Being a pandemic, the COVID-19 coronavirus threatens everyone around the world, regardless of national borders.

But this is not to say that all communities are equally vulnerable. Indeed, organizations like Oxfam have warned that people living in low- and middle-income countries, and those living in marginalized communities within high-income countries too, are especially vulnerable to the COVID-19 pandemic.

Even when there is not a global pandemic raging, people living in poverty are far too vulnerable to gaps in the global health care system. As recently as 2017, it was found that at least half the world’s population did not have access to essential health care services, according to the World Health Organization. Furthermore, health care expenses globally are so high that they push 100 million people into extreme poverty each year.

The reasons for this are often complex and interconnected — for instance, vaccines can be hard to access because of a lack of electricity for storing them safely, and people living in crowded slums are also likely to have little access to clean water and sanitation. But all must be addressed by Global Citizens in order to achieve the goal of quality health care for all.

Here are some of the biggest obstacles people living in poverty around the world face in accessing quality health care, and how this lack of health care can affect their lives.

1. Lack of Access to Vaccines

Scientists are working diligently on a coronavirus vaccine. Yet for millions of infants, vaccines that already exist are still out of reach. In 2018, nearly 20 million children, primarily in developing nations, did not receive routine vaccinations, according to the WHO.

Meanwhile, in 68 lower-income countries there are still more than 10 million children who have not received even a single vaccination, according to Anuradha Gupta, the deputy CEO of Gavi, the Vaccine Alliance. Some of the factors that might interfere with vaccination delivery are conflict, lack of investment in national immunization programs, and disease outbreaks, according to UNICEF.

Vaccines currently prevent 2 to 3 million deaths every year, according to UNICEF, but nevertheless, vaccine-preventable diseases can still cause devastation. In 2018, for example, an outbreak of measles killed over 140,000 people, mostly children under five, and with sub-Saharan Africa hit the hardest, according to the WHO.

“Immunization is a public health magic bullet — or as close to one as there can be,” Dr. Robin Nandy, chief of immunization at UNICEF, told the Telegraph. “It is a widely available, inexpensive intervention and it’s a real tragedy that we continue to see people suffer and die from preventable diseases.”

2. Lack of Access to Medication

Over 5 million people die every year from antibiotic-treatable diseases, according to Science Daily, with the majority of these in low- and middle-income countries. Worldwide, nearly 2 billion people cannot get basic medications, according to a report from the WHO.

In Africa, the prevalence of malaria, tuberculosis, and HIV-related illnesses — all of which are medically treatable — threatens health and livelihoods.

Organizations like the Global Fund to Fight AIDS, Tuberculosis, and Malaria are working to expand access to treatment options for people living with these diseases, but major financing gaps persist.

3. Poor Water and Sanitation

The COVID-19 pandemic has highlighted the critical role that hand-washing plays in ensuring quality health. Yet 3 billion people around the world do not have access to basic hand-washing facilities with soap and water at home, according to UNICEF. It is even estimated that one in six health care facilities around the world do not have functional toilets or hand-washing services.

Beyond hand-washing, over half of the global population, 4.2 billion people, do not have safe sanitation, according to UN Water, forcing people to defecate in the open, which can then contaminate drinking water. Globally, 2.2 billion people do not have steady, reliable access to clean drinking water, and 2 billion people use a drinking water source contaminated with feces, according to the WHO.

Water can also be contaminated by diseases from insects that live and breed in water. Diseases or illnesses that can be caused by contaminated water include diarrhoea, dysentery, hepatitis A, and polio.

Ensuring everyone in the world had access to clean water would dramatically improve global health outcomes.

4. Lack of Electricity

One in 10 people worldwide — nearly 800 million — still lack access to electricity, which makes it hard to receive health care. In low- and middle-income countries, “an estimated tens of thousands of health centers,” lack electricity, according to Sustainable Energy for all (SEforALL).

