Paul Farmer, medical anthropologist and founder of Partners in Health, identifies what he calls the epidemiological insight – diseases make a preferential option for the poor; thus, healthcare workers must as well.

Throughout Pathologies of Power: Health, Human Rights and the New War on the Poor, Farmer argues

“To act as a physician in the service of poor or otherwise oppressed people is to prevent whenever possible, the diseases that  afflict them – but also to treat and if possible to cure” (145)

Highlighting the need for innovation in healthcare, Farmer focuses not on high tech, expensive medicine but on attacking the connection between poverty and illness. What is needed, he argues is attention to public health and basic services  – public health must be made a priority.

For Example, Infant Deaths Drop After Midwives Undergo Inexpensive Training offers concrete evidence of medical training programs in Zambia.

Midwives from 18 Zambian clinics were taught a basic course in newborn care and encouraged to teach their colleagues as well. The course covers simple interventions like cleaning and warming a newborn, resuscitation, breast-feeding and diagnosing common illnesses. (Above, a birth attendant listened for a baby’s heartbeat with a clay stethoscope.)

The midwives normally handled births that were expected to be uncomplicated, with women typically going home with

heir babies after one night in the clinic.

The researchers compared survival rates among 20,000 babies born before the teaching and 20,000 afterward. The first-week death rate among babies had dropped by almost half, they found, to 6.8 deaths per 1,000 live births from 11.5 deaths.

Past studies have suggested that the single most important aspect of training, in terms of saving lives, is to teach midwives that an infant who is not breathing at birth can be revived with quick action — by massaging to prompt it to inhale, or using a simple resuscitator.

Today’s NY Times “Global Health Update” provides yet more evidence, as Farmer often argues, it is about providing structural change,  health education/training so that people within countries are able to provide effective healthcare – this requires money and resources; but positive outcomes do not necessarily require large amounts of money or technology.

The crux of Farmer’s argument is the realization that:

“We thus find ourselves at a crossroads: healthcare can be considered a commodity to be sold or it can be considered a basic right. It cannot comfortably be considered both of these at the same time. This, I believe, is the great drama of medicine at the start of this century. An this is the choice before all people of faith and good will in these dangerous times.” (175)
What this recent study demonstrating that training midwives is both inexpensive and effective at reducing infant mortality indicates is that effective and human public health programs are not out of reach economically – the question is one of commitment and will. Thus, Farmer poignantly challenges:
“If access to healthcare is considered a human right, who is human enough to be entitled to that right?” (206)