"The world is not okay. Many readers of this book have chosen to study global health because of a realization that globalization shaped by the neoliberal project of capitalism has left billions behind in its wake. Delivery of healthcare to the world's poor is one way to work toward global justice and fight for a world in which human rights are globalized." These lines are from Joia Mukherjee's new book "An Introduction to Global Health Delivery," a highly readable, inspiring book that firmly places global health in the context of equity and human rights.
Source: Oxford University Press, 2018 & Dr Joia Mukherjee, Harvard Medical School
Mukherjee is an infectious diseases physician by training, and the Chief Medical Officer at Partners In Health. She is also an academic, working as an Associate Professor at the Department of Global Health and Social Medicine, Harvard Medical School. Her considerable experience in Haiti and other low income countries gives her book tremendous credibility and solidity. Throughout the book, you can sense her frustration about the state of healthcare delivery in impoverished countries, and lack of sufficient progress in achieving universal health coverage (UHC).
At McGill University, I teach a course on Fundamentals of Global Health, and I am always on the look out for good books that I can draw upon. In my view, Mukherjee's book is an excellent course text for an undergrad level introductory global health course. I particularly enjoyed the first (and really important) chapter, which traces the roots of global health inequity. Mukherjee does not pull any punches: "The legacy of slavery and colonialism impacts health in the present day through racially based oppressive policies that result in differential risk, poor access to care, and unequal health outcomes," she argues forcefully. Throughout the book, she reminds the reader to think about equity and the need to see health care as a fundamental human right.
Mukherjee's book makes for serious, at times, depressing reading - she does not shy away from pointing out the appalling state of healthcare in many countries, and the failures of the global health and development community. But, thankfully, she uses the AIDS movement to show that things can be improved, and that activism works. The final chapter of the book provides concrete examples on how advocacy has worked, and how all of us, including students, can do our bit to improve the situation. While UHC is a key component of SDGs, and the central focus of WHO now, under the leadership of Dr Tedros, there is no doubt that serious activism will be required to make sure countries invest in health, and make UHC a reality.
The book is full of wonderful photographs, graphs, tables, and boxes. This, combined with the structure of the book (short, easy to read chapters with key points at the beginning of each chapter) makes the book a pleasure to read. I do hope the publisher will make all the figures/graphics and tables available to instructors as PPT files.
How can the book be improved? I have a few suggestions for future editions. Mukherjee does a great job of using Global Burden of Disease (GBD) and DCP (Disease Control Priorities) to describe disease burden, epidemiological transition, and health needs. But neither the GBD nor the DCP approaches are critically examined. A critique of these approaches and their limitations would add value to the book.
In the same vein, she does a terrific job of explaining the evolution of access to drugs, but nothing is mentioned about the need for essential diagnostics. Patients need access to both diagnosis and treatment, and essential medicines require essential diagnostics. But then diagnostics are neglected by everyone - it took WHO 40 years after the first Essential Medicines List (EML), to begin work on developing an Essential Diagnostics List! And this EDL is expected in 2018, and hopefully future editions of the book can talk about the importance of access to good diagnostics, and the critical need to protect and preserve antimicrobials.
Overall, as a global health researcher and teacher, I found Joia Mukherjee's book to be authentic and reflective of my own experiences in delivering health care in rural India. I would gladly recommend her book to any student interested in global health. Hopefully, the book will inspire them, as it inspired me. Towards the end of the book, Mukherjee argues the need for a right to health movement. She quotes Martin Luther King's statement (which paraphrased Theodore Parker): "the arc of the moral universe is long but it bends toward justice." She then quotes President Obama, who said, "[the arc] does not bend on its own. It bends because we bend it, because we put our hand on that arc and we move it in the direction of justice, and freedom, and equality, and kindness, and generosity." Joia Mukherjee, clearly, has done her share to bend the arc - with her global health work, research, advocacy, and this book. We need to do our part.
Disclosures: I have no conflicts to disclose