All posts by Sierra N Fisher

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.


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.