Inequalities in Medicine: Where did they come from and How to Fix Them

The idea that there are drastic inequalities of medical resources between developed and undeveloped nations is not a new idea to emerge in global health. It is an issue that is not only almost universally agreed upon, but also documented and addressed in a variety of fashions. In the paper ‘Ethics and Governance of Global Health Inequalities’, author Ruger provides some bleak statistics: “Global health inequalities are wide and growing: a child born today in Afghanistan is 75 times as likely to die by age 5 years as a child born in Singapore. A girl born in Sierra Leone can expect to live 50 fewer years, on average, than her Japanese counterpart. The number of African children at risk of dying is 35% higher today than it was 10 years ago. Although the average global life expectancy has increased by 20 years over the past five decades, the poorest countries have been left behind.” In Improvising Medicine, author Julie Livingston documents these inequalities in stark clarity by telling the story of an oncology ward in Botswana. The doctors and nurses who work in the ward not only have very little medical equipment and treatment, they are also severely understaffed. Although these inequalities exist, the underlying causes of them are not so easily apparent. In addition, it is not certain how to change them in a favorable way.

How did these inequalities in medicine arise? Are they solely due to differences in socioeconomic status? Does the privatization of healthcare exacerbate these inequalities? Could be due to the fact that we as a global society place more value in some lives than others? As I attempt to explore each of these questions, keep in mind that the inequalities in medical resources are not only on a country to country basis. There are also inequalities between states, between towns, and between individuals.

In Improvising Medicine, the author uses case studies to explore the level of care provided in countries that have universal care compared to those where the medical industry is privatized. Although the level of care at the oncology clinic in Botswana (where they have universal healthcare) was significantly lower than in the US, the Batswana that arrived at ward fared better than their Zimbabwe counterparts, who at many times couldn’t afford the treatments.

Another way inequalities in medical resources can exist for so long is the differential values placed on human life. In the book ‘In the Company of the Poor’, Paul Farmer makes the encompassing statement, “The idea that some lives matter less is the root of all that’s wrong in the world”. This different valuing of human lives is apparent not only in the severe inequalities of medical resources but also when it comes to our response to large scale global health issues.

For example, during the Ebola outbreak last year, the WHO declared it a “public health emergency of international concern” on August 8th 2014, after there were already 1,779 infections, and 961 deaths. Had these deaths been majorly Americans rather than Africans, would we have spurred our reaction to the epidemic sooner? In fact, when only one or two Americans were infected with Ebola, the nation watched their cases very closely, and knew their individual stories, while the many deaths of Africans were little more than statistics and numbers in a chart.

So what can we do to alleviate these inequalities in medical resources? Should the whole global health system be completely changed to account for these inequalities? Or is humanitarian aid enough?

These questions are not easily answered. In the essay ‘Governance of Global Health Inequalities’, the author proposes a universal healthcare system that would not only encompass nations but the world as a whole. He called for a mass redistribution of medical resources. For this distribution to occur, he relied on people’s morals and good heartedness, rather than coercion.

Although his method sounds ideal, it’s hard to tell how realistic or feasible it actually is. Many people would most likely object to having any of their medical resources taken away from them after they are already used to having them, even if they are going to people who have virtually no medical resources. However, on the other hand I don’t think humanitarian aid is quite enough either. Humanitarian aid only goes so far as to help individuals who are in need of help in the present, but does not extend to drastically alter the health system in any way.

There are no simple answers to these questions. Although the path to take is not clear, there is no uncertainty that these inequalities must be abolished if there is going to be real, large scale improvement in global health.

Sources:

Griffin, Michael, and Jennie Weiss. Block. In the Company of the Poor: Conversations between Dr. Paul Farmer and Fr. Gustavo Gutierrez. N.p.: n.p., n.d. Print.

Livingston, Julie. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham: Duke UP, 2012. Print.

Ruger, J. P. “Ethics and Governance of Global Health Inequalities.” Journal of Epidemiology and Community Health. BMJ Group, n.d. Web. 01 Oct. 2015.

