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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.

This article brings forth the idea of “structural violence.” This develops the argument that in areas in poverty people to not have access to the treatments or medication they may need and in denying people treatment/ medications disease will continue to spread and worsen. The article argues that providing healthcare to those who can’t afford it not only increases their life expectancy but decreases transmission rates and can potentially lead to the eradication of certain diseases. 

After reading this article I looked further into the ART treatment that was discussed, the mother to child transmission program, and I read more about what Paul Farmer has done in his career. 

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.

Paul Farmer is an American physician and anthropologist who is known for providing appropriate healthcare in under developed regions and developing countries. Farmer is situated in emergency response in that he is a physician providing care to those in need and works toward ensuring that people will have access to healthcare despite socioeconomic conditions. Bruce Nizeye works alongside Farmer and specializes in TB infection control in Rwanda. Sara Stulac is a physician who specializes in women’s and children’s healthcare. Her focus has included pediatric HIV prevention and treatment, malnutrition care, inpatient pediatrics and neonatology, and pediatric oncology and other non-communicable disease treatment. Salmaan Keshavjee is a physician who specializes in multi-drug resistant tuberculosis and in providing access to healthcare in poverty stricken regions. 

 This article is referenced in a medical journal that discusses cultural effects on the healthcare system. 

“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.

The article has a very long list of references and most seem to be primary sources. This shows the article was developed and is supported by people who are helping and seeing people struggling economically and the effects it has on their health.

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.