It is clear that the pharmaceutical industry is not by any stretch of the imagination doing enough to ensure that the poor have access to adequate medical care.
If you look just at the decades after 1934 you know it’s hard to point to really inspired and positive support from outside of Haiti to Haiti and much easier to point to either small-minded or downright mean-spirited policies.
Civil and political rights are critical but not often the real problem for the destitute sick. My patients in Haiti can now vote but they can’t get medical care or clean water.
Haiti is always talking about decentralization and nothing has been so obvious perhaps a weakness as the centralized nature of Haitian society as being revealed by the earthquake. I mean they lost all these medical training programs because they didn’t have them anywhere else.
I mean everybody should have access to medical care. And you know it shouldn’t be such a big deal.
Anywhere you have extreme poverty and no national health insurance no promise of health care regardless of social standing that’s where you see the sharp limitations of market-based health care.
But if you’re asking my opinion I would argue that a social justice approach should be central to medicine and utilized to be central to public health. This could be very simple: the well should take care of the sick.
If any country was a mine-shaft canary for the reintroduction of cholera it was Haiti – and we knew it. And in retrospect more should have been done to prepare for cholera… which can spread like wildfire in Haiti… This was a big rebuke to all of us working in public health and health care in Haiti.
So I can’t show you how exactly health care is a basic human right. But what I can argue is that no one should have to die of a disease that is treatable.
The biggest public health challenge is rebuilding health systems. In other words if you look at cholera or maternal mortality or tuberculosis in Haiti they’re major problems in Haiti but the biggest problem is rebuilding systems.
We’ve taken on the major health problems of the poorest – tuberculosis maternal mortality AIDS malaria – in four countries. We’ve scored some victories in the sense that we’ve cured or treated thousands and changed the discourse about what is possible.
You can’t have public health without a public health system. We just don’t want to be part of a mindless competition for resources. We want to build back capacity in the system.