What’s rational?

A pretty sweet discussion is brewing between Alanna Shaikh and Isaac Holeman about global health programs which at first glance may seem to be completely irrational. A great example is Partners In Health who has flown patients with complex diseases such as cancer from Haiti to the US for treatment. This of course costs a lot of money, and one could argue may take funds away from more important broad-based public health interventions.

Alanna wants to consider alternatives:

How do we do it better? It’s not very realistic to argue that you should just ignore seriously ill people and spend the money on public health interventions. No human can do that….

You can’t ethically just take that cash and save fifty children from malaria or helminthes. But you can fly in a team of specialists or oncologists. You can most likely talk them into donating their time for the chance to help someone in a faraway location.

Isaac argues that creating compelling and heartening stories far outweighs the the actual costs:

I think a key issue at the heart of some such of programs is the balance between long term effectiveness and the fierce urgency of now. I agree that the programs she describes would play a very small role in an ideal global health care service, but ultimately what we need more than any specific program is for people to give a damn. Some people have excess resources; we need them to care enough that they are willing to share some of those resources with the rest of the human family. If irrational programs will occasionally inspire people, perhaps they are worth the cost.

I think that the real irrationality lies in the fact that we live in such a divided world that somehow it makes sense to us to spend tens of thousands of dollars a day providing life support to someone who is essentially dead but consider it irrational, not “cost effective” to spend the same on cancer treatment for a young Haitian woman. I think that it is irrational (and immoral) to weight the value of life differently based on color of skin or nation of origin. This means that it is our challenge to fight against the structures that keep resources in the hands of the wealthy and redouble our efforts to bring resources down the gradient of inequality.

Be sure to check out the comments sections on both Alanna’s and Isaac’s posts for some more great dialogue.

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6 Responses to “What’s rational?”


  1. 1 Isaac Holeman January 16, 2009 at 12:48 pm

    Hey Jon,

    Thanks for joining the discussion! I agree with you. A lot of my perspective on peace and social transformation is shaped by my experiences as an exchange student the year after high school. Everything is easier if we know each other a little better, and can be a little more empathetic.

  2. 2 bupublichealth January 17, 2009 at 5:43 pm

    Hi Jon,
    I think many would unanimously agree with your claim that “it is irrational (and immoral) to weight the value of life differently based on color of skin or nation of origin.” Building off of Issac’s comment, hopefully as groups like Partners in Health and the internet in general allow people of wildly different backgrounds to see and interact with each other, many more people will be exposed to these sorts of inequalities and change will occur.

    Alex

  3. 3 Ankur January 18, 2009 at 10:40 am

    “It is irrational (and immoral) to weight the value of life differently based on color of skin or nation of origin.”I’m becoming more and more convinced that this is the foundation of many of the struggles for GHE. Ultimately, this is the same struggle that Civil Rights leaders faced in the U.S. trying to secure equal liberties regardless of skin color. It’s the same struggle that the United Kingdom faced internally in abolishing the slave trade, and the same struggle that Gandhi and people in colonial India fought against the U.K.. The understanding that all human life must be valued equally seems to be the fundamental ongoing struggle for humanity. If we can overcome that, then we have a much brighter future ahead.

  4. 4 Alex January 19, 2009 at 9:37 pm

    Ankur,
    I would dare say that this problem facing GHE is bigger than the civil rights struggle in the US, than abolishing the slave trade. We’re talking about all of humanity this time, and actually operationalizing this right that people should not be treatedly differently based upon their origin or color of skin is such a massive undertaking, perhaps we should find a different, more pragmatic line of reasoning to expand quality health care to others?

    Alex

  5. 5 Ankur January 20, 2009 at 3:44 pm

    The scales in terms of numbers of people between a movement for GHE and other historical examples are vastly different; but the underlying challenge is the same — operationalizing a collective mind-shift of one, large group of people to view another group as sharing the same fundamental human dignities and rights. While a Laurie Garrett argument – that quality health care must be expanded to others in order to prevent a ‘common plague’, or an Exxon Mobil argument- that malaria must be tackled because it is a prevalent problem for much of its African workforce – have certainly started to drive forward important results, it inevitably sidesteps the root problem, which lies in the way many individuals view poverty and inequities in health. The successes of the Civil Rights movement, is not that it mobilized thousands to march. Rather, it lies in its ability to have radically shifted the way one group of people viewed another in the U.S.. The deeper pragmatism for GHE lies in understanding how (what tools, stories, politics and larger strategies) we can use to operationalize this mind-shift towards a recognition of dignity and rights in all.

    In terms of scale: let’s just start with our own nation(s). Even that will help drive a lot of things forward in the right direction.

  6. 6 Laura January 22, 2009 at 6:50 pm

    What a great post & a solid conduit to incredible dialogue. I have two quick points:

    1. I don’t think that this is necessarily a problem with race and nation of origin. I think that it becomes more of a classist issue…no matter the country of origin, race/ethnicity, etc. the fact remains that people without a voice are not treated with the same dignity as the affluent whether it’s in Haiti, South Africa, or the US. I dare say that the spending of exorbitant health costs for a diplomat or eminent leader would resound much differently in the eyes of the public than one of Dr. Farmer’s patients from Cange.

    2. I have a problem, not with the spending of resources for individual patients who need help, but with the health care costs that have been allowed to inflate indefinitely. For me, the question is not–is treating this patient cost effective?– but instead, how have we allowed this system to spin out of control in such a way that we must employ an economic algorithm to determine whether the life should be saved?


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Welcome to the Students for Global Health Equity (SGHE) blog. Published by university students, the SGHE blog seeks to explore news and issues related to global health.

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