“I’ve seen how rural health clinics struggle to provide adequate health care in rural villages around the world,” said Robert Freling, the executive director of the Solar Electric Light Fund. “There’s no way to deliver babies at night, there’s no way to turn on a light, there’s no way to store vaccines and medicines because there’s no power for refrigeration.”

5. Crowded Living Conditions

Social distancing has entered the public consciousness as people stay in their homes in order to halt the spread of COVID-19. Yet being able to properly practice social distancing is a luxury. Over 1 billion people worldwide live in urban slum environments where housing is poor, according to the United Nations.

“Even before pandemics strike, such places erode the health of residents, causing and worsening ailments that include respiratory diseases,” wrote David Sanderson in the Conversation.

When describing attempting to stick to COVID-19 social distancing health measures, Jeetender Mahender, a sanitation worker in northern Mumbai, India, told CNN: "The lanes are so narrow that when we cross each other, we cannot do it without our shoulders rubbing against the other person. We all go outdoors to a common toilet and there are 20 families that live just near my small house.”

"We practically all live together. If one of us falls sick, we all will," he added.

6. Lack of Doctors

Over 40% of WHO member states have fewer than 10 medical doctors for every 10,000 people, and over 26% reportedly have fewer than three doctors for every 10,000 people, according to the WHO. That's compared to over 26 doctors per 10,000 people in the US, for example, and over 42 doctors per 10,000 people in Germany.

The global spectrum ranges from 84 doctors per 10,000 people in Cuba, to 0.14 in Tanzania, according to the WHO's latest data. 

Africa suffers disproportionately in this regard, with more than 22% of the world’s disease burden but only 3% of its health care workers.

One factor in this is what's referred to as “medical brain drain”, with doctors leaving low- and middle-income countries to practice in wealthy countries — particularly in the US and UK, according to an article published by the World Economic Forum — for reasons such as greater compensation and higher-quality living conditions.

One possibility for mitigating this, according to the report, could be for medical students from low- and middle-income countries to do their pre-clinical training and residency programs in their home countries, with funding assistance from countries such as the US and UK to support high-quality residency programs.

7. Lack of Health Care Facilities

For people living in rural communities, even just physically accessing health care facilities can be difficult. A 2015 report by the United Nations found that over half of the people living in rural communities do not have health care access.

The situation is especially pronounced in Africa, where 83% of people living in rural communities do not have access to health care. Yet health inequalities exist between rural and urban communities in lots of countries globally, for example, in the US. 

Researchers have found an inverse relationship between the time it takes to travel to health care facilities and the standard of health care in low-income countries, according to the Harvard Health Policy Review. In Ghana, according to studies cited in the report, reducing the distance between health care facilities and rural communities by half caused the use of medical services to double. 

What's more, even when health care facilities are built in rural communities, there are still logistical problems when it comes to ensuring that these facilities can be properly staffed, equipped, and financed.

8. Cost

Health care is expensive and, for the almost 8% of the world's workers and their families who live on less than $1.90 a day, that is a problem. 

The cost of health care services is one of the most telling factors in determining how well someone is be able to access quality health care, as noted in an article in the Harvard Health Policy Review.

As many as 90% of the people in low- and middle-income countries have to pay for their medication out of pocket, according to World Health Organization estimates. Meanwhile, 800 million people globally have to spend at least 10% of their household budgets on health care costs, according to the World Bank.

It's one of the ways that poverty can become a vicious cycle: living in poverty can make you more vulnerable to illness while reducing your chances of being able to access quality health care, and at the same time accessing that health care can drive you further into poverty. 

All around the world marginalized people are suffering disproportionately from the impacts of COVID-19. To put an end to the pandemic, we need to drive forward the effort to develop tests, treatments, and vaccines against the virus; and, vitally, ensure that these tools reach everyone, everywhere, equally.

Join the movement by taking action here to support our Global Goal: Unite for Our Future campaign, and call on world leaders to step up funding to support these efforts. You can read all of Global Citizen's COVID-19 coverage here.