Lachlan Forrow, Beth Israel Deaconess Medical Center and Harvard Medical School
9 April 2014
Sir Nigel has, as usual, done a wonderful job of summarizing some very important issues about how global cooperation to improve health can and should work, to the benefit of all partners, and of all of the people we serve.
The language we use is crucial, and evolving beyond the language of so-called "developed" and "developing" countries and regions is a great advance. But I find myself rebelling against words like "resource-poor" settings, since the most important resource in any setting is the people there, and my experience is that people in what we now label "resource-poor" settings, while often lacking in material "resources", are unusually "resourceful" (or "resource-full"?). We should relentlessly recognize and affirm that.
And while I appreciate the language of "empowerment", I wish we would find better language than talk of "empowering patients". My dictionary (Google) says "empower" means "to give power to". (See http://www.merriam-webster.com/dictionary/empower ). That still assumes that "we" have the "power" and need to "give" it to others. I think that the truth is that the "power" already resides within each person, but historical cultures and power structures have blinded us all to that -- or worse, created such barriers to individuals exercise their own power that the reality is that they have too often tragically become "powerless" in important ways. I don't think that this affirmation of the "power" each individually naturally has is politically-correct ideology, I think that it is a fact of human nature, one might even say a "biological fact" of the way we human beings are constructed -- we (individuals within natural local family/community units) are not only capable of doing many (most?) of the things we need for ourselves, we also thrive most when we are living that way. What we need to do is to stop "dis-empowering" so many people.
Finally, while we talk a lot about the need for many more "health care workers", with appropriate training, we might keep in mind that the most important "health care worker" who can and should be working on behalf of each patient is the patient her/himself (or for a baby/child, the mother and/or father). If we thought first of how to ensure that _these_ "health care workers" (all >4 billion of them, if we set young children aside) have the training that they need, then we would likely find that many health problems would be solved even without needing as many additional trained and paid personnel as we generally assume. This must never, of course, be done in a way that leaves patients or mothers/fathers without the support they need from health professionals -- there are dramatic and unconscionable shortages in doctors, nurses, midwives, community health workers, and other professional personnel that we must urgently address. But we should always first and foremost focus on educating patients and families themselves, both about the things that they can do by themselves and for themselves, and about the things for which they should seek professional assistance (and demand that it be made much more readily available if it is not yet).
If we can do that, then maybe one day Sir Nigel can write a sequel to his wonderful book "Turning the World Upside Down", perhaps titled "How We Turned the World Rightside Up".
Globalization and Health
Superb commentary, but still not radical enough
9 April 2014
Sir Nigel has, as usual, done a wonderful job of summarizing some very important issues about how global cooperation to improve health can and should work, to the benefit of all partners, and of all of the people we serve.
The language we use is crucial, and evolving beyond the language of so-called "developed" and "developing" countries and regions is a great advance. But I find myself rebelling against words like "resource-poor" settings, since the most important resource in any setting is the people there, and my experience is that people in what we now label "resource-poor" settings, while often lacking in material "resources", are unusually "resourceful" (or "resource-full"?). We should relentlessly recognize and affirm that.
And while I appreciate the language of "empowerment", I wish we would find better language than talk of "empowering patients". My dictionary (Google) says "empower" means "to give power to". (See http://www.merriam-webster.com/dictionary/empower ). That still assumes that "we" have the "power" and need to "give" it to others. I think that the truth is that the "power" already resides within each person, but historical cultures and power structures have blinded us all to that -- or worse, created such barriers to individuals exercise their own power that the reality is that they have too often tragically become "powerless" in important ways. I don't think that this affirmation of the "power" each individually naturally has is politically-correct ideology, I think that it is a fact of human nature, one might even say a "biological fact" of the way we human beings are constructed -- we (individuals within natural local family/community units) are not only capable of doing many (most?) of the things we need for ourselves, we also thrive most when we are living that way. What we need to do is to stop "dis-empowering" so many people.
Finally, while we talk a lot about the need for many more "health care workers", with appropriate training, we might keep in mind that the most important "health care worker" who can and should be working on behalf of each patient is the patient her/himself (or for a baby/child, the mother and/or father). If we thought first of how to ensure that _these_ "health care workers" (all >4 billion of them, if we set young children aside) have the training that they need, then we would likely find that many health problems would be solved even without needing as many additional trained and paid personnel as we generally assume. This must never, of course, be done in a way that leaves patients or mothers/fathers without the support they need from health professionals -- there are dramatic and unconscionable shortages in doctors, nurses, midwives, community health workers, and other professional personnel that we must urgently address. But we should always first and foremost focus on educating patients and families themselves, both about the things that they can do by themselves and for themselves, and about the things for which they should seek professional assistance (and demand that it be made much more readily available if it is not yet).
If we can do that, then maybe one day Sir Nigel can write a sequel to his wonderful book "Turning the World Upside Down", perhaps titled "How We Turned the World Rightside Up".
Competing interests
None.