"Progress is more plausibly judged by the reduction of deprivation than by the further enrichment of the opulent. We cannot really have an adequate understanding of the future without some view about how well the lives of the poor can be expected to go. Is there, then, any hope for the poor?" -Amartya Sen, "Will There Be Any Hope for the Poor" as cited in Paul Farmer's book titled, "Pathologies of Power: Health, Human Rights, and the New War on the Poor."
Paul Farmer's book, "Pathologies of Power," is a compelling read about health inequities and "structural violence"--inequities caused by the systems in which people find themselves. I find the above quote, like most of the book, thought provoking. How frequently we measure progress by looking at the "have's" rather than the "have-not's." The author argues that in improving the lives of the poor, we need to focus not on interventions that are guided by "cost-effectiveness" or "sustainability," (terms that pervade the field of public health today) but rather on those that strive for excellence and equity.
A focus on "excellence" and "equity" in health, which ultimately comes from a focus on health as a human right rather than the more popular notion of market-driven health, will require a new way of thinking about health. A poem by Bertolt Brecht begins with these lines, "The more there are sufferings, then, the more natural their sufferings appear. Who wants to prevent the fishes in the sea from getting wet?"
That, in part, is our challenge.