W5: Poverty Worsening Infectious Diseases

This week in our lectures we learned the term “structural violence”, coined by Paul Farmer, that can be explained best by breaking it into its two parts. Structure, comes from the social arrangement being completely rooted in our economic and political systems. It is violent because they cause injury to people. This phrase is used to describe the way social arrangements can put specific individuals in harm’s way. To call Ebola an emerging disease is not accurate. According to Paul Farmer, Ebola was identified decades ago, why it is just now gaining attention could be because of who is now at risk, “Is it simply because they have come to affect more visible-read, more “valuable”-persons?”(Farmer 1999, 156). Historically Ebola breakouts occurred in isolated villages in remote areas. Michael Osterholm points out in The Changing Face of West Africa Has Fueled The Ebola Crisis that the virus has not changed, Africa has changed. The population in Africa has tripled over the last four decades; remote areas and isolated peoples are now closely confined. The first step to combat Ebola and other infectious diseases is to find the root of the problem. In many cases this problem has underlying socioeconomic ties. Studies conducted have found a strong correlation between poverty and the spread of infectious diseases. Partners in Health stated that Ebola suffers living in poor conditions infected 3.5 times more people than suffers living in rich areas (Partners In Health, 2016). This information is staggering, it points at a clear first step, invest in medical care in impoverish areas. Focusing on developing the slums could significantly reduce future risks of infectious disease outbreaks, “Poverty makes people sick; treat both” (Partner in Health, 2016). Quarantining entire villages does not solve the underlying problem. Most importantly they need supportive care in the form of “staff, stuff, and supplies”. Areas need properly trained medical staff and the supplies necessary to keep them safe. It should start with community health workers first, followed by nurses, then doctors. Infectious disease specialists are not needed to treat Ebola or malaria.

The current state of the world has lead to much debate of the health and well-being of those who have had to flee their homes to become refugees. Similar to what occurred in Africa, large groups of people living in close and unsanitary quarters. The likelihood of the spread of infectious disease is high. From the Spirit Catches You and You Fall, like those in Africa the people in the refugee camps were forced to live in toxic conditions, “the camp officials tend to hold the Hmong responsible for their own dependence, poor health, and lack of cleanliness” (Fadiman 1998, 180).


African Ebola Outbreak: Growing Inequality in Global Healthcare at Root of Crisis. Democracy Now! 2014. http://www.democracynow.org/2014/8/22/dr_paul_farmer_on_african_ebola

Beaubien, Jason. “The Changing Face of Western Africa Has Fueled The Ebola Crisis”. September 2014. NPR. http://www.npr.org/sections/goatsandsoda/2014/09/05/346142023/the-changing-face-of-west-africa-has-fueled-the-ebola-crisis

Fadiman, Anne. 1998. The Spirit Catches You and You Fall. Farrar, Straus and Giroux.

Farmer, Paul. 1999. Partner to the Poor. University of California Press

Partners In Health. “Study Finds Poverty Spread Ebola”. January 2016. http://www.pih.org/blog/study-finds-poverty-accelerated-ebola



9 thoughts on “W5: Poverty Worsening Infectious Diseases

  1. Sohpia, I really appreciated your reference to Farmer’s “staff, stuff, supplies.” When outbreaks like Ebola happen outside the US, many people are always going about the countries afflicted taking care of it themselves, or blaming them for the outbreak because the US would never let it happen. Every time there is an outbreak it just refreshes in my mind how little most of the country understands even the basic interplay of the economic strength of a country and its ability to implement public health precautions. Even the idea of ‘poor’ or ‘tropical’ diseases aren’t even accurate, since, as Dr. Farmer said, pathogens don’t care about borders. But there is such a sharp divide in the type of health care poor people get when compared to more well-off people, as you said.
    I also liked your reference to how the Hmong’s terrible living conditions became, in the eyes of those in charge of these camps on the other side, their own fault from their choices. Totally ignoring that almost no one would choose to live in those conditions unless the other options weren’t plausible. At the end of the day, most people want happy, healthy lives with their families, and the Hmong had no guarantee of any of those things if they left the camp since their homeland was destroyed. And yet, the average camp official seemed to think the Hmong preferred living in diseased squalor. But we know, from the book, the real reasons so many stayed and wouldn’t risk leaving.

