January 01, 2009

Global Inequality: Healthcare

author_janis By Janis Prince Inniss

clip_image002Every time we go to a new doctor, there are those dreaded forms asking about our family history. I always feel a little silly when I state that the cause of my father’s death is “unknown,” or I write “cancer???”. How is it possible that in this modern day his cause of death could remain unknown?

At the time of his death, my father lived in the tiny island of Antigua. At 108 square miles (that is 14 by 11 miles), and with a population of about 68,000, Antigua is the main island of the country Antigua and Barbuda. Its location in the Caribbean, the 365 beaches, and year-round balmy weather are some of the reasons that it is a tourist haven. In fact, Antigua’s economy is heavily dependent on tourism and it has luxury resorts that attract some of the world’s richest and most famous.

My father, who was Antiguan, had lived in several countries but returned home in 1976. In 1985, on the advice of a physician friend visiting from the U.S., Daddy went to the only local hospital, Holberton. (Here’s a picture of the hospital taken more than twenty years after my father was there. I don’t remember whether this is what it looked like during his stay though.) There, he learned that his white blood cell count was so low that the medical staff was stunned to learn that he could be alive, much less walking around. Soon after, Daddy was admitted to the hospital. What was going on? Why was his white blood cell count so low?

I no longer remember what tests were performed, but I will never forget being told that the medical staff wanted to do an x-ray. Why is that unforgettable? What has remained with me after all these years is that they could not perform the test because there was no barium sulfate at the hospital! Barium sulfate is given to people as a chalky tasting drink or by enema to illuminate certain parts of the body during an x-ray. This basic item, without which a number of x-rays are useless, could not be performed because there was none available on the island.

clip_image005I recall a discussion about when or whether there would be some barium sulfate arriving from Barbados. Perhaps there was even talk about whether my father was well enough to fly to Barbados to have this x-ray; at that time, many people flew there for medical care. The x-ray was never performed and for me this meant that absolute diagnosis of my father’s condition would remain impossible. He remained in the hospital, emerging only once before having to be rushed back. Within a few days of his second trip to Holberton Hospital, my father died.

This story of one patient’s tragedy exemplifies what health care is like in poorer countries. Today, the Gross National Income (GNI) of Antigua and Barbuda makes it a high-income country as defined by The World Bank, thanks to tourism, online gambling and off-shore banking industries. But in 1985 its GDP was a fraction of what it is today, and it ranked 139 out of 156 countries. As a result, health care suffered.

I have written about some of my mother’s experiences as a cancer patient in the U.S. For as many problems as she has faced, however, the one faced by my father in the Antiguan hospital would never have happened in the U.S.

There are racial and other gaps within the U.S. and in other high income countries, infant mortality being one important example. But, overall differences in health outcomes for high-income versus low- income countries are myriad and usually indicate that people in lower-income countries have poorer health and die earlier. What kind of healthcare could be offered under the circumstance of Antigua’s lone hospital with such woefully inadequate facilities? Compare that experience—and picture—with Antigua’s newly opened “modern facility” Mount St. John Medical Centre. With a helipad to transport patients from neighboring areas, Antigua’s improved GNI seems to be positively impacting the country’s health system.

There is no way to know whether my father would have lived any longer had he walked into a state-of-the-art hospital for that first blood test. Surely, he would have received the proper screenings to identify his illness. It is likely that his final days would have been more comfortable because of the medications and expertise available. Perhaps if he lived in a high-income country he would have accessed routine, preventative health screenings and his illness would have been diagnosed early enough to buy him more time, even if his illness was not curable. And had my father received proper care, my siblings and I would have more information about our own health history, and that information would help keep us healthy.

Should these kinds of issues be so dependent on macroeconomic factors? How could we restructure healthcare so that more people, regardless of whether they live in high or low income societies, can have access to first-rate care?


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This rather sad story which is all too common is the developing world/third world, does a good job of illustrating the effects of both macro and micro sociological forces in determining the life chances and circumstances of individuals within certain social contexts. In addition a historical legacy of "informational inequality" was also created by the existence of material inequality. Interesting for discussion.

How might others lives be different based on different health care resources?

Very poignant post. My family is experiencing the exact same situation currently in a poor (but oil rich) Latin American country. My father-in-law's health and prospects for recovery have no doubt been influenced by country's minimal social spending (due in part to the massive external debt brought on during the height of neoliberal reforms in Latin America). The new leftist President promised increased social spending (such as healthcare and education) but as the worldwide economic downturn has taken effect, the budget which was pegged to the high price of oil must now of course be adjusted. Increased spending in healthcare would not save my FIL's life, it's already too late for that. But the life chances of future generations are being shaped and a lack of preventative care or access to such services will continue this problem for years to come.

thank you for sharing this story with us all.

This article shows a great example of Sociological imagination with the comparing of the health care on the island to that of more developed countries. It also is a prime example of Verstehen, because of the authors current experience she has learned that better care could have been provided for her ill father. When ever health care is discussed one has to think of functionalism, because each country has a different level of care it can provide whether is because of beliefs, income, or other factors. The island of Barbados demonstrates postmodernism due the finical changes that have occurred on the island since the 1980's. How would Comte view the modern day health care inequality in a lower income country to that of a higher income?

I feel that this article gives a good description of how health care differniates between country to country. From one country to another, health care can be literally worlds apart. I thought that the comparison from Antigua from the United States was interesting and demonstrated her point even further. I think that if Anigua did have the top of the line hospitals and healthcare it would have made a difference, maybe not in her father's life but definitly in the lives and at the benefit of his children. I am sure it was hard to not have any explaination about what happened to her father and to have an issue like this; it needs to have closure and an explaination.

Good article.This article shows a great example of Sociological imagination with the comparing of the health care on the island to that of more developed countries..

First of all, thank you for sharing your story. In my online sociology class, we are learning about how different societies are throughout the world. I was shocked to read how different healthcare is in other countries. A simple test could have helped save your father's life.

Thanks for sharing your personal experience. I’m glad that Antigua made a turnaround in 20 years, but some countries are not that lucky. The disparity in healthcare due to the GDP of the nations is shocking. I understand that developed countries have an established healthcare system, but a universal health care plan seems too ambitious, when I see that nearly 46 million Americans are uninsured and suffer from inadequate healthcare.

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