that exacerbate it. The gap between the rich and the poor still gets wider and wider all the time and deepens the inequalities. Unlike the rich, those who live in poverty continue to bear the brunt of poor health and discrimination. A potential solution to address poverty is to have the highest calibre of political leadership that will show commitment and vision to meaningfully and sustainably address the issue of poverty. This chapter gives a critical overview on the following topics: Historical influence on current policies and practices in public health; Poverty as a public health issue; Impact of inequalities and inequities in public health.


Colonial history of public health Ethnicity in public health Inequality Inequity Medical model Political power in public health Poverty Socioeconomic status in public health 


  1. Backman, G., Hunt, P., Khosla, R., Jaramillo-Strouss, C., Fikre, B. M., Rumble, C., Pevalin, D., Paez, D. A., Pineda, M. A., Frisancho, A., Tarco, D., Motlagh, M., Karcasanu, D., & Vladescu, C. (2008). Health systems and the right to health: An assessment of 194 countries. The Lancet, 372(9655), 2047–2085.CrossRefGoogle Scholar
  2. Birn, A., Pillay, Y., & Holtz, T. H. (2009). Textbook of international health: Global health in a dynamic world. New York: Oxford.Google Scholar
  3. Chopra, M., Lawn, J. E., Sanders, D., Barron, P., Abdool-Karim, S. S., Bradshaw, D., Jewkes, R., Karim, Q., Flisher, A. J., Mayosi, B. M., Tollman, S. M., Churchyard, G. J., & Coovadia, H. (2009). Achieving the health millennium development goals for South Africa: Challenges and priorities. The Lancet, 374(9694), 1023–1031.CrossRefGoogle Scholar
  4. Coovadia, H., Jewkes, R., Barron, P., Sanders, D., & McIntyre, D. (2009). The health and health system of South Africa: Historical roots of current public health challenges. The Lancet, 374(9692), 817–834.CrossRefGoogle Scholar
  5. Dennill, K., & Vasuthevan, S. (2005). The health of southern Africa. Cape Town: Juta.Google Scholar
  6. Merson, M. E., Black, R. E., & Mills, A. J. (2012). Global health: Diseases, programs, systems, and policies. London: Jones & Bartlett.Google Scholar
  7. Naidoo, J., & Wills, J. (2009). Foundations for health promotion. London: Elsevier.Google Scholar
  8. Scambler, G. (2008). Sociology as applied to medicine. London: Elsevier.Google Scholar
  9. Sewankambo, N. K., & Katamba, A. (2009). Health systems in Africa: Learning from South Africa. The Lancet, 374(9694), 957–959.CrossRefGoogle Scholar
  10. Walley, J., & Wright, J. (2010). Public health: An action guide to improving health. New York: Oxford.CrossRefGoogle Scholar
  11. White, A., Richardson, L. C., Kronitras, H., & Pisu, M. (2013). Socioeconomic disparities in breast cancer treatment among older women. Journal of Women’s Health, 0(0), 1–7.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Mbuso Precious Mabuza
    • 1
  1. 1.Johns Hopkins UniversityBaltimoreUSA

Personalised recommendations