Massachusetts General Hospital Vincent Program in Global OB/GYN
Welcome to the March newsletter! Our goal is to share with you stories from our work around the world, important new publications from academia and the media on global women’s health, a few fun facts, and tips on how to stay safe while traveling. We’d love your input, so if you have a story, or wish to share a tip, send them our way at firstname.lastname@example.org.
From the Editors: AK Goodman, Adeline Boatin, Tom Randall
Medicine is a tool to restore and monitor health. Good policies and good socioeconomic standing are the means to health. In this newsletter, let's explore the relationship between socioeconomic status and health.
Notes from the Field
By Arun Chaudhary, MPH
Abiral Foundation team members responding to the earthquake (Lalitpur, Nepal, 2015)
Prasit Kandel (in the middle), co-founder of Abiral Foundation, at a Temporary Learning Center (Dolakha, Nepal, 2015)
During the 2015 Nepal earthquake, my Nepalese friends in the US, predominantly from middle and high-income families, and I were fortunate enough to have our families in Nepal escape severe consequences of the earthquake. Amongst my large network of friends in the US and Nepal, I did not learn of a single incidence of casualty. 10,000 random deaths (mostly among low SES people), a total population of 29 million, and not a single casualty in my wide network- these statistics startled me. While I am grateful that my network was unharmed, the earthquake’s disproportionate harm to low SES people was quite unsettling.
In Kathmandu, the entry point for foreign aid delivery, authorities could not have been less prepared. International responders, food, and medicine sat at the airport instead of being swiftly deployed. Unable to manage responders, at one point, the Nepali government forbade additional international responders from traveling to Nepal. Food distribution was redundant in some affected locations but scarce or absent in others. Incompetency and unpreparedness resulted in an unspecified amount of food to rot and later dumped in landfills. Mismanagement and lack of accountability allowed powerful and opportunistic people to plunder foreign aid like tents, fuel, food, and medicine and trade them in the black market, creating an utterly shameful scene. A system that allows a tragic event to unfold in such a shameful way is the surest sign of all forms of inequalities. In such settings, we can safely assume health inequality is large, and natural disasters disproportionately affect lower SES people.
A group of my friends in the US and Nepal and I had responded to crises in Dhading, Dolakha, Lalitpur, and Gorkha. These settlements were heavily devastated, but what troubled us more was how little families owned and survived on. Some families’ living conditions were so dire that our aid brought access to more food. We knew right away that short-lived disaster response was far from being an adequate relief. At the time, I had just begun my master’s in public health; a non-profit organization that promoted rural health made sense. We called ourselves Alliance for Health Aid and Awareness for a couple of years, and later Abiral Foundation, which works to improve the overall socioeconomic status, including rural health.
So why did we switch our focus from rural health to overall socio-economic development? As we conducted health missions in rural areas, it became clear to us that by focusing on just health, we were only attending to symptoms of interconnected underlying issues- poverty, illiteracy, lack of infrastructure and gender inequality- and health projects alone were inadequate in solving socioeconomic issues or health problems. We realized that a lot of our previous work, including cataract surgeries, health screening, free medicines, and referrals to specialists, uncomplimented with socioeconomic development, simply meant rescuing sick people from one health condition to suffer from another later.
Epidemiologically, socioeconomic issues are no different than infections- in lack of effective intervention, it transmits from one generation to another, bad policies and governance are vectors, and our sociopolitical system is the environment that allows them to flourish. Our efforts are often reactive, and we respond only after the culmination of adverse events. But socioeconomic issues are already too prevalent to manifest as an outbreak, and low SES people already live in post-disaster like conditions. All policies are health policies, and all interventions are health interventions. Whether in health or non-health sectors, everyone’s work impacts health. So, are our current efforts adequate to fix health inequalities at the very root level?
Author's biography Arun Chaudhary is a social epidemiologist and an advocate for gender equality and socio-economic development for health equity. He completed his master's in public health (epidemiology and global health) from the University of Texas Health Science Center at Houston in 2018. Currently, he coordinates a global health program- Global Initiative to End Gender-Based Violence- at Massachusetts General Hospital and manages a clinical laboratory at Boston Medical Center. He is a co-founder and a board member of Abiral Foundation and an active member of Health Foundation Nepal, non-profit organizations that work to improve socioeconomic status and health of rural population in Nepal.