This Monday, I had the pleasure of sitting in a beautiful theater in Santa Barbara to see one of my heroes, Dr. Paul Farmer, speak about health care as a global human right. After just finishing his book Pathologies of Power which addresses the same subject, I was quite intrigued to hear what he could add to my knowledge of development economics and public health.
Turns out, I learned a lot. Regarding Paul Farmer as a person, I learned that just one person with enough passion can truly make a global impact. This makes my efforts seem less futile, and certainly gives the hope and the promise that I, along with anyone else, can make a large difference if they put in the effort, no matter how cliche that may sound. He exposed his genius while simultaneously demonstrating his light sense of humor…joking about things from AIDS to the rigidness of public health officials to the United States. After all, how could one possibly live day in and day out with so much suffering if they could not stay lighthearted about it? Watching his charisma, intellect, humor, and passion all packaged into this humble and respected man shined as a perfect model for my future role in health care.
Moving to the content matter, Farmer began by showing some pretty insightful maps. Here is a map of the world according to population:
Now compare this to the prevalence of HIV in the world:
And further compare this to the amount of physicians working per area:
When I first saw these images displayed in this way, it really put it into perspective how disproportionate health care is in the world. There is an inverse relationship between physicians working and the prevalence of HIV, and absolutely no correlation to population size. Instead, the most physicians work in the wealthiest areas, which typically does not represent the most populated areas. Ironically, these maps really stamp out the fact that the higher the rate of HIV, the lower the rate of physicians…when the exact opposite scenario is necessary to effectively treat global health diseases.
Now Paul Farmer did not pretend to act like there was one answer to obtaining better global health equity. Although his efforts have made dramatic impacts in Rwanda and Haiti, the world’s current global health status is a far cry from equal.
However, he did have one idea that I felt was crucial to understanding how to positively affect the future. He used this story: Say a woman comes to his clinic with HIV, about to die. He gives her ART (Anti-Retroviral Treatment), which puts her health back to a good condition. However, she will now come to him and complain that her kids have nowhere to go to school, or she cannot eat, or she does not have a roof over her head. The problem with poverty and health care is that they are inextricably linked- while you may solve health care issues, the underlying poverty will still lead to a poor quality of life.
And the wealthy countries seem to be in no hurry to eradicate the problem of poverty. Farmer explained that at one conference he went to, the guest lecturer continued to show countries in terms of “WTP”, which he later learned meant “Willingness to Pay”. Regardless of feelings or morals, the fact remains that this world is run by money, and as the previous maps display, there are not enough people willing to work in these poor countries and sacrifice the money they would make in more developed areas. Therefore, he stressed the importance of solving not health issues, rather attacking poverty as a whole.
One method he tried with great success was involving the native peoples to participate in health care, a process he called “scaling up”. In Rwanda, his team decided to fix up a health care clinic to better serve the community. Rather than do it themselves, his team decided to base the project around the community members. The clinic was cleaned, developed, and expanded by local Rwandians. Once the construction was complete, Rwandians comprised a significant portion of health care workers, instead of just patients. This allowed the community members to have jobs, obtain a medical education, secure better wages, and have more faith and emotional investment in the clinic. These results were astounding in that the clinic continued to flourish, creating both better health care and better economic conditions at the same time.
Although I have stressed in previous articles the imperativeness of developmental economics for public health, attending this lecture further confirmed my belief in this system. By creating self-sustaining development programs in conjunction with quality health care, there can be hope for a better future for those who are less fortunate.