Why you can’t understand global health

This is another reprint from my sadly abandoned Global Health Basics blog.

If you are reading this blog post, you can’t really understand the most important dynamic in global health: poverty and ill-health. They go together in a powerful vicious cycle. When you are poor you lack access to medical care and are you exposed to environmental factors that put you at a hugely increased risk of getting sick.

If you can read this, that’s not you. By definition, you speak English and you have access to the internet. You earn more than a dollar a day. You can’t understand.

It’s all well and good for people to opine and analyze global health issues. We can obsess about behavior change, system strengthening, and maximizing the value of dollars spent on health. But when you are poor, your life is a zero-sum game. Everything you do has a trade-off somewhere. There is no give in the system. It’s a level of decision management that is impossible to fully understand from the outside.

Among other things, that’s why bad treatments are destructive, even when they aren’t physically harmful. They cost money that is needed elsewhere, and take time that poor people need to spend doing things that support their basic survival. There is nothing unimportant that they can give up. Everything opportunity cost is brutal.

I can’t actually understand what it’s like to live that. Neither can you.* It is very important to remember that when we design programs. That’s the real reason that consulting with your communities is best practice. It’s not a new trend, a way to appease the donor or local government, or a belief in social justice. It’s because nobody except the poor knows what their lives are like. There is a role for outside experts to see opportunities and combinations, using their larger base of outside-the-system knowledge. But they don’t know what it’s like to live in poverty. Nobody does, except poor people.

*Unless you started your life that poor and accumulated wealth now. My dad did that; it’s not impossible. It is, however, rare.


(photo credit: cooperniall)

Jargon of the day: Health care provider

Jargon: Health care provider

Translation: Anyone who takes care of patients. This includes physicians, nurses, physician’s assistants, nurse practitioners, and midwives. I’m guilty of using this term myself – it’s an easy way to describe a big group. It’s unclear to outsiders, though, and can be a barrier to understanding.

Not talking about abortion

Outcry Over Search Word Ban on Health Site. Johns Hopkins recently made it impossible to search for the word “abortion” on their health information site, and then reversed the decision. Although I certainly agree that people need to be able to find information about abortion on a health website, I also feel bad for Johns Hopkins. They really can lose their USG funding for this.

The USG controls what you can say about abortion and family planning if you take their money. Agree or disagree with it, but that’s the way it is. The government’s policies put Hopkins in a terrible position. They have to choose what is “right” over what gets them money. That sounds like an easy decision. But it isn’t as if they were spending their government grants on strippers and hot air balloon rides. Their government funding goes towards vital research that benefits at least as many people as the information on abortion would. I wouldn’t want to have to make that decision.

Lesson: Diversify your donor base.