Schnirring, Lisa. “WHO Declares Ebola a Public Health Emergency.” CIDRAP Center for Infectious Disease Research and Policy CONNECT WITH US Newsletter Signup Facebook Linked In Twitter Email Alerts Contact Us MAIN MENU Main Menu. CIDRAP News, 8 Aug. 2014. Web. 1 Oct. 2015.

17 thoughts on “Inequalities in Medicine: Where did they come from and How to Fix Them”

  1. Discussion Questions:

    1.How did inequalities in medicine arise? Are they solely due to differences in socioeconomic status and monetary wealth? Does the privatization of healthcare exacerbate these inequalities or help them? Could they be due to the fact that we as a global society place more value in some lives than others?

    2. What can we do to alleviate these inequalities in medical resources? Should the whole global health system be completely changed to account for these inequalities? Is these realistic or even feasible? Is humanitarian aid enough?

    1. Hi Sierra,
      I found your post to be very interesting and it really called to mind what I think is the most pressing issue in global health – what can we do to alleviate the inequalities in medical resources globally?
      Obviously, there is no simple answer to this question. As we have seen through our readings, there have been many proposed ideas and possible solutions to this situation, but it seems somewhat impossible for them to be executed. In my opinion, it is most important that we, as individuals living in a developed country with an excess amount of medical resources, truly prioritize this issue and recognize that we can help. Whether it be creating a universal health care system, or redistributing resources globally, there is one definite thing we need to do: execute our plan. It is not enough to merely discuss this issue and offer possible solutions. It is essential that this issue is addressed and dealt with.
      To answer the second part of your question, I don’t think it is realistic to change the global health system. If anything, I think it is important to start on a national scale (or potentially even on a state scale). I think once this starts to happen, more and more nations will start to change their health care system, and hopefully will help alleviate the medical sufferings and inequalities in developing nations.
      I found your first discussion question to be very interesting and I have one potential answer: racial discrimination is the origin of medical inequalities.
      While I think socioeconomic inequalities play a huge factor in the origin of these medical inequalities, I think that it essentially all goes back to one main idea: racial discrimination. As we have seen in earlier readings in the semester, racism played a huge factor in inequalities around the world. In an earlier unit, we read about how Africans were discriminated against because they were thought, to the European mind, to carry diseases. Obviously times have changed and racial discrimination is not as severe as it used to be, but it is still a problem in the world we live in. I think this is the main cause for many of the inequalities we see today, but especially the medical inequalities.

  2. Hey Sierra,

    I think you brought up some substantive points in your blog post, especially when you addressed how there is no simple answer (a common theme in global health) and that humanitarian aid by itself does not go very far. There are so many factors that need to be considered when thinking of an ideal health care system on a global scale.

    Humanitarian aid can only go so far, since money can’t buy everything. In general, a health care system needs human resources with specialized skills and knowledge in the medical field, an education system to increase awareness of disease prevention and to train medical professionals, a monitoring and evaluation system to collect data about the progress of the health care system to figure out what strategies are working or what areas need more improvement, medical technology to improve the quality of health care, and a governing body to make policy changes to allow for bigger changes in health care. These were just things off the top of my head; I’m sure there are many more factors to consider.

    In regards to how the inequality in medicine arose, much of the inequality is rooted in history. As we discussed a couple weeks ago in class, the colonialism era set the stage for economic inequality among countries, and health disparities ties into that inequality. I think that privatization of health care exacerbates inequalities in health care within nations (as in the US with having private insurance or being eligible for Medicaid/Medicare vs. being uninsured), but I’m finding it hard to apply this on the global scale. Universal health care seems to be the ideal, but as seen in Improvising Medicine, it doesn’t always work out that way, mostly due to the limited resources at the Botswana oncology clinic.