  2. The way in which you broke apart “structural violence” and defined it in two parts provided a very clear explanation of what this phenomenon coined by Dr. Farmer is. Furthermore, your explanation of why Ebola is now garnering more attention is very shocking. This disease has been around and affecting people longer than some think, and yet it has not gained much attention because the people being effected were not seen as “valuable”. Now, however, with this disease affecting more and more people (people who are seen as “more valuable”) and the possibility of it spreading to other countries, it is massing more attention and more fear.

    I think it is ridiculous that individuals, such as the Hmong and other people in refugee camps, are being held responsible by officials for the poor health that runs rampant in these conditions. What can people do to combat these poor situations, both in refugee camps and in poverty-stricken communities, when they do not have the necessary “staff, stuff, and systems” needed to improve the health of the people? Countries with the ability to provide the three key elements that Dr. Farmer points out, need to step up and help teach people how to be educated staff, help get the medical stuff that is needed to improve peoples’ health, and help put into place systems to prevent an outbreak of infectious disease, such as Ebola, from happening again.

  3. Hi Sophia! I really like how you explained what the term “structural violence” is. It is astounding that inequalities in political, economic, or social power lead to better or worse outcomes for particular groups of people. It is also astounding that the Ebola outbreak, like you said, is now gaining so much attention possibly because they have come to affect more “valuable” people. If this had happened in the United States we would have had the resources to contain the disease and restrict it from spreading. It is overwhelming that socioeconomic status can have such a huge impact on ones health. From an article that we read this week called, Rethinking ‘Emerging Infectious Diseases’, it mentions that many “tropical” diseases affect the poor; the groups at risk for these diseases are typically defined more by socioeconomic status than by latitude. In Haiti, for example patients with malaria are almost exclusively those living in poverty (Farmer, 2006). There is also a great concern with the way that local people are treated. Local people feel exploited or ignored by the international biomedical teams. Euro-Americans would move up and down the river in fast boats, stopping only to take blood or fecal samples. The Euro-Americans did not ask about their well-being and also did not tell them the results they were finding (PDF 5.1). Hopefully we can combat these issues so that one day there will be equal access of medical care to everyone and that there will be a greater concern of emotional well-being and peoples cultural norms.


  4. I too used Farmer’s quote about how emerging diseases are not emerging, but they are only gaining attention now based off of the “valuable” people who are not affected. I like how you connected the fact that these diseases are usually found to be linked to socioeconomic aspects. I found that very interesting, and something that a lot of people do not realize. It also made me question why we know that disease spreads so much faster in these areas of poverty, but nothing is being done. Healthcare is so important to any community or country, it should be treated as a top priority. It’s no wonder why people try to go to countries with modern medicalization, when some areas have absolutely nothing to offer. You’re right, specialists are not needed to treat these diseases, an average hospital with enough people and supplies will work just fine. We can’t blame the people when they have no knowledge of the severity of these diseases or what kind of care they deserve to have. Most think that this is the way things are supposed to be, and their governments are doing nothing about it. At the end of the day, the people in a community are the most important part and that needs good healthcare.

