ASTMH Blog

Farmer: It's all about health equity

December 6, 2011 · No Comments

By John Donnelly

All Dr. Paul Farmer wants is equity.

He wants the people of Haiti, the people of Rwanda, the people in developing countries everywhere to have the same access to good health care as anyone else in the world.

And he doesn’t understand why anyone would disagree.

Farmer delivered the keynote lecture Tuesday at the ASTMH annual conference in Philadelphia, telling a packed convention hall that the situation in Haiti post-earthquake shows how a poor health system, fueled by dirty water supplies everywhere, created conditions for the world’s worst outbreak of cholera.

Farmer – well-known in global health circles for his nearly three decades of work in Haiti and elsewhere around the world and for the depiction of him in Tracy Kidder’s Mountains Beyond Mountains, required reading for many college freshmen – said that cholera could spike again during the next rainy season. In fact, he saw no reason why it wouldn’t, as Haiti’s chronic health and infrastructure problems are nowhere near fixed.

“If we do not invest in municipal water systems, there will be major outbreaks of water borne disease,” he said. He said that “cynical manipulation of foreign aid” derailed water projects in 2002 and 2003, and “now it will take years to rebuild that system. How long does it take to build public water systems with governments? It takes a long time. We don’t have a long time.”

He called on scientists, researchers, physicians, and students belonging to the Society not to shy away from a health “equity” agenda for Haitians and for poor people around the world. “Call it equity strategies,” he said, adding that “understanding the role of equity is one of the major challenges in 21st century research.”

One place in great need of more people fighting for equitable treatment is Haiti, he said.

“The standard of care has to be of the highest caliber in Haiti because this is one of those clear examples of international responsibility of what became in 300 days the largest killer of adults in Haiti’’ – the cholera epidemic, which has killed more than 7,000 and has hospitalized more than a half-million people. The outbreak came just 10 months after a devastating earthquake ruptured Haiti, killing an estimated 250,000 people and leaving more than 1.3 million people homeless.

“I hope some of you share the sense that I have -- I am appalled such a small country, Haiti, with 10 million people, could be home to such a huge epidemic (of cholera),” he said. “It would have been much worse without the humanitarian aid, but this is still completely unacceptable, as long as we have an equity strategy.”

Farmer also echoed the calls of ASTMH’s leadership for Society members to become more effective advocates in pushing forward the agenda of global health in order to bring better health care to all.

“Think of the impact we can have when we link our understanding of improvements in people’s lives to policy endeavors that can change the lives of millions,” he said. “There’s a problem why it doesn’t happen more in our world of tropical medicine and neglected tropical diseases. All of our diseases can be defined as neglected. The question is how we can build consensus in the scientific community and among our allies, and how we can build coalitions to pull those policy levers more effectively.”

At the end, Farmer poked a little fun of himself, as he often does.

“I’m sorry if I sound like an Old Testament prophet,” he said. “But I feel like I’m with the home team.”

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