  3. Hi Sierra,

    The statistics you present in the beginning of your post make an important point–although the global life expectancy has raised by 20 years in the last 50 years, huge problems still obviously exist in global healthcare and no one should be fooled by the apparent “progress”. Your question of if society places more value on some lives more than others is a very important one to consider, because no government, or even person would openly admit to valuing one life over another. However, it is apparent through your example of the 2014 Ebola outbreak that the United States is spurred into much greater action and awareness when the people at risk are within proximity of each other. In the “Drowning Child” paradigm we discussed in class, it is much easier for people to help when they can associate a face or a narrative to the person they are helping. This creates a strong disconnect, because empathizing with an unknown is nearly impossible, and an unintentional valuing of one life over another can be the result.

    The root of inequalities in medicine is convoluted due to the layers of history and types of inequality. If one says that the inequality is due to socioeconomic factors, one can also say that racism led to these socioeconomic factors. Taking another step back, the factors of imperialism and colonialism come into play, and it results in a cascade of causes and effects that lead to the current situation of global health inequality. To address inequality would requiring efforts to address all of these factors–an approach that would require action on a social and economic front. Ruger’s concept of relying on people’s morals and good heartedness is very, very idealistic, and instead we should focus on figuring out motivations that drive people to be good hearted and moral and apply that to creating a system for redistributing medical resources.

  4. Your blog touches many of the complex, extensive subjects that exist at the core of global health. As you discussed in your post, there clearly are no definite or faultless answers to the questions that have been raised; I will, nonetheless, attempt to convey my opinions/concerns.

    As discussed in class and in your post, differences in socioeconomic status, while an undeniable contributor to medical inequalities, are not solely to blame for disparities in global healthcare. Rather, the roots of ‘global poor health’ exist as a large, complex gamut whose breadth includes (but is not limited to) colonialism, racism, social conditions, gender inequalities, abuse of corporate powers, and uneven division of/access to medical resources. It is, in my opinion, not viable to discern which of these factors is most at blame; their histories are intertwined. It is important to note this ‘intersectionality’ of race, poverty, and gender; each of these subjects must be examined in order to learn how individuals’ and populations’ perspectives or experiences are framed. To fail to take into account one of these factors is to lack understanding of the manifestation of inequities. Also essential to consider is that the roles of race, poverty, and gender are not additive (i.e. black + woman DOES NOT EQUAL black woman).

    I think that you have brought up a good point about how privatization may lead to exacerbation of inequalities in medical resources. I took Healthcare in the United States last semester and learned a lot about how privatization of healthcare prevents certain populations from accessing necessary medical care. Usually healthcare is evaluated on three bases: access, quality, and cost. Having privatized healthcare can lead to problems in all three of these categories; people who cannot afford or get insurance cannot visit the doctor without worrying about exorbitant costs. To put it succinctly, the poorer you are, the more difficulty you have getting care. In countries such as Botswana, where the GDP per capital is about $7,300, universal healthcare plays a crucial role in granting citizens the capability to be treated. Easy access to specialized care – especially in the case of cancer, as seen in Livingston’s Improvising Medicine – is still lacking because of limited resources (hospitals, staffing, resources, treatments, etc.). However, as you noted, the Batswana who have the ‘privilege’ of being admitted to PMH can be treated. In this sense, universal healthcare, while not a cure-all, is necessary.

    Your question of whether society values some populations more than others is imperative to consider. In regards to the Ebola outbreak, I do think that the WHO was at fault for declaring so late that Ebola was a public health emergency of international concern. I think in addition to the WHO’s “office politics,” society’s view of Africa as “sick country” contributed to the late international response. But, as another commenter noted, I think it somewhat makes sense that America as a nation focused on the American individuals who contracted the virus. And I think this is because of proximity – where fear and sensationalism is much more tangible. Then again, this nation has largely ignored other illnesses that are present in minority populations – namely tuberculosis. So, in this case, why doesn’t proximity play a role in awareness and action? Perhaps it is because we don’t value lives equally.

    1. If possible, could you clarify what you mean by redistribution of medical resources? Do resources refer to doctors, hospitals, medications, etc.?