  5. This was a great post. You touched on things that a lot of people don’t want to call out, like “Ebola was identified decades ago, why it is just now gaining attention could be because of who is now at risk, “Is it simply because they have come to affect more visible-read, more “valuable”-persons?”” It’s amazing to me that such strong political and economic inequalities lead to a severe decrease in human safety and health. Labeling a human as more valuable than another human is a sickening thought. It really seems to me that there is a continuous negative feedback loop going on here: the more inequality there is leads to more poverty which leads to more spreading of disease, and so on and so forth. I would like to agree with you when you say that the root of the problem, what we are searching for in order to fix the problem, lies within socioeconomic statuses. It always has and it always will. That is the structural part of the structural violence in my opinion. The structures we form our world around will always, so it seems, keep the world at a standstill. There will always be the best populations and the worst populations, if you will, an invisible line that separates the higher SES and the lower. That’s the root of the problem, and it’s only possible to fix it when we all come to terms with this idea and completely change it.

  6. Sophia,

    I completely agree with you that poverty is worsening Infectious diseases. Developing countries simply cannot afford to provide the correct health care for their communities. In my opinion I think that developed countries should come together to create a better health care system in developing countries. Our world is made up of humans and all humans deserve to be treated equally. As a developed country we are fortunate to have enough money to provide great health care and it is our duty to help our neighbors. If we could help instill some proper health care methods in developing countries such as Africa the infectious diseases would be much more well controlled. Although in theory socioeconomic status should not have anything to do with healthcare, unfortunately, as you said, it has a lot to do with healthcare. These poor people are not given the basic tools to run and operate proper health care facilities. Instead of Americans going to developing countries to take blood and do research, they should be going over there to build and leave an impact on others. The reason “white” people are so stigmatized in developing countries is because it appears that we go to these countries not to help these communities but to help ourselves.

    Taylor Dabish

  7. Hi Sophia, great job on your post. What really caught my attention on this post was how Michael Osterholm pointed out that the “virus has not changed, Africa has changed” and that virus is referring to Ebola. I do not know how I feel about this statement because I feel that it is easy to agree and disagree with. I agree with it because Africa is changing day-by-day but I disagree with it because it is not changing in that sense. Ebola is a disease that does not discriminate who it infects and whom it does not. But I feel the reason that it is more prevalent in areas with high poverty rates is because they do not have the same access to health care. Access to health care, I feel, is the biggest problem people face. I do not agree that poverty makes people sick. It is not a leading cause for many infections, but being in poverty does not help when you are infected with a disease like Ebola. Blaming people in refugee campus for the spread of disease and infection is not right. The camps are very tight and people are very close to each other. It is not the refugees faults that disease is spreading.

  8. I think your post was very insightful especially for addressing who is valuable and who is not. I also found it interesting as well to know that Ebola has been a present disease for decades now and I absolutely agree that if this disease had spread in a privilege country such as the United States that it would have been addressed and stopped quicker than it has. I completely agree and it is very frustrating to know that socioeconomic status has an impact on the type of health care received. This is not just true amongst countries but also amongst the citizens in those countries. By that I mean that those who have a lower socioeconomic status receive less healthcare prevention, access, and care than those who have a higher socioeconomic status. This is outrageous because those who are in a lower socioeconomic area need better health care due to increase exposure to disease, higher risk of contagious infections, and much more. I think that this world is based on power and privilege if you are not a part of that then you have to go through harsh conditions to have better health. I am wondering what is the best way to share the healthcare equally?

  9. I agree very much with the statement you highlighted that said, “poverty causes illness treat both”. I could not have said this better myself because if you think about it poverty stricken people tend not to seek preventative healthcare. The cause for them not seeking preventative care is because mainly it costs a lot to have medical treatment or even medical advice. Yes I know doctors need to make money and provide for themselves but if you think about it if every doctor in the world took a weekend ou of every month to help those who cant afford healthcare we would be able to get disease and illness rates down significantly. Or even if there were clinics that were sponsored by the government that were in poorer areas then people would be able to be seen. If we know that the root of the problem comes from poverty stricken areas then we should obviously start there for working on making sure outbreaks of illness are better controlled. Also making sure people have the right information on how to take care of themselves and prevent disease from spreading plays a huge roll in making sure illnesses and diseases stay contained.

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