CMB Equity Fellows have come from 10 countries, where populations range from Singapore’s 5.6 million to China’s 1.3 billion, and economies span Laos’ annual GDP of $17 billion to China’s $11 trillion. These variances in size, combined with differences in culture, governance, resources, and other factors, mean that Fellow will face diverse challenges in building a community of support for health equity in their respective countries. To promote a nurturing environment, a critical mass of Fellows and allies would be essential in key countries. This is feasible for the more populous countries like Thailand and Vietnam, but challenging for less populous countries like Laos and Cambodia. During a January trip to Laos, CMB President Lincoln Chen explored the context in which young Laotian leaders for health equity will emerge, the current status of health equity in the country, and future opportunities to pursue pro-equity options.

Laos is one of the smallest ASEAN countries, with 6.7 million people. Per capita GDP reached $2,150 in 2016, fueled by a decade of one of the highest growth rates in the world at 7.8%. The Mekong River serves as a major conduit in this landlocked country, with a new high-speed rail that links Kunming-Vientiane-Bangkok-Singapore increasing the flow of people and goods through Laos. Health indicators point to some of the country’s challenges in meeting basic health needs: infant mortality remains high, at 50 per 1,000 live births, and maternal mortality at 200 per 100,000 live births. Health spending is low, at only 1.9 percent of GDP; January news reports indicated that the Ministry of Health will prioritize four fields in 2018: hygiene/promotion; communicable diseases, treatment, and insurance.

How can a small number of Equity Fellows in Laos (2 to date) take steps to create an equity community? Building a critical mass in-country may not be possible in the short term, but the Equity Initiative may engage Equity Fellows from Laos in neighboring (e.g., Thai) community-building exercises, link them to other Equity Fellows in joint projects, or perhaps create a special network for the smaller EI countries (Laos, Cambodia, Malaysia, Singapore, etc.). CMB will look to its current and future Fellows from Laos and neighboring countries for further ideas on ways to translate the core values of health equity into practice.