Deserving or non-deserving? There is NO question!!

What makes a person or a population non-deserving? I cannot even fathom a person trying to find a justified answer to this question. The concept of “lower class” or “non-deserving people” has been part of society for several centuries and still exists today, as shown by the pictures of the Roma people. Bottom line --I believe that there is no such thing as a non-deserving person or population. Especially when it comes to basic human rights—I believe that every person should be treated the same despite where they come from, class, race, gender, sexual orientation, etc. In particular, health care is also a basic human right. Every person in the world, despite demographic characteristics, deserves a healthy life. As health care professionals, it is not up to us whether a person deserves health care or not—our job is to treat/care for any individual. Today’s society focuses greatly on curing the individual rather than helping an entire population and most often policy makers see vulnerable populations at fault for their status. For example,
lack of education, obesity, unemployment, drug/substance abuse are often stigmatized against, thus less policies are made for these types of issues—as Mechanic and Tanner state in their article. When it comes to vulnerable populations such as those depicted in the pictures, it gives us more reason to justify that these populations are deserving. Every individual has the same capacity to achieve a healthy life—but it is what that person is provided with by society that makes the difference. If society provides its people with a safe community, education, and even basic health care, the people would be a lot healthier and live their lives with the dignity they deserve. All populations are deserving—vulnerable or not—but vulnerable populations need to be given more assistance to put them on the right track. If higher classes/majority of the population treats stigmatizes and outcasts a minority—and it results in high unemployment, low education, drug/substance abuse, social/mental problems, etc. At the end of the day it is not the fault of the vulnerable population—it is the fault of society as a whole. Thus, all populations deserve the right to a healthy life—despite of race, class, religion, gender, etc.

Fabiola Enriquez

After looking at all the pictures, I do not think we should ask each other whether these people are deserving of help or not. It should not be a question. Living in the conditions they live in, they should receive the help they need whether they hold passports or not. From just looking at the pictures, one can easily conclude that the Roma Gypsies are suffering from psychosocial, as well as health issues. People live in small rooms under bridges. Any infectious disease can be easily transmitted and their quality of life is obviously diminished. The question should not be if they deserve question but who should help these people. I think it is everybody's responsibility to help those in need. Some people may think that the poor are not deserving of help because they might not be as productive to society than the rest of the population. In some cases this is true, but it is also true it is society's responsibility to take care of their poor and provide them with the tools they need to become productive members of society. Our society is not only responsible of providing the poor with health care but also education. Society's of the world have to take care of the poor because they play a role in society just like any other individual. The Roma Gypsies seem to be trying to make a living one way or another. The government insists in putting them in camps that do not provide a safe or healthy environment. I think they deserve services because they are human beings and they do not deserve to be left to suffer because they were not one of the lucky people to be born in a rich family. Our society does not provide poor individuals with the necessary skills to get themselves out of their poor conditions.

Undeserving

I have spent the past two hours in locating the suggested pictures regarding "Roma" population in Italy. I went to guardian site several times and could not find them. So never mind Roma, I would recommend reading the article written by Mechanic and Tanner. This article titled as "Vulnerable People, Groups, and Populations:Societal View" is beautifully written, comprehensive and insightful.

I don't have good impression about Gypsies, I was approached by two young girls who wanted to do "reading" on me. And I gently told them no, yet they would NEVER leave. It was as frustrating as trying to find a site having their pictures. At this point, I do not need their stories nor pictures. It's surprising that at such young age they began to solicit their clients and being very tricky and crafty. Perhaps some of you might think I transfer my anger toward them--innocent and vulnerable ones. No, I don't.
I have very unpopular view on this: they don't deserve our precious resources. We are using our resources toward an unworthy cause, meanwhile we neglect the more needy and deserving ones. Usually these people who caught our eyes and attention at the first glance before others want us to remember them as priority, this does NOT mean that they deserve our priority consideration. Many other silent vulnerable groups suffer more pains and are more worthy of our help. Cheap sympathy can be a dangerous game. Unfortunately quite a large number of people who committed to health care professions got carried away in the schemes of sympathy play. In public health, we need discerning mind to utilize our oftentimes limited resources more effectively. Sympathy without discernment is just as bad as other types of mismanagement or deliberate oppression. Though we are tempted to think the absolute equality is noble and applicable. The reality of our current human conditions would force us to be thoughtful of our public health approaches. Public health education I hope is not to produce easy-catch in sympathy-guilty-give trilogy but thoughtful and discerning policy makers.
P.S. I got e-mail from Jocelyn and was able to see these pictures. Certainly this is a sad story. Who is responsible for it? many factors including girls' own parents. Instead of focusing on the miniatured, we need to address the global health as a whole. Each culture and each society has to implement their own initiatives as they see it fits (may NOT be from our perspectives). They too also have the right to be wrong and hopefully learn from past mistakes. However, seeing the pictures does not alter my views.

