How can a research university address problems of health care delivery, especially for the poor or otherwise vulnerable? The late Paul Farmer asked that same question to open an op-ed published in The Crimson eleven years ago this past May. As we commemorate his remarkable life and legacy at a University-wide memorial event on October 1, revisiting this question has never been more urgent.
At the heart of Paul’s vision for mobilizing universities to address global health inequities are two powerful ideas: That health care is a human right and that disparities in health outcomes and access to quality health care are symptoms of deep historical injustices. This moral clarity guided his life’s work, an essential part of which was his commitment to building global health as a vibrant discipline for education, research, and service.
The past few years have seen the coincidence of two major global forces which have highlighted the importance of universities in addressing global health inequities.
First is the growing acknowledgement that health disparities are inseparable from the global history of colonialism which led to the inequitable distribution of power and resources within and between nations — the subject of Paul’s final book.
Second is the deepening of existing health inequities by the pandemic. Witness, for example, higher Covid-19 mortality rates in low-income communities and the offering of now multiple rounds of boosters in wealthy countries while many in less-resourced countries had not even received their first dose. These inequities are all set to worsen as the health consequences of climate change begin to bite deeper, hitting the already worse-off the hardest.
As these global challenges mount, we are called to embrace and advance the legacy Paul left us.
We must do so with a clear moral vision. Strong collaborations with institutions that serve low-income or marginalized populations are at the heart of our efforts to realize global health equity. Such partnerships must be founded upon the kind of long-term, consistent commitment necessary for building deep and mutually rewarding relationships. As Paul argued in his op-ed, it is insufficient to invest solely in one’s own students and faculty; instead, he argued that “every training program at Harvard should be ‘mirrored’ by similar commitments to help our host countries address their own training needs, since in each of these countries there are talented students and trainees who would also like to devote themselves to improving the health of their fellow citizens.” Turning these stirring words into bold action, Paul spearheaded the founding of the University of Global Health Equity in Rwanda in 2014, which has since emerged as a major force in the field in the Global South.
The best memorial we can offer for Paul’s untimely passing is critical reflection on how we might further his vision of “accompaniment” — an approach to global health that calls for universities like ours to partner deeply with less-privileged institutions that closely align with our mission. There is no place in global health for those who wish to bungee jump in and out of contexts like tourists. Accompaniment requires a deep and long-term investment in mutual capacity across fields and disciplines. It is essential for these collaborations to be acknowledged as central to the University's mission to create a more equitable world. Our partner institutions offer unprecedented and privileged access to populations in disadvantaged contexts that is essential for global health research and practice. Moreover, we need to emphasize that investing in partnerships with such institutions is not an act of charity but a fulfillment of duty.
We must also acknowledge that global health is not just about people in other countries; vast health disparities persist in the U.S. despite the fact that we spend much more on health care than any other country in the world. Our partnerships must also embrace domestic institutions serving populations with poorer health outcomes and limited access to quality care, including rural communities and low-income neighborhoods.
In the concluding remarks of his op-ed, Paul wrote that “taking global health from a hobby to a serious pursuit is well within our reach if we commit adequate resources to a series of tasks that include research, training, and improved delivery of quality care.” We pride ourselves on being a University committed to solving the world’s most pressing problems through education, research and service, and there can be few issues as important as global health equity.
Eleven years after Paul called on us to treat global health as more than just a hobby, it is time for the University to rededicate itself to the goals and vision that he lived by and animated so brilliantly through partnerships with institutions serving the poor and marginalized. Harvard’s commitment to redress its role in slavery by financing partnerships with historically Black educational institutions in the U.S. offers a model for how we might similarly nurture partnerships with institutions in the Global South. We need to do this both because of our moral responsibility to support equity, social justice, and human rights and dignity and because such partnerships represent a fundamental asset to nurture, support, and value global health. Without this kind of commitment, the mission of Harvard Medical School to “nurture a diverse, inclusive community dedicated to alleviating suffering and improving health and well-being for all through excellence in teaching and learning, discovery and scholarship, and service and leadership” cannot truly be realized.
Vikram H. Patel is the Pershing Square Professor of Global Health at Harvard Medical School and a professor in the Department of Global Health and Population at Harvard T.H. Chan School of Public Health.