Equity in Action: Transforming Access, Care in Underserved Regions

By Huiam Mubarak, MD, Director of Barrow Global Neurology, Assistant Director of Barrow Global, Assistant Professor of Neurology at Barrow Neurological Institute

What does it mean when a patient’s location can determine their neurological health outcome? Neurological disorders account for 9 million (95% uncertainty interval [UI] 8.8–9.4) deaths globally, making them the second leading cause of death after heart disease.1 Growing up in Sudan, I witnessed firsthand the challenges faced by my community. Even in Omdurman, currently the second most populous city in Sudan with over 2 million inhabitants, many relied on faith and home remedies rather than hospitals. This stemmed from mistrust of the medical community, lack of access, and financial struggles. Despite these barriers, my parents inspired me to dream big, ultimately supporting my journey to becoming a physician and neurologist.

Huiam Mubarak, MD, reviews imaging at Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa.

In sub-Saharan Africa (SSA), approximately 26 million people live in nations without neurologists, and 270 million people reside in countries with fewer than five neurologists nationwide.2 These statistics reflect a glaring global health disparity, highlighting the urgent need for equitable health care.2

Having the opportunity to contribute to meaningful change for my community is a responsibility I do not take lightly. Empowered by mentors, I strive to amplify the voices of those without platforms. My most transformative moments in medicine have occurred while serving underrepresented and under-resourced populations, for example the amazing mission trips to both Peru and Haiti. Now, as part of Barrow Global, the mission to achieve health equity and global collaboration has never been clearer. Language barriers, health literacy, financial burdens, transportation challenges, and cultural beliefs factor into every patient encounter. In an increasingly connected world, intentionality in addressing these challenges is paramount. The Human Brain Project represents the widespread support and interest in investing in and further developing the field on a global landscape.3

doctors racette and mubarak rounding on patients in south africa
Dr. Mubarak and Barrow Chair of Neurology Dr. Racette join Professor Andrew Mochan, head of the Division of Neurology at Wits University, to consult on patients at Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa.

The 2015 Global Burden of Disease (GBD) study introduced a broader measure of socioeconomic demographics through the Sociodemographic Index (SDI), offering valuable insights into health disparities.1 An aging population and the rise of non-communicable diseases (NCDs) further strain societies and health systems.1 Successful health promotion requires coordinated action across governments, health care sectors, NGOs, local authorities, and industries.4 For neurological diseases, this includes implementing enforceable policies like helmet laws to reduce traumatic brain injuries or regulating toxins such as manganese.4,5

Global inequities in neurological care—alongside the delayed diagnosis they cause—hamper essential early interventions and modifiable disease strategies, especially in low- and middle-income countries (LMICs). Specialized neurological or neurosurgical care remains unattainable in many LMICs, where personnel and resources are insufficient. Addressing these gaps aligns with the United Nations Sustainable Development Goals, emphasizing universal health coverage without financial hardship.4 More than half of the world’s population lacks essential health services, and low-income countries struggle with an aging health care workforce that is ill-equipped to meet increasing demands.6 Per 10,000 people, low-income countries have medians of 1.1 medical doctors, 7.5 nursing personnel, 0.04 dentists, and 0.2 pharmacists—starkly contrasted with high-income countries’ medians of 35.6, 76.8, 7.0, and 8.8, respectively.6 Neurology faces an even sharper disparity: 0.1 neurologists per 100,000 people in low-income countries versus 7.1 in high-income countries and 9.2 in Europe.7

“As a first-generation college student who navigated the U.S. system, I know the transformational power of representation. It means something when those who teach, research, and provide care reflect the histories, cultures, and personal experiences of their patients.”

-Huiam Mubarak, MD

The key to addressing these disparities lies in training, mentorship, and the development of future health care leaders. As a first-generation college student who navigated the U.S. system, I know the transformational power of representation. It means something when those who teach, research, and provide care reflect the histories, cultures, and personal experiences of their patients. My own success is a testimony to the value of mentorship and family support. These experiences drive my commitment to fostering opportunities for others.

Representation is crucial not only for fostering trust but for shaping the research and care patients receive. Training programs that prioritize mentorship, cultural competence, and equitable collaboration ensure that health care systems grow stronger and more inclusive. Investing in education and resources is not just an ethical obligation—it is the foundation for a healthier, more equitable global community.

  1. GBD 2016 Neurology Collaborators. (2019). The global burden of neurological disorders. The Lancet Neurology, 18(5), 439-448.
  2. Bower, J. H., Diop, A. G., Gouider, R., & Schmutzhard, E. (2014). Addressing neurologic needs in Sub-Saharan Africa: An opportunity for multisociety cooperation. Neurology, 83(12), 1085-1087.
  3. Lawson, A., Lee, C., & Illes, J. (2022). Toward Health Equity in Neuroscience: Current Resources and Considerations for Culturally Broadening Educational Curricula. Journal of Neurological Research, 12(2), 76-91.
  4. World Health Organization. (n.d.). Nervous system diseases. 2. Public health. 3. Cost of illness. World Health Organization. ISBN 92 4 156336 2 (NLM classification: WL 140), ISBN 978 92 4 156336 9.
  5. Racette, B. A., Nielsen, S. S., Criswell, S. R., Sheppard, L., Seixas, N., Warden, M. N., & Checkoway, H. (2017). Dose-dependent progression of parkinsonism in manganese-exposed welders. Neurology, 88(4), 344-351.
  6. United Nations. (2024). Goal 3: Ensure healthy lives and promote well-being for all at all ages. Sustainable Development Goals Report 2024.
  7. Bassetti, C. L., Accorroni, A., Arnesen, A., Basri, H. B., Berger, T., Berlit, P., Boon, P., Charway-Felli, A., Kruja, J., Lewis, S., Markowski, M., Medina, M. T., McCombe, P., Moro, E., Ozturk, S., Smith, P., & Vuletic, V. (2024). General neurology: Current challenges and future implications. Journal of Neurology, 271(6), 1620-1635.

Sign Up for Barrow Global Updates