Vulnerable populations & my travels

I have lived and visited many places around the world, but no matter where I go, I can always find individuals or groups of people who are clearly more vulnerable than the rest of the population. A luxurious hotel I stayed at in Malaysia was situated right next to a huge slum…In Bangladesh there were countless numbers of street beggars constantly tapping on the windows of cars passing by…The street children and orphans in Mongolia who rummage through the garbage piles and live in the underground sewers…undocumented immigrants in LA who have no access to healthcare…I would say that the disparities in Japanese society are the least obvious out of what I've seen, but I think they are just better at hiding them away in the corners of society…and then you have New York City…I would say that my four years in New York were the most eye-opening in terms of exposing me to issues concerning vulnerable populations…because everything was so close together on one small island. In Manhattan, it is easy to see and feel the full range of lifestyles people live. All around you there are people who have mental disorders having conversations with themselves on the subway, people in wheel chairs begging on the streets, people who can’t speak English having trouble getting what they need, people who are isolated in little corners of the city (its easy to forget you are even in America when you get deep into places like chinatown), drug addicts, homeless people, dangerous neighborhoods…..all of these juxtaposed right next to 5th Ave, celebrities, rich wall street workers (although debatable right now!), leaders from around the world, the greatest institutions, and the richest neighborhoods in the country. When you see the clear disparities between the extreme rich and the extreme poor and those with easy access to resources and those with absolutely no access to health care or safety…all right next to each other…that’s when you know that something is wrong. So do I believe that vulnerable populations are deserving of help? DEFINITELY. As a public health professional…and as a human…I strongly believe that our efforts need to focus on helping these people in order for them to live better lives…lives that we wouldn’t mind living ourselves. I think everyone has the right to health and happiness and we should work toward this ultimate goal.

The cycle!

Vulnerable populations need to be the most deserving populations in order to intercept the cycle of poverty, health, and economy. As so many have said, as health professionals we need to give without question. We need to continue to attempt to eliminate the disparities until the rest of the world sees the relevance of health to success and development. As health professionals, we cannot settle the way politicians can thinking that health conditions are self-inflicted. It is our job to understand the social determinants of health, in order to understand the situation of vulnerable populations. A great example of this lies in tobacco use. At one point (and still in some ways today), tobacco related health problems were seen as self-inflicted. This change largely when tobacco companies were sued for knowingly promoting harmful products. Policymakers now understand the need to protect populations from the control of tobacco companies.  This example needs to be asserted across all social determinants of health! 

Understanding Vulnerability --> Doing something about it

There is no doubt that all vulnerable populations are deserving of help. Any ideation to the contrary only reflects a misunderstanding of the interconnectedness of diminished opportunity (i.e. in the form of wealth, health, resources, education, trauma-free childhood, etc.) and vulnerability, such as that illustrated by poor health outcomes. Those of us with this understanding know that diminished opportunity and increased vulnerability will only perpetuate in a vicious cycle if no interventions are put in place to help vulnerable populations. We question how anyone could be content with relegating the vulnerable to their dire straits. I reiterate my argument that these people simply don’t understand.

To illustrate my point, I’d like to share a personal anecdote from my time in the Philippines. I was able to do some work with the country’s national program Doctors to the Barrios, which deploys physicians to rural, doctor-less municipalties. The doctors primarily worked out of clinics located in the town centers but also did visits to “far-flung barrios”, as they called them. One particular visit that I went on stands out in my mind. I accompanied the doctor and other health workers to a remote barrio in the mountains, where barrio residents were awaiting us. There were numerous women, toting multiple children each. The children were mostly naked, filthy, urinating where they were standing/sitting. It seemed like the mothers just could not care for all their children; it was a difficult sight to behold. But each woman that the doctor spoke to essentially disregarded any suggestion of contraception. As the day wore on, I started to think that these women were hopeless cases, with no desire to lift themselves or their children out of their dire straits—and yes, the thought crossed my mind, “So why bother to try to help them?” I threw all understanding of cultural competency and the cycle of diminished opportunity and vulnerability out the window. Now I was deeply ashamed of myself when I realized what was going through my mind (so don’t hold it against me!)—I claim momentary insanity.

