Ironies of Inequality: The Ethics of Treating Diarrheal Disease

Rachel Mahoney

In his text Pathologies of Power, Paul Farmer discusses the “ironies of inequality” pertaining to global health standards.  Farmer criticizes the way first world medical research efforts “ditch” medical ethics codes as soon as research begins in poor and underdeveloped countries: “In arguing the health care is a human right, one signs on to a lifetime of work dedicated to erasing double standards for rich and poor … without a social justice component, medical ethics risks becoming yet another strategy for managing inequality” (Farmer 201).

The global crusade to end diarrheal disease is not spared from these double standards, as  “global control of diarrheal disease has always been highly political” (Pollard et al., 165).  In the 1980s the WHO founded several organizations to combat diarrheal disease.  But because most of the funding for these campaigns came from US corporations (pharmaceutical and the like) that stood to gain from vaccine proliferation in the third world, WHO’ anti-diarrheal disease efforts downplayed structural approaches for treating and preventing diarrhea in favor of pharmaceutical ones.  These agenda-minded corporations eventually obscured the importance of diarrheal disease on the global health stage, as efforts to improve general “childhood illness” made diarrheal disease “invisible” (Pollard et al., 165).   Breastfeeding is critical to both the prevention and treatment of diarrhoea. Infants who are exclusively breastfed for the first six months of life and continue to be breastfed until two years of age and beyond develop fewer infections and have less severe illnesses, including diarrhoea.  Even though this information is widely accepted by the international health community, companies like Nestle are still allowed to infiltrate developing markets with less-nourishing infant formula.

Pollard and his colleagues connect these features of diarrheal disease to Farmer’s sentiments about the risks of medical ethics being divorced from social justice:  

“Death from diarrheal disease is equivalent to death from failure to access the most basic form of primary health care.  Thus, the risk of death is very heterogeneous and concentrated among communities that lack access to care, either for geographical, social, or economic reasons.  Even in a country with good vaccination program, those communities are the last to get access to vaccines, especially expensive, new vaccines”  further contending that, “countries must come to see rotavirus vaccines as one of a range of possible strategies available to help combat the problem of diarrheal disease mortality rather than as a standalone intervention” (Polland et al., 166-167).

Causes of child deaths in low-income countries Source: WHO, World Health Statistics 2011

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