Check Your Privilege
(By DFID – UK Department for International Development via Wikimedia Commons)
As a leftie feminist who follows many other leftie feminists on Twitter, the phrase "check your privilege" has been popping up rather a lot recently. I'm no intellectual theorist but to me, it seems to be about realising how lucky you are in many ways even if in others, the world is against you. Those "lucky" parts might affect how you see others or speak about issues, and you should be careful not to assume that everyone sees the world through your eyes. For instance, I'm a woman. It's still a disadvantage in the world for millions. But also, unlike many women I am white, I have no disabilities, I identify as a woman and was born in a woman's body, I am the mother of a typical nuclear family in a wealthy rural part of the UK. My husband is a pleasant chap I chose myself and doesn't seek to control me, either economically or through violence. I'm bisexual in a country where, while I may get the occasional misunderstanding or mild abuse, the police will take my side if I'm the unlucky victim of a hate crime and I don't risk going to prison if my next sexual partner is a woman. And, most importantly, I have the privilege of sitting here writing a blog post on my iPad which, via the privilege of a good reliable Internet connection, might reach a few hundred people with equally reliable Internet connections who can read and nod along as they drink their coffee.
Last week, I wrote a post on vaccination and why herd immunity is important. On the same day I read this excellent post in The Guardian by Jon Butterworth about his own difficult decision, at the height of the MMR scare stories, on whether to vaccinate his son. My eldest child's MMR was due in 2004, so it was a few years after the scary headlines, but doubts were still openly discussed by the parents in my village and I'm sure some chose to ignore the appointment letter that came from the local GP.
I never doubted the weight of scientific evidence. I got my daughter vaccinated without hesitation, and did the same 2 years later for her younger brother. But there was something else I never for one moment considered.
I didn't consider my role in the giant patchwork of global health and what it means to live where I do, in a post-industrial society in one of the wealthiest countries in the world. The process of taking my kids to be vaccinated is steeped in my culture, the history of the British National Health Service and the Western Medical Tradition from Hippocrates onwards. In short, I didn't check my health privilege.
What do we mean when we talk about global health? To many it might conjure up images of famine ravaged babies, generations stricken by HIV and AIDS in Africa and not much else. We might even watch TV images of a flood in Bangladesh or an earthquake in Pakistan and, while hoping all those poor people get rescued, give little thought to how they will live from now and how those future living conditions might affect their long term health prospects. Why should we? We can turn off the TV, change the channel and in 10 minutes there will be something else to look at. A disaster no longer than an attention span.
When we look at Global Health in capital letters, what we're really doing is asking three big questions:
1) How have large scale health patterns been shaped past and present by social, economic and environmental changes such as industry, agriculture and global warming?
2) Do countries with low incomes have similar health and disease patterns to their wealthier counterparts long ago? Will they have the same health issues and demographic changes as have already happened in higher income nations in their future?
3) How can we relate health patterns in a country to its socio-economic structure? Or is it all just biology and personal lifestyle? What part is played by politics, geography and culture in who gets ill and why?
Like climate change, global health is a problem we just can't ignore. Consider where you were born. If, for the sake of argument, you were born in 2010 ( and are a highly advanced 3 year old who likes reading epidemiology blogs) you can still expect your life to be longer or shorter depending on where you live. Japan or Iceland? Congratulations, you hit the jackpot! Your average life expectancy is 82 or 83 years old, live long and prosper. Afghanistan, Chad or the Central African Republic? Tough. You're looking at an average life expectancy of just 48 years.
It's not just the life expectancy between different nations that's huge, either. Even within a single country there can be big difference. A man living in the most economically deprived neighbourhoods in Scotland can expect to live a full ten years less than his wealthy compatriot. In Australia, an indigenous man has a life expectancy of 58 compared to the 77 of the white male population.
So why does equality in global health still seem so far away, when we have more information and resources than ever before? What's going wrong? If the aim of epidemiology is to make health a more level playing field by changing the variables, then we need to find out.
Like most parents, I've made a fair few trips to the local doctor's clinic in my time dragging a small, hot sulky child with a sniffle or a snuffle or a nasty tummy bug behind me. Let's think for a while about how that every day, almost humdrum task might have played out if, by chance of geography, I'd been born in a different country.
The first question we'd need to ask is if I have access to a doctor or a medical clinic in the first place. And even if I do, have they access to any drugs that can help? I may have to travel more than the 10 minute walk I have here in the UK. Will it take hours or even days for me to seek help? And if they can supply me with medicine for my child to get better, are they close by if something goes wrong? What if she has an allergic reaction or needs aftercare? Is my child ill with something that could have been prevented by vaccination? Does she have HIV, and if so is she more likely to have problems with similar ailments In future?
And what about me, am I likely to be able to keep up with the treatment recommended for my child? Do I have to pay for her care, do I have health insurance or do I just have to deal with my family's health problems financially as best I can? Will I have to take time off work, travel to clinics on expensive or unreliable public transport? Will I be able to read the medicine notes and dosage instructions? Am I educated? Do I live somewhere with clean water and sanitation, do I have other children who might get ill or who are already? Do I have my own home, or do I share a crowded space with other families or armies of relatives?
The questions we've looked at so far don't even stretch beyond the walls of a family home, yet already there are so many, enough questions to burst out of the walls and reach into my community. Is the problem my daughter has a common one? What other diseases are common around here, and do we know why? Does my community have schools, work, transport, roads? Are we well connected? Is there a pharmacy nearby? And if there is a health clinic, are there a enough people to staff it properly? Are they qualified, is it run by the government? A charity? A private company?
And finally... What country do I live in? Does it have a high income, or is it allies with a high income nation? Does it have good trade relations, does it take notice of international treaties influencing drug patents, food subsidies, human rights, climate change? Does it have a good relationship with global health organisations? Does it have resources to help the poor, does it have some kind of centralised health service or strategy? Does the government pay nurses, doctors, and other healthcare practitioners a living wage?
All of this from one poorly child who needs to see a doctor.
Taking my child to the doctor might be a humdrum, irritating task to me, something to be crossed off between the weekly shopping and the play dates, something I take for granted. But that's a privilege. Here in the UK, I don't even have to hand over money or sign an insurance form at the reception desk. To a parent in Kazakhstan, or Belize, or Ghana, or India or Bolivia or even rural Tennessee, taking a child to the doctor might be a completely different prospect. I shouldn't forget that even when my child has been puking on the bed sheets for 48 hours, I'm actually a very very lucky woman.