My point is that when people don’t understand (or momentarily forget) the upstream causes of why certain populations are vulnerable, they’re less likely to see vulnerable people as deserving of help. A society must promote this understanding in order for the people of the society to see it and act on it. Such promotion can come through media, the curricula of the education system, etc. Now I concede that I’ve presupposed that people (or governments or countries) will give to those who deserve help—because helping others also means giving up a little something for yourself. But being the idealist that I am, I do hold on to the hope that the more privileged in the world will uphold, for all others, basic human rights and the right to live with dignity.

Who draws the line?

Before I start, let's take a closer look at St. Peter's Basilica in Vatican City, in the middle of Italy's capital, Rome, where many gypsy families can be seen begging:

http://www.sacred-destinations.com/italy/rome-st-peters-basilica.htm

Anyone venture to guess the level of affluence Vatican City has? St. Peter's Basilica, the mecca for the Catholic faithful and tourists alike, holds tremendous value. All the buildings around the square are adorned with granite and marble, while the interior displays "the finest Renaissance monuments and decoration money could buy, employing the talents of such greats as Michelangelo and Bernini." So, there are homeless people in a city of such great wealth? What's wrong with this picture? Where is the money going? Catholic priests and nuns live in simplicity and I'd imagine that revenues from tourism exceed overhead costs...

Now, I'm sure that the catholic church does significant outreach to underprivileged individuals throughout Italy, but who decides the right amount? And who decides on which groups to give aid to?

I agree with Yasmin that as health professionals, we can only keep giving without questions. While our political leaders squabble over those questions posed above, we can each choose to act. Instead of drawing lines on who is "vulnerable" or "deserving of aid," why not view them as people needing help? Instead of ignoring those homeless people on the street, help one of them out. Instead of just giving money to them, pay them for an idea or for some advice or just for the conversation..."When you help someone up a hill, you get to the top as well." --Anonymous



For all those considering medical school, here's Carola Eisenberg's (p.19-21) perspective "On Doctoring" :

http://books.google.com/books?id=zLnv9jQ2JB4C&pg=PA248&lpg=PA248&dq=on+doctoring+excerpts&source=web&ots=Gn9g8pmQSl&sig=yT-UsFWwlSAJEjPT3q7TgGgik9A&hl=en&sa=X&oi=book_result&resnum=1&ct=result#PPA20,M1

Sinners versus Saints

Going back to Chp 1 of our good 'ole book, I do believe that health care is a positive right. By definition, a positive right is imposes obligations on society to provide adequate services so that each individual in that society is able to exercise this right. The Roma populations in Italy are clearly discriminated against to appalling degrees, as evidenced by the photo essay posted. It represents a good starting off point, however, to discuss why people within a society may harbor such resentment towards a population of people.
Controversy exists surrounding vulnerable populations. Those viewed to be undeserving perhaps engage in deviant, high-risk behavior and are now in greater need of health care. People may argue that those who knowingly place themselves in this situation should not be utilizing our health care resources. On the contrary, veterans, children, and those with chronic illnesses outside of their control will be granted a higher level of sympathy and are viewed as a deserving vulnerable populations. These sentiments have a rippling effect on policies. If society as a whole is unwilling to help ALL those in need based on stereotypes and moral judgments, then we are less likely to have policies in place to help these people.
It's important to remember that those same people who are involved with sex, drugs, and rock and roll? Uhh...prolly not, are at a disadvantage from the start, maybe b/c they live in areas where all of these things are more prevalent and socially acceptable. Perhaps they do not have the parental oversight that others in more affluent areas enjoy simply b/c their parents need to work long hours simply to make ends meet financially. Or perhaps mental illnesses cause people to turn to other means as a method of self medication. Whatever the reason may be, it simply isn't our right to judge why people are in their paricular situations. Beyond that, noone should have the ability to deny someone's inalienable human right to a respectable level of well being.

human rights worldwide

The photo essay of Roma gypsies in Italy reveals that the problems of human rights are worldwide. If we were to look at China or Africa, violation of human rights can be found. I believe that this photo essay succeeds at increasing awareness of existing human rights around the globe. When developed nations condemned China’s violation of human rights in Nepal during the Olympic season, photographer Robin Hammond brought out images of a developed nation that needs to address its own human rights issues.

I am not surprised to see the case of Roma gypsies in Italy because similar kinds of immigration issues are happening in the US. Illegal immigrants in US are treated similarly to gypsies. They are forced to live in poor and crowded conditions. Many do not have access to public services or will not reach for those services for the fear of being expelled.

When assessing the human rights issues in the case of the Roma gypsies, it seems fair to consider some reasons for the non-deserving argument. Why the Roma are continuously forced to live in camps? Are the Roma population viewed as criminals? Can the Italian society avoid breakouts to the rest of community if the government tried to reach out to these groups and address health issues?

A human right is the higher kind of right that is morally based and universal, whether it would be health care or an entitlement to its position in the society. Every human being deserves these fundamental, undeniable rights; such as the right to life, the right to recognition as a person before the law, and the right to well-being of self. In hindsight, to exercise these fundamental rights depends on the right to health care. The right to health includes the right to clean water, education and safe, healthy working conditions. Therefore, violation of any of these human rights is an infringement.

To ensure the achievement of human rights in the communities, we need to act together to promote education, increase awareness, advocate and implement strategies. Based on the undeniable human rights, every human being deserves help, including the Roma populations in Italy.

We Don’t Have Any Boots! Can We Use Some of Yours?

Vulnerable populations are most definitely deserving of help no matter how dire their situations may be. The Roma example in Italy is just one of the many instances of bigotry and hatred that just doesn’t seem to leave this human condition. It has traveled through all cultures, continents and civilizations. In each case through out history, I know that vulnerable populations did not become helpless by their own deeds. I don’t think that they just all of a sudden decide that they want to be placed in at risk situations. In all likelihood, susceptible populations are unjustly discriminated against in several ways leaving them in volatile positions. Therefore it is necessary to help them. It is quite ironic how certain groups can say that others are not deserving of help when the main reason that group needs help is because of the insolence, discrimination and malevolent deeds that the flourishing group does to the vulnerable populace.

Albeit, it is not entirely the faults of individuals who harbor negative views toward others because a lot of the hatred stems from the environment they were raised in. Society can create perspectives of people that, after a point, no longer need to be reinforced and people just adopt them. It takes a potent effort to overcome the dreadful indoctrination of intolerance of others that is instilled in one from birth. When family, friends, government, social pressures, etc tell you something starting from a young age, it is almost impossible to get rid of the prejudices. They may argue that these populations are lazy, not grateful, not fit for society and so on. The phrase people “need to pull themselves up by their own bootstraps” is often touted, implying that anyone can improve their situation by their own efforts without any help from others. However, we fail to recognize that vulnerable populations may have inferior quality boots or even worse not even have any boots at all. How can people help themselves when the odds are stacked against them? More often than not, people who harbor negative views toward vulnerable populations were never in the position of being vulnerable. Experience is the best measure of actuality and if one has never had to face what vulnerable populations have to face, then that makes that individuals opinion of lesser value. Maybe instead of saying “lift yourself up by your own bootstraps” they should try and see how difficult it is to lift yourself by your own bootstraps when you don’t even have any boots.

Human Tribalism

If we truly seek to be enlightened and “civilized” as a species and as a society then there can be no such a thing as “undeserving” or “non-deserving” populations.  Every human being regardless of race, gender, religion, creed, nationality, sexual orientation, etc. deserves to be respected and shown the same rights as every other member of the species.  I feel the sad truth is that since globalization is a relatively new phenomenon, the human species is still mired in its typical tribal view of the world.  The continued prominence of the “us” and “them” viewpoint with the only differences being the extent of people included as “us”.  Intentionally or not, we all subscribe to this notion, defining ourselves through seemingly limitless qualifiers that only serve to highlight how “we” are different from “them”.  Unfortunately, throughout our history, when a less mainstream group of people prove to be threatening or undesirable in some way to the dominant culture they are typically ostracized, marginalized, or outright victimized, as in the case with the Roma population in Italy.  In most instances the threat is usually invented to some extent as a scapegoat for some larger societal failure. For instance, many people in modern U.S. society blame minorities for high crime rates, homosexuality for the failure of marriage or immigrants for economic hardships.   There always seems to be a need for a “them” to blame for life’s disappointments and imperfections. Occasionally this can erupt, dramatically and disastrously, as occurred in the blaming of the ills of German society on the Jews by the Nazis, resulting in the Holocaust. 

As enlightened individuals we know that there are no inherently lazy, criminal, or deceitful races or populations. Therefore would it make any sense that populations such as the Romas would choose to be “non-deserving”?  Would any group of people want to have higher than average unemployment or crime rates?  Would any parents want to see their children drowned and left indifferently for hours on a beach because they were born to a specific sub-culture?  Non-deserving populations do not exist, only intolerant and hateful individuals who wield too much influence and power.  I can only hope that this is the explanation for the shameful views of the more than two-thirds of the Italian population who want to see the Romas forcibly expelled. 

Animal Instinct??

