The network - Towards Unity For Health

BOOK REVIEWAwakeningHippocratesBook review of: Awakening Hippocrates:population growth, environmental events,A Primer on Health, Poverty and Globalethics, religion, and human rights.ServiceAuthor: Edward O’Neil, JrFollowing this display of information, thereISBN 1-57947-772-0, 502 pp.is then a shift of focus to give the readerexamples of physicians who have worked in“Never underestimate the ability of a smallparts of the world with the greatest healthgroup of committed individuals to changedisparities. O’Neil uses these vignettes tothe world. Indeed, they are the only onesdemonstrate the ‘power of direct action’.who ever have”.Some of these individuals are iconic fig-- Margaret Meadures for most health professionals: AlbertThis essentially describes the thesis of EdwardO’Neil’s book. His desire is to makethe case that as health professionals weshould all engage in a global work forceto improve health in the parts of the worldwhere others are less fortunate than we are.EngagementIn his first chapter O’Neil discusses theforces of disparity which propagate illness.He tells us that the greatest enemiesof good health are poverty and structuralviolence. O’Neil wants his readers and allhealth professionals to engage in not onlyunderstanding the disparities in health,but in becoming part of the solution. Hethen goes on to lay out the case for thecurrent state of health in the developingworld. He tells us there are three simpleobservations: the first is that most wealthycountries have “a large cadre of healthcareproviders whose healing powers now reachunprecedented levels”; the next, that ourprofession concentrates our knowledgeand skills for those who can afford them;Schweitzer, Tom Dooley, Paul Farmer. Allof their stories remind us that as individualswe can do something to improve thehealth of others.Primary CareFrom cover to cover, Awakening Hippocratesdoes stir up the reader’s emo-tions about the state of health and thetremendous disparities that exist aroundthe world. To that end, Edward O’Neil hasbeen successful. However, through his verydetailed and careful navigation of thesewaters he does neglect an important opportunity.There is no mention of the valueof primary care in improving health. BarbaraStarfield and other authors have repeatedlydemonstrated that evidence showsthat primary care helps prevent illnessand death, and that it is associated witha more equitable distribution of health inpopulations. This is a finding that holds inboth cross-national and within-nationalstudies. In addition, the means by whichprimary care improves health have beenidentified (Starfield, 2005).O’Neil. However, when one looks at theMillennium Development Goals, perhapsthe best opportunity to achieve them liesin the training of a primary care workforceof healthcare providers, to allow access tohigh quality care.O’Neil’s book is a wonderful compendiumof back ground information and inspirationalstories that should encourage healthprofessionals to work globally. Let us hopethat it will also serve as a catalyst for discussionsby policy makers about what hasworked, and what has not, to achieve quality,accessible healthcare for all.ReferenceSTARFIELD, B., SHI, L., & MACINKO, J.(2005). Contribution of Primary Care toHealth Systems and Health. TheMilbank Quarterly83 (3), 457–502.This review has been published before inEducation for Health, Volume 20, no. 3,2007.D E C E M B E R 2 0 0 8 N E W S L E T T E R N U M B E R 0 2 | V O L U M E 2 7and finally, that “there is an ethical imperativethat compels us to care for all whoSo although we must support the eradica-Alain J. Montegut | Department of Familyneed us”.tion of poverty and of structural violence,Medicine, Boston University Medicalwe must also work to truly strive for theCentre, United States of AmericaO’Neil reports to us about how we haveaccessibility of quality primary care for all.Email: jgravdalmd@gmail.comtried to improve health in the world throughThe funding that goes towards the verticalagencies such as the United Nations andpublic health programmes for disease con-many non-governmental organisations.trol - such as the fight to prevent malariaHe also examines the forces of disparityand tuberculosis - are having some impactlooking at e.g. trade, racism, governance,on health indicators as documented by7