Wednesday, May 9, 2007

Why are the Poor So Often Sick?

Connecting the dots from public health to poverty to corruption.

Doctors treat their patients one at a time. But spend enough time chronicling the realm of medicine--as I have--and you really start to appreciate the importance of public health. (Keeping youngsters from smoking is, after all, more satisfying than telling them a few decades later that they have heart or lung disease.)

Spend enough time in the public health world, however, and you start to understand how much poverty magnifies the damage caused by germs, accidents, hunger or violence.

And so, it's no surprise that the Bill and Melinda Gates Foundation is now including poverty reduction as one of the aims of their grant work. Last week they announced a five-year, $5 million initiative to fund research into the effectiveness of micro-finance tools to alleviate extreme poverty.

But spend a couple of decades working on poverty--as Paul Farmer of Partners in Health has--and you get a strong feel for the link between poverty and corruption.

Oh, corruption. Everyone's against corruption--taking bribes and that sort of thing. We may even deplore the old Cold War habit of propping up a dictator for security reasons.

But in a speech on Tuesday, Farmer challenged students and faculty of the Wagner School of Public Service at New York University, to look beyond bribe-taking and geopolitics to the unspoken rules of academia that say it's okay to collect data and publish research papers about the poor and unhealthy without also providing for direct service to them. (A RealPlayer video of Farmer's talk should be available soon.)

After all, there's nothing intrinsic to being poor that means you must also be sick. With access to clean water, proper sanitation, well-run clinics and effective treatments, even the poor can be healthy. You don't need a study to tell you that.

I'm not sure the audience understood that Farmer was challenging them personally. He has a habit of leavening his talk with funny asides and indirect comments that allow you, at least for a while, to think he's criticizing somebody else. And then the next morning, you wake up and realize, no, he's talking about you.

Some day those Wagner students will be earning their living from "trying to help the poor." (Indeed, Wagner is one of the grantees for the new anti-poverty Gates initiative.)

The question is whether the effort will leave the poor just as poor and unhealthy--but better studied--than they were before.

No comments: