The main argument is that susceptibility to certain diseases is not only determined by biology but also social conditions, leading to a disproportionate disease rate among the poor, and minority groups without access to medical services. The author shows that addressing these social conditions leads to a decrease in disease when combining treatment and prevention plans.
The article has primarily been referenced in later works by Paul E. Farmer who has written several other papers and articles on both the medical state of Haiti and Rwanda as well as structural violence in many capacities. The article was initially published in 2006 and has since been published in journals, books, as well as open online collections for use by the sts community.
The authors are Paul E. Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. All of the authors are involved with the nonprofit organization Partners in Health in some capacity, with experience working with rural or poverty stricken areas. Paul E Farmer, the primary author of the article is a medical doctor also working for the United Nations who has published many other articles on similar topics.
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.
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.
“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 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.
The bibliography shows references to several papers by many of the same authors, showing it was produced as a continuation of previous ideas but showing new information learned through the PIH’s activities in Haiti and Rwanda. The bibliography also shows many references from the early to mid 1990’s showing similar thoughts to initial research done in Baltimore and other places with high rates of AIDS.