  5. Hi Sierra,

    In regard to your second question about what we can do or what humanitarian projects can do to help mitigate the inequalities in medical care I think that the solution is at a very basic level–through early education. The entire global health infrastructure may need to change for us to see more equal access to resources for people all over the world, but whether healthcare is private or funded by state governments, I think that the general knowledge or at least the specific statistics of what we have learned in this course needs to be taught to people early on. This is applicable to inequalities within one’s own country or inequalities in another, as you mention are both issues we need to deal with.

    In the case of the US, I think that in order to change the mentality of seeing deaths in Africa as only inevitable statistics affecting people we don’t know far away, we should be teaching better geography, history, and current event courses in middle and high school. I went to a public high school and I feel like students there, myself included, hardly received any current event coverage of these issues and that many growing up in the US get the same shallow and vague coverage of global health issues. This makes them seem distant and insurmountable both as a teenager and a voter. Creating a curriculum that allows students to gain a broader understanding of the world probably won’t turn everyone into a Paul Farmer, but I think that a better informed public in both more and less economically developed countries would help to close the gap in healthcare inequalities.

  6. Hello Sierra,

    I appreciated your discussion above about our cultural attitude to diseases like Ebola. The reporting (by both the media and by numerous health organizations) that followed last year’s Ebola outbreak certainly sensationalized the cases that occurred but it also speaks to the fact that those who we task with the job of providing, monitoring, and bettering care have a very implicit racial bias. For example, you pointed out the WHO’s labeling of the Ebola outbreak as a “public health emergency of international concern.” I agree with the notion that doing so not only exaggerated the event that took place locally in the US but also trivialized every Ebola-related death that predated that announcement. This also speaks to societal categorizations of some diseases being more appropriate in certain parts of the world and cause for hysteria in others, an idea that often places an unfair and unjust racial context to global health.

    In response to your first discussion question, I agree with what Yuki said above and would add that the privatization of health care exacerbated the system put in place by colonialism. The capitalist idea that consumers should receive based on how much monetary value they place on a good displaces those individuals who lack the ability to pay for their care (creating an issue of equality vs. equity). Though universal health care systems at least partly remedy this, the uneven distribution of health resources can still be inherent in such a health system model.

    In response to your second question, I think restructuring the global health system would be met with far too much opposition even if a complete overhaul was possible; as we have see in commerce, politics, and many other aspects of our lives, the price of letting others suffer in a given system, to many, is offset if that same system benefits oneself—an morally objectionable truth which is the harsh reality of care in Improvising Medicine. I think humanitarian aid can provide relief on some levels. Such intervention programs, however, can sometimes be inefficient if there architects lack cultural awareness and sensitivity.

  7. Hello Sierra,

    Your blog post is exceptionally rich with outside information, statistics, and complex questions. You mentioned the debate between the benefits of universal healthcare versus the benefits of private healthcare that was mentioned in “Improvising Medicine.” In a way, I think this debate is at the center of the inequality around the world and the idea that the global society values some lives more than others. Privatizing health care often causes people of lower socioeconomic status to be unable to receive certain necessary procedures or have to sacrifice a money that could have been used for food or housing. Universal healthcare proposes that each human has the same right to a healthy life. While the level of care might be less, people aren’t discriminated against based on their ability to pay. In response to your first questions, I think privatization does exacerbate medical inequalities. If a society like the US doesn’t believe that all of their citizens should have equal access to healthcare, how could they believe that there’s value in possibly redistributing resources to other places that might need their help gaining access to new medical technology or money to build clinics? I think that medical inequalities arise because a society values certain people over others.

    In response to you second question, I think that alleviating inequalities in health resources is necessary but not possible solely through humanitarian aid or restructuring the global health system. Restructuring the global health system would be the ideal way for inequalities to disappear, but it would be impossible. The time and effort it would take to redistribute the resources would leave many people to be lost in the process. There would be opposition from around the world, and I just don’t think it would ever be feasible. Humanitarian aid I think has helped with some inequalities of health such as HIV/AIDS, but I don’t think it’s made a tremendous dent in the world healthcare system. What is truly necessary is a shift in mindset. I think what is stopping the world from educating the people who live in societies with lack of access to medical care is this value that global society places on certain people. The effects of colonialism around the world can still be seen, as American STILL think of Africa as a “sick” continent and don’t even distinguish between the different countries and cultures that make up Africa. If inequalities are ever to be stripped away and equal access to medical resources is ever to be achieved, this mindset of “some people are worth less” that is still around due to colonialism has to change and be dramatically shifted.

