A Conversation with Global-Health Activist Paul Farmer

The following conversation is taken from Time magazine (13 May 2013).  Dr. Paul Farmer, a Harvard professor and global-health expert, is the founder of the NGO “Partners in Health” and the subject of the bestselling book Mountains Beyond Mountains.

You say the very poorest don’t get health care because of a failure of imagination.  Is that really what it is?

It must be, because a lot of the technologies or the human resources that you’d need to do a good job in settings of poverty, we have them.  We have great preventives like vaccines.  We have new ways of diagnosing.  We have a lot of therapies that can save lives.  We know a lot about how to build teams who can deliver care.  So it must be a failure of imagination.

Instead of aid, you prefer the idea of “accompaniment,” of staying with people until they believe all their needs are met.  Doesn’t such an open-ended approach take more resources than we can spare?

Great health care may be less expensive than emergency or tardily administered health care.  I’ve been lucky enough to work in rural Haiti, rural Rwanda, and have seen what happens when there are judicious investments.

Does it exhilarate you more to change public policy or to physically save one guy?

In Rwanda, for example, just 10 years ago there was no community-based health-insurance scheme.  Now almost 95 percent of Rwandans are involved in at least some health-insurance scheme.  Life expectancy has almost doubled.  Child mortality has plummeted.  Death during childbirth and deaths from AIDS and tuberculosis have dropped precipitously.  Although it’s enjoyable to deliver care, it’s better to do it in a system that’s going to protect everybody.

What is the best idea you’ve ever had?

My success as a doctor has been dependent on people who can make sure patients and their families receive the services that we prescribe.  The best delivery idea we’ve had, looking at chronic disease, has been community health workers, who can accompany patients over time.

Farmer’s new book is titled To Repair the World.

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2 Responses to A Conversation with Global-Health Activist Paul Farmer

  1. Adverse selection is an important concern for any voluntary health insurance scheme. Targeted subsidies are often used as a tool to pursue the vision of universal coverage. At the same time targeted subsidies are also associated with increased adverse selection as found in this study. Therefore, it’s essential that targeted subsidies for poor (or other high-risk groups) must be accompanied with a sound plan to bridge the financial gap due to adverse selection so that these schemes can continue to serve these populations.

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