There are several basic determinants of health including living conditions, education, nutrition, and protection from environmental hazards. Attainment of these is heavily dependent on jobs and income. Minorities, the poor and those with less education tend to be experience more health problems in general over the course of their lives, based on an array of indicators of need, than do their more socioeconomic advantaged counterparts. Mortality and morbidity rates are higher among poor populations.
Two explanation of poverty are the social structure and the other is the characteristics of individuals that are assumed to contribute to poverty. It is the assumed part the author of this book has problems with. Social class has an enormous effect on our health. The lower people’s income the more often they are sick even our chances of living and dying are related to social class. The principal is simple, the lower people’s social class, the more likely they are to die before the expected age. This principle holds true for all ages and part of the reason for these death rates is the unequal access to medical care.
The result is a two tier system of medical care; one is superior care for those who can afford the cost and inferior care for those who cannot. Unlike the middle and upper classes, few poor people have a personal physician and they usually must spend hours waiting in crowded public health clinics. And then after waiting most of the day told they must come back tomorrow. And when the poor are hospitalized they are usually treated with rotating interns who do not know them and cannot follow up their progress.
Throughout the last two decades, the U. S. government and transnational corporations have worked more or less in concert with the World Bank, the International Monetary Fund and the World Trade Organization to promote a neo-liberal agenda of deregulation, privatization and reduction in the role of government. Paul Farmer’s “Infections and Inequalities” reflects on his experiences since 1984 as a physician at Clinique Bon Sauveur in rural Haiti, dealing primarily with victims of TB and AIDS.
In a collection a collection of ten essays, half have already been published; he relates personal stories in the voice of the marginalized victims and then adds his own analysis. Farmer lays much of the blame for this tragedy on the double standard that is applied to the health and lives of people in less industrialized countries. Cost effectiveness is often used as a justification to fund only low cost, “appropriate technology” interventions for HIV and AIDS. Farmer believes that this argument is unethical and dishonest.
Farmer’s Third World colleagues want hospital, not preventive programs. Instead of the needs assessments and studies they want access to new advances of pharmacotherapy. Farmer concurs with Marcia Angells, editor of the New England Journal of Medicine that the use of a placebo control group in an African study of HIV treatment is unethical when the prohibitively expensive antiretroviral AZT is already known to be effective in reducing prenatal transmission of the virus.
It is reminiscent of the notorious Tuskegee trials in the early part of the 20th century when African Americans with syphilis were left untreated in order to observe the natural history of the disease. Farmer finds it ironic that those who promote the HIV study say that they could not impose American standards of care on African people, yet they often have no compunction supporting government and institutions that impose structural adjustment, which have a devastating effect on the poor.
Robert Koch’s discovery of the tubercle bacillus in 1882 saw into the future Farmer quotes Koch: “one has been accustomed until now to regard tuberculosis as the outcome of social misery and to hope to by relief of distress to diminish the disease. But in the future struggle against this dreadful plague of the human race one will no longer have to contend with an indefinite something, but with an actual parasite. ” As McKeown documented a generation ago, knowledge of the parasite, although it was an important scientific breakthrough, was not responsible for the decline in TB mortality in industrialized countries.
It was relief of social misery that led to TB mortality’s drop down the tables of leading causes of death in developed countries, and also from modern novels and poetry. Tuberculosis did not go away it only slipped from the consciousness of people in rich countries. Farmer’s thesis is that it is the persistence of poverty and social inequalities that led to a greater death toll from tuberculosis in 1995 than in any year in recorded history.