    A shift in mindset takes a long time, but I think what Yuki said about education is a great point. In areas of lack of access to medical care, educating and training people as medical professionals is very important along with educating the community and gaining access to drugs and equipment. As I think we talked about with the dump in Central Falls, RI vs in the East Side of Providence, education and agency can play a huge role in gaining resources and power in a certain area.

  8. Hi Sierra,

    I found you post very interesting and informative, especially when you talked about how complex the underlying causes of health inequalities. I also found the facts and statistics you posted very shocking and illustrated well how bad health inequalities are in other countries.

    Concerning your first question, you raised the very interesting point of how societies value life differently and it is true that this was highlighted during the Ebola outbreak. However, this is a very complex subject that has many possible answers. I do think that the difference in socioeconomic status and wealth of a society plays a big role in health inequalities. In the US, because we have lived and grown up in a society where health care and treatments are usually readily available, it can be difficult to imagine the inequality in health resources that arises in many different countries. This can then cause a lack of awareness to help others that have difficulties getting medical care. Privatization of healthcare also accentuates the inequalities, since not everyone can afford getting healthcare when they can’t even afford food for their families and allows the rich people to get treated while the others who can’t afford it have to turn to homemade remedies.

    Although volunteers and humanitarian aid can be helpful, it can only achieve things on a small scale of the problem and cannot make big lasting chances. I think that even if alleviating these inequalities is a long and complex process, it can only be achieved if the government of respective countries as well as the entire global health system worked together in order to allocate funds for better health care as well as by the implementation of health reforms. I would say that this is the main way we can achieve change because people trust their government and if the intervention is a national movement to decrease health inequalities, people might be more inclined to change their habits. Also, changing the global health system would allow to raise awareness around the world about the inequalities happening in the world as well as a better allocation of funds to reduce these inequalities.

  9. Thank you, Sierra and others, for sharing your thoughts.

    I would like to begin by echoing Julianne, Thu, and Sachit’s points about including discussions of race and racism in this thread as we consider how inequalities in medicine arise. As Sachit mentions, implicit racial bias, which refers to unconscious discriminatory attitudes toward certain racial/ethnic groups, affects the reporting and monitoring of disease transmission. This reveals how factors, such as socioeconomic status, are trumped by racism in healthcare systems, and more specifically our healthcare system in the U.S.

    The article “Racial Disparities in Healthcare: Study Finds Doctors Force Blacks, Latinos to Wait Significantly Longer” posted by Atlanta Blackstar on Wednesday emphasizes the implicit racial bias observed in physician offices. It refers to a study released in JAMA Internal Medicine, which highlights differences in waiting room time: “Black, Brown, less educated and unemployed people” wait 25% longer in the waiting room compared to white patients. Timeliness to obtaining care and treatment is crucial, especially because marginalized groups of people often have to spend more time travelling to the location where care and treatment are provided. As many have said before me, health disparities and global health disparities do not have catchall solutions. This study and article, therefore, raise further questions for me: To what extent are these disparities due to extenuating factors, such as a shortage of primary care physicians and overcrowded, urban areas? Is place playing a larger role than race in (poorer) outcomes of health?

    To come back to your second question, Sierra, and address how we can alleviate these inequalities in medical resources, I think it would be beneficial to first define what we mean by “medical resources.” For example, community health workers, vaccines, and surgical equipment can all be seen as medical resources, but which one are we prioritizing, if we are prioritizing any at all? Training local community health workers and clinic staff to support their own communities would be very different from sending “necessary” medical supplies, such as gauze and medications. This brings me to the point that, although humanitarian aid aims to relieve these constraints by working to improve many of these “deficits,” we need to do more. There should be a way to implement global health policies, and then hold countries accountable for appropriate implementation and sustainability.

