The US and the compromise of global healthcare: Who knew US forgein policy practice and Idi Amin had something in common?

In 2005 I stood before a room of 35 people and declared I hated politics. Now I can’t get enough of it. I credit Paul Farmer firstly and a political science course on the causes of war secondly. Through these forums, I began to realize how powerful the United States is on the world stage.

Paul Farmer enticed me to explore the history of US-Haiti relations. It’s not a pretty one. I learned how the US manipulates weak states to serve their own interests. I learned how the media manipulates the US actions to bolster patriotism. I learned how the poor affected by these manipulations suffer. I learned that if you truly wish to know the truth, you have to dig for it—there’s a solid chance it won’t be hanging out on the surface for the public to glimpse as they put their shoes on in the morning.

While speaking with my uncle, who served a tour in Iraq, he told me stories about playing soccer with the kids, about jokingly trying to sell one of the women logisticians, about the cultural differences, and about how the entire time he was there and the year previous, civilians didn’t have reliable electricity. Why? It had been initially cut during the invasion in 2003 when Iraqi infrastructure was destroyed and two years later in 2005, they still had unreliable power. This has numerous impacts on health, from the sanitation of unrefrigerated foods to the lack of electricity and thus running water in clinics and hospitals.

The actions of the U.S. affect the standard of living for people all over the world. In Iraq, for example, economic sanctions prohibited the nations from importing the materials needed to repair their destroyed infrastructure. The same sanctions, I imagine, inhibit the advancement of medicine. It almost seems a stretch to discuss advancement of medicine when their healthcare infrastructure was struggling to provide services to people in its precarious state.

U.S. policy and U.S. ideals have had great, and sometimes negative, impacts on other nations around the world. I read of rebel groups destroying infrastructure in the DRC. I read of Idi Amin’s destruction of the formerly impressive Ugandan healthcare infrastructure. It at first may seem different when this destruction involves actors on the same level (i.e.- all actors of developing areas), but it’s necessary to take a step back and realize that the United States is participating in the same actions. As Amin brought mass human rights violations in Uganda in the 1970s, the US brings them upon less stable, less developed states now. The U.S.—which ideally should be an example in human rights if it is to be a world power with mass resources—is just as guilty of violating human rights. They’re just better at covering it up.

We denounce the cruelties of rebel groups roaming sub-Saharan Africa, but who is holding the United States accountable? It’s certainly not the UN.

Who Lives? Who Dies?

“It makes no great difference how a society distinguishes the marks of infamy that allow it to separate those who may live from those who can or must die; the human mind, endowed with limitless imagination, can redefine them in accordance with the latest notions of an ideal society. While in certain countries skin colour or the way a particular word is pronounced is enough to provoke a roadside execution, in contemporary Western societies such indicators have been displaced from the surface to the interior of the human body. Today, because of ‘biological deviance’ (hypocholesterolaemia) or ‘behavioural deviance’ (obesity), an individual may be refused treatment or medical insurance.”

-In the Shadow of 'Just Wars': Violence, Politics and Humanitarian Action

It’s interesting how the idea of what society should be changes the discriminatory factors attached to certain peoples. It changes like fashion—yesterday it was the minimal, two button blazer; today it’s the strong shouldered blazer heralding the shoulder pads of the early 90s. While discrimination by race in the US has reduced since the Jim Crow days, new forms of discrimination have bubbled under the surface of society, so ingrained that most don’t notice them on a daily basis. The genetic factors that deprive people of appropriate health insurance, the economically challenged neighborhood that denies residents access to fresh foods. These are forms of structural violence that go widely unnoticed in the United States—in Knoxville—except by those who live it.

Perhaps it’s because I spend too much time reading of people living far away that the implications of the above passage stopped me. As soon as the change from external to internal discrimination indicators was explicitly stated, it was blatantly obvious. I knew these problems existed; I’ve spent hours in conversation denouncing the injustices of the healthcare system and the health inequities due to socioeconomic status. But never had I directly linked them to the term structural violence* and put them on the same mind page as corrupt aid-hording governments I come across in my readings of the developing world.

Lately, my global health comrades at AMSA (American Medical Student Association) have been pushing the fact that global health includes the entire globe—yes, that includes the U.S. We are not above global health inequities, yet we like to talk as if we are in another class. We have “the best healthcare in the world”. (I’m still trying to figure out what statistics people are looking at when they declare this.) Yet Americans are plagued by government corruption (any lobbyists in the crowd?) that creates obstacles in obtaining healthcare. Complaints in some regions of sub-Saharan Africa are that there are no clinics, no doctors. We have the clinics and doctors, but that doesn’t mean they are accessible to the average uninsured person. A person without health insurance likely cannot afford medical treatment. They almost positively will not seek preventative care. If they have a known genetic disorder and try to purchase insurance? Forget it. No one will insure them if they have a preexisting condition.

In the States it’s no longer denial of opportunities because you’re black. But it might be because your grandfather had high cholesterol. The internalization of discriminatory factors has pushed injustices behind the curtains. You only notice them if you’re in the play. If you’re healthy and living in suburbia with 2.1 kids, you probably won’t notice the violence committed against your fellow citizens by the very government that is supposed to protect them. These internal markers are not as blatant as skin color, but the consequences of modern discrimination create inequities just the same.

*Structural violence is the violence that systems—political, economical, social, cultural, religious– commit against individuals.