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Emergency response is addressed in terms of both long term response and future emergency prevention. The method used by the PIH in both Haiti and Rwanda were implemented in response to high rates of disease in those places, showing that an emergency can occur gradually and the response may require creating a permanent system. Prevention is also discussed as a portion of emergency response, that it is important not only to deal with emergencies as they occur but also to identify the causes and change the system to prevent the same emergency in the future.

The main argument of this article is that modern medicine searches only for the molecular basis of a disease and neglects the biosocial circumstances of a disease, which has allowed for discrepancy in treatment and spread of disease among rich and poor. This article discusses the concept of structural violence and how that has played a role in disease among the poor. The point of the author in this article is that if science and societies are able to address these issues, there would be a decrease in the spread of disease and an increase in prevention plans. 

Paul Farmer has used this paper in later works and has been published in various journals and books. 

Data collected from a study done in Baltimore in the 1990’s, including statistics and observations is used to support the main argument. The methods used in Haiti and Rwanda as well as the results from implementing those methods are also used as examples for the claim that social conditions greatly impact disease susceptibility.

The authors are Paul E Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. All of whom work for Partners in Health. Paul Farmer, the primary author, is a physician and an anthropologist who has deeply investigated human rights and health. He also works with low-income neighborhoods and cities within the US as well as abroad. 

Emergency response is discussed more in terms of prevention. While the PIH model was used as a response to the high prevalence of disease in the area, it can be used to show how emergency response may require reaction using a model or system that can be long-term. Prevention is explored using the concept of structural violence and how inherrent structures within our society are causing spread of disease. The paper offers the idea that identifying issues within a society could help response to further emergencies. 

“Pioneers of modern public health during the nineteenth century, such as Rudolph Virchow, understood that epidemic disease and dismal life expectancies were tightly linked to social conditions [55,56].” (Farmer 5)

“…large­-scale social forces—racism, gender inequality, poverty, political violence and war, and sometimes the very policies that address them—often determine who falls ill and who has access to care.” (Farmer 1)

“In an attempt to address these ethnic disparities in care, researchers and clinicians in Baltimore reported how racism and poverty— forms of structural violence, though they did not use these specific terms—were embodied [33,34] as excess mortality among African Americans without insurance.” (Farmer 2)

The article focused on treatment and prevention of diseases affecting communities, however I was interested in the initial causes of these epidemics in places that were originally free of disease. I read an article “The Tipping Point” published in the New York Times that explained multiple social theories as to how epidemics begin, using Baltimore as a case study.

I looked into the stated mission and some of the work done by the Partners in Health, as they are a group that responds to epidemics. It was interesting to see that they focus not on immediate emergency response but instead on creating lasting infrastructure to gradually stop epidemics, as well as educating locals on how to react to future emergencies of the same nature.

The article mentions that clinicians are not trained to see social issues as they are so commonplace in everyday life as to become invisible, I felt that was a limited mindset and read an article written by Doctors for America. The article showed that while it is true that comparatively little time is spent on social issues during a doctor’s education, clinicians dealing directly with patients clearly recognize social conditions effecting health. The article suggests that the lack of attention on those issues in the medical field is not due to ignorance but rather the lack of an existing system through which individual doctors can report their experiences and work towards a solution.

Methods used by Farmer, et al include collecting data from the study done in Baltimor in the 1990's. They analyzed the statistics and observations found as main points of their argument. The model used in Haiti and the results from other methods implemented by physicians in those areas are also used as arguments to strengthen the article. 

The argument is supported through a combination of historical information including rates of AIDS in the early 1990’s and a study done in Baltimore in an effort to reduce AIDS rates in African Americans, who were more likely to be in poverty, by addressing monetary barriers to heath care. Two more recent cases are also used to support the main argument, implementing a method created by the Partners in Health to prevent transmission and provide AIDS care in rural Haiti and rural Rwanda. Throughout the article references were made to the current medical professional’s dilemma, where they are in a position to see the social inequalities contributing to disease rates but not trained to report or change common social contributing factors. This makes the article more relatable to the reader that may have experience in the medical field which elps to support the argument.