    Article: https://atlantablackstar.com/2015/10/07/racial-disparities-in-healthcare-study-finds-doctors-force-blacks-latinos-to-wait-significantly-longer/

  10. Hi Sierra! Great post! It flowed very nicely and I definitely want to respond to some of the questions you asked throughout your piece. You quoted Paul Farmer above who basically said that all of the inequality and injustice in the world is due to the valuation of some lives over others, and though I don’t think that it is wise to collapse all of the issues that contribute to inequality into one, I do agree that prejudice and discrimination are the root of it. This quote reminded me of the philosophy of liberal cosmopolitanism that Professor Mason described in class last week. She explained the theory through a hypothetical scenario: if before you were born you could decide what the world would look like in terms of opportunity, how would you want the world to be? Most people would logically choose for the world to be based on an egalitarian system so they don’t end up on the bottom, and although this decision is made out of self-interest, it still promotes the idea that most people would want an equal world. Thus, the people who are not born at the bottom should try to convert their privilege into public good and service to those less advantaged. Though we discussed in class that this theory seems too negative to be effective and that most people won’t respond well to being guilt tripped into helping, I think this theory really speaks to a lot of people (certainly to Paul Farmer). Guilt might be a good way to promote empathy and the kinds of emotions that stir people into action.
    You asked whether the ebola outbreak had occurred in America rather than Africa would the US and international community had responded faster, and I agree that yes definitely, just not because of the value of American lives but of white lives. We would react sooner not because ebola would threaten black American lives, but because it would threaten white life. It’s a minor point to make, but I think important to remember the distinction there.
    To your point about whether humanitarian aid is enough, I agree that it is not. Humanitarian aid as it was conceived was meant to serve a population and then get out. These organizations were not meant to arrive and then be installed due to a community’s dependence on their services. An example of this is the establishment and consistent renewal of UNRWA, which is department of the UN that provides humanitarian services to Palestinians. Without any solutions or sufficient action by the governments involved, this branch has continued for decades to basically keep many of the people in this region alive. The organization has struggled as an impartial organ of the UN amidst so much conflict to fulfill its duties, and securing funding for these services has been very politically complicated. Clearly, humanitarian aid is not the answer.
    It’s hard to imagine what we can do to lessen inequality of resources then considering the complexity of interests. To attempt to answer your final question, I think part of the solution lies in our ability to re-conceptualize national borders. At one point in history the boundaries between nation-states held a certain significance that might not be as relevant today. We should realize that the world’s population is so much larger than then and is only growing, our resources are dwindling, and if we cannot learn to think in more open and communal terms, than we are just pushing more and more people further into poverty and conflict. Why does a line on a map have to signify such absolute divisions of people and who can be served by whom?

  11. Hi Sierra,

    Thanks for your post! You raised a lot of difficult questions about health inequalities. Something I am particularly interested in is how healthcare systems can improve or worsen health inequalities in places. It is interesting that even though we are in one of the wealthiest countries in the world, we consistently do poorly on international health reports and repeatedly prove to have great health inequalities in our country. I thought it was great how you brought up the feasibility and practicality of a universal health care system for the entire world. I agree with you that a huge portion of the world population would reject this kind of system. I think that this is highly exemplified by our own capitalist society that has repeatedly rejected healthcare reform policies that would try to emulate universal healthcare systems rather than the private healthcare systems we have in place. I think privatization of healthcare improves care for the wealthy and greatly exacerbates inequalities in health. However, our world is based largely on money, and I am unsure how we could create real and successful policies that prevented this unequal privatization from occurring. It seems unfair to limit those with money from receiving better care if they can afford it, but it also makes these problems of inequality much worse…

    I find it to be kind of depressing, but I am really unsure of how to combat inequalities in health. I think that humanitarian aid is a good thing, but it’s clearly not enough. It doesn’t create systematic and sustainable change that can help the huge population of people in the world who are living in poverty, without access to healthcare. We need systematic, institutional changes, and diagonal approaches to combat inequality in health.