As humans, we have evolved beyond the limitations of only instinct, developing reason, advanced cognitive processing, and deeper affect than all other animals.  This development in reasoning carries with it certain responsibilities that we should all maintain for one another in order to continue striving as a species.  In particular, it is each person’s duty on this planet to help ensure the health and safety of one another.  So, yes, every person, regardless of their vulnerability in this world, is deserving of basic health and social services.  To a certain extent, perhaps ensuring others safety is animal instinct, as seen in this video: http://www.youtube.com/watch?v=LU8DDYz68kM   This video depicts what we should all internalize as our responsibility – we need to take care of each other or the whole population suffers.  Like the buffalo in the video, you protect everyone in your group, regardless of how small, weak, hurt, or insignificant they may seem to be to the larger scale of the population. 

Looking at the photo essay of the Roma groups, I would venture to say that these people are who they are because that is simply what they were born into.  Like royalty, some elite, indigenous people, or regular folk, they simply don’t know what other life to have because being gypsy is all they know.  Does this mean we condemn them simply for the family they were born into?  If so, I can’t imagine this being different than the discrimination shown to slaves in pre-Revolutionary United States, or to the Jews in Hitler-ruled Germany, or even to “colored people” in the 1950’s.  Somewhere along the line, this reasoning we’ve attained has made us feel entitled to judge other people’s rights, when in reality we all deserve the same things in this life.

I understand that this altruism is very easily defended, but extremely difficult to manage financially.  However, there must be a way to help every person receive care without an enormous financial burden.  Perhaps we need to look more into having those who are given free care return their health with service.  So for example, if a person receives services valued at $1,000 that they are unable to pay, they must repay the care with their own time of 5 hours.  This may seem too simplistic, but something has to be better than the nothing that most would offer now.

The Catch 22 argument

I’d like to focus my opinion toward the broader applicability of this isolated event as it pertains to our course discussions; in particular, applying it to the concept/debate of health care allocation to the vulnerable. In doing so, we come to the simple debate: should science trump social values in resource allocation?

In assessing the distributive analysis of equitable resource allocation, there is an underlying application of risk analysis. In determining the feasibility and justifications of distributing resources to population groups, policy makers are prone to factoring in the nature, duration, severity, and probability of risks and harms (I’m discussing it in the context of medicine/health, and not upstream [non-health-related]determinants for the time being). But in order to respond to the crisis in the need for resources to the vulnerable groups, shouldn’t there be a social value factor equated into their calculations of distribution?

The public has a different contextual understanding of risks since they have a perspective which mirrors social norms, values, as well as personal/cultural beliefs. So society may interpret what are risks and the extent of its severity based off of these factors. And at the very foundation of their interpretation of health, is their understanding that it is a human right and a right deserving for everyone. As a result, policy makers should try to weigh potential for health disparities against the potential harms to traditional values.

However, the “Catch-22” is society does tolerate hazardous risks (i.e., smoking) because they believe they are aware of the harms associated, and that they are in control of their voluntary choices to uptake the behavior. That is why society doesn’t want extensive regulations on hazards that they believe are voluntarily incurred (smoking), rather, place them on those risk factors that are non-volitional.

And this is where the challenge stems from: providing a society that is eager and demanding toward unconditional rights to health access, affordability, and equity across all spectrums of care and resources in an environment of constrained resources. Yet, they are still adamant toward their ‘individualistic paternalism’ in the face of population initiatives geared toward improving the collective burdens of self-regulating diseases/illnesses. And furthermore, this is applicable when considering the efforts of policy makers in response to the challenges of upstream/non-health related determinants of population health.

What we have to understand is there will always be trade-offs; whether by values, health, SES contributors, etc.

Can we compromise? Will we?

Another Big Con from the Roma population?

Below are some astonishing captions from the photo essay that I found:

“According to a recent newspaper survey, more than two-thirds of Italians want Gypsies expelled, whether they hold Italian passports or not”

“The bodies of the two Roma girls lie on the beach after drowning in the sea in Torregaveta, near Naples on July 19 2008. The ambulance did not arrive for three hours, so they were covered up and beach-goers continued their picnic”

But photo essay is typically a bias view of things. Or is it? I did a quick search for some news articles on this vacation at a beach with rigor bodies nearby. I guess it is a norm of that beach?

http://www.telegraph.co.uk/news/worldnews/europe/italy/2309927/Italians-sunbathe-next-to-drowned-gipsy-children.html

“The bodies of two drowned Roma children lay covered by towels on an Italian beach while "indifferent" holidaymakers carried on enjoying the sun….Cristina Ibramovitc, 12, and Viola Ibramovitc, 11, were left on the sand for an hour among the holidaymakers after being caught in rough seas.”

Wow you kidding me? It seems like I am saying that phrase a lot after reconfirming my hatred to Oregