Around the world, billions of people live without access to critical lifesaving surgery. Many also have no access to cancer care, and in many places those who become ill often face the intense pain of disease without the benefit of medications to ease it.
When Ebola hit West Africa in 2014, many global experts said it would be impossible to provide even basic supportive care, such as oral rehydration, and some suggested that it would be best to avoid all contact with patients.
What is at the root of these health inequities and, more importantly, what can be done about them?
These were the central questions panelists discussed on May 19 at the fifth symposium in a yearlong series celebrating 150 years of social medicine at Harvard Medical School.
The panelists analyzed the epidemics and pandemics of the 21st century, combing the recent past and present for insights into how to best address the challenges of coming years.
“We have to start to think about epidemics a little bit differently,” said Salmaan Keshavjee, professor of global health and social medicine in the field of medical anthropology in the Blavatnik Institute at HMS. Keshavjee’s work has focused on fighting outbreaks of infectious disease, such as tuberculosis, in countries from Russia to Peru, while also trying to build a global infrastructure for researchers interested in the science of care delivery aimed at treating a wide range of maladies, including chronic, noncommunicable diseases.
A new way of thinking
The mainstream model of epidemiology often focuses on investigating microbial pathogens, missing the crucial role social, political, economic, and historical forces play in the spread and severity of disease, Keshavjee said.
To address the effects of these forces, it’s crucial to start with deep, sophisticated analysis of intersections and interactions between complex biomedical and social forces, and to look for connections that point the way toward a solution, said Allan Brandt, the Amalie Moses Kass Professor of the History of Medicine in the Department of Social Medicine (In the Faculty of Medicine) and interim head of the HMS Department of Global Health and Social Medicine.
Brandt drew on examples from the work of the department’s former chair, Paul Farmer, who died suddenly in February and had been originally scheduled to participate in the discussion.
Research insights must be translated into action, Brandt said, noting that delivering the promise of modern medicine to all people, thereby averting the many potentially catastrophic disease outbreaks and suffering that the 21st century might yet bring, will require aggressive activism and advocacy.
Keshavjee and Brandt were joined by three panelists who discussed how this approach can lead to more effective responses to some of the world’s greatest health challenges, noting that failure to take social forces into account when trying to protect global health may lead to failed responses and tragic loss of life.