    Thanks for your post!

    -Rebecca

  12. Hi Sierra,

    Thank you for insightful post on how drastic health inequalities are in the world right now, and your thoughts on the difficulties on creating a universal health care system across nation borders.

    I think your question in your post about what an ideal health system would like is critically important to think about, and one I think we don’t spend a lot of time thinking about because most systems that we would believe to be ideal are probably unrealistic. You are right that relying on people’s morals and good heartedness to fix our global healthcare state is not a realistic idea, nor is the current state of humanitarian aid good enough. I think while a global healthcare system is out of reach, a global tax that can be used to pay for healthcare for least privilege is something that’s feasible and could help to attach health disparities. Echoing what others have said in their blog post comments about how the origins of health disparities largely were largely due to racial discrimination, and colonial power, I think a tax would serve an ideal Pogge style redistribute justice.

  13. Hi Sierra!
    Wow! I think your post was really cool! The facts that you gave were really interesting/sad. I was really shocked by some of your statistics.
    I think this dates back to colonialism. In the Smedley and Smedley reading, it is mentioned how there are higher mortality and higher morbidity rates at every level for ethnic people regardless of socioeconomic status. Although, I believe that socioeconomic status and wealth play a huge role in an individual’s health because if they have more money, they most likely have access to healthcare and can also afford to pay for it. I do believe that in global society we place more value in some lives than in others, which causes these higher levels of mortality rates.
    To answer your second question, Jacob (post above yours) mentions this idea of redistributing wealth. I think this is a good idea, however, a difficult one to do. I agree with McKeown’s hypothesis in that the rise in the standard of living, improvements in hygiene, and better health will dramatically reduce the mortality rates in developing countries. What do you think developed countries can do to help this?

  14. Hi Sierra, thanks for your post! The idea you bring up about different layers of inequalities, from national to state to individual, is interesting. Just like the Rose paper we had to read at the beginning of the class illustrated, thinking about and comparing different populations can lead us to different conclusions about causes and interventions. In particular, I appreciated you pointing out the differences not only between the U.S. and “developing countries” in general – a characterization that often happens – but recognizing the individual systems in place in Botswana and Zimbabwe as well, important to think about when developing interventions and critiquing their health problems.

    Another point from your post that made me think was the evidence you provided for the claim that different lives are being valued differently – that the U.S. provides more care for its citizens than for others, in a very simplified and direct way. And regardless of my position, I think that many U.S. citizens would agree that this type of prioritization is justified – that the U.S. can spend significant amounts of money on cancer care, for example, regardless of if it would be cost-effective when there are people dying of TB. Like we discussed in class, there is no global pie. However, this justification rests heavily on the continuation of national boundaries and a national identity – something a little bit more flexible today, it seems, in the face of globalization. Similarly to one of the authors you mentioned, my response to this was indeed to create a true global health community. However, in contrast, my conception of this is an organization with actual regulatory power, a system that can stop relying on people’s “good heartedness” and compassion – otherwise, it seems pretty similar to the way we do things now. What do you think? Should we be giving organizations like the UN and the WHO governing power? What are some of the pros, cons, unintended consequences of a decision like this that I may not be considering?

    1. Hi Allison,
      I think the points you bring up are really interesting. Like you said, even in the era of globalization, there are many people who think of themselves as solely ‘Americans’ instead of being part of a greater global community. I think in part this patriotism is largely due to the fact that (most) humans are naturally drawn to having communities that they can rely on. It also probably stems from history and other factors as well. However, I think it would be a huge step just to get people starting to think about a global community, where we all help each other. This viewpoint is starting to happen a little in the environmental sector, because environmental problems affect every person who inhabits this earth. But I do agree with you that changing the way people think or just relying on their good-heartedness is not enough. I think it would be a great idea to have a global governing body such as the UN or WHO to help with global health inequalities and other problems. The WHO has had good ideas in the past but had no real power to enforce them, therefore making them ineffective.

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