|Year : 2007 | Volume
| Issue : 3 | Page : 135
Book and electronic media review editor, Education for Health
|Date of Web Publication||28-Jan-2013|
J A Gravdal
1775 Dempster St., IL 60068 Park Ridge
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gravdal J A. Book Review. Educ Health 2007;20:135
Awakening Hippocrates: A primer on health, poverty and global service
Edward O'Neil, Jr
American Medical Association, USA (2006)
502 pp., ISBN 1-57947-772-0
"Never underestimate the ability of a small group of committed individuals to change the world. Indeed, they are the only ones who ever have."
- Margaret Mead
This essentially describes the thesis of Dr. Edward O'Neil's book Awakening Hippocrates: A primer on health, poverty and global service. His desire is to make the case that as health professionals we should all engage in a global work force to improve health in the parts of the world where others are less fortunate than we are.
In his first chapter Dr. O'Neil discusses the forces of disparity which propagate illness. He tells us that the greatest enemies of good health are poverty and structural violence. Dr. O'Neil wants his readers and all health professionals to engage in not only understanding the disparities in health, but in becoming part of the solution. He then goes on to lay out the case for the current state of health in the developing world. He tells us there are three simple observations: the first is that most wealthy countries have "a large cadre of health care providers whose healing powers now reach unprecedented levels", the next, that our profession concentrates our knowledge and skills for those who can afford them, and finally that "there is an ethical imperative that compels us to care for all who need us".
Dr. O'Neil reports to us about how we have tried to improve health in the world through agencies such as the United Nations and many non-governmental organizations. He goes into detail about bilateral aid and multilateral aid as forces for development. He strives to analyze perceptions and the realities of what he describes as "Our Beneficence". He examines the forces of disparity looking at trade, multinational corporations and private financial flows. He also looks at the impact on health disparities by racism, governance and militarism as well as sexism, population growth, environmental events and infectious diseases. Finally he discusses the impact of ethics, religion and human rights on people's health.
Following the display of information, there is then a shift of focus to give the reader examples of physicians who have worked in the parts of the world with the greatest health disparities. Dr. O'Neil uses these vignettes to demonstrate the "power of direct action". Some of these individuals are iconic figures for most health professionals: Albert Schweitzer, Tom Dooley, Paul Farmer. All of their stories remind us that as individuals we can do something to improve the health of others.
From cover to cover, Awakening Hippocrates does stir up the reader's emotions about the state of health and the tremendous disparities that exist around the world. To that end, Dr. Edward O'Neil has been successful. However, through his very detailed and careful navigation of these waters he does neglect an important opportunity. There is no mention of the value of primary care in improving health. Barbara Starfield and other authors have repeatedly demonstrated that the evidence shows that primary care helps prevent illness and death, and that primary care is associated with a more equitable distribution of health in populations. This is a finding that holds in both cross-national and within-national studies. In addition, the means by which primary care improves health have been identified (Starfield et al., 2005).
So although we must support the eradication of poverty and of structural violence, we must also work to truly strive for the accessibility of quality primary care for all. The funding that goes towards the vertical public health programs for disease control such as the fight to prevent malaria and tuberculosis are having some impact on health indicators as documented by Dr. O'Neil. However when one looks at the Millennium Development Goals, perhaps the best opportunity to achieve them lies in the training of a primary care workforce of health care providers to allow access to high quality care.
Dr. O'Neil is correct. There is a need for a call to action for all health care professionals in the developed world to be more responsive to the needs of others. Perhaps the focus of that call however should be to encourage participation in a global effort to provide uniform medical education for primary care providers. This might shift the stories that Dr. O'Neil refers to about people and organizations that have "percolated down through the medical profession like surreal dreams" instead to stories that would demonstrate concrete systematic changes leading to improved health.
Dr. O'Neil's book is a wonderful compendium of back ground information and inspirational stories that should encourage health professionals to work globally. Let us hope that it will also serve as a catalyst for discussions by policy makers about what has worked, and what has not to achieve quality, accessible health care for all.
"Give a man a fish and he will eat for a day. Teach him how to fish and he will eat for a lifetime."
Alain J. Montegut, MD
Department of Family Medicine
Boston University Medical Center
Starfield, B., Shi, L. & Macinko, J. (2005). Contribution of Primary Care to Health Systems and Health, The Milbank Quarterly 83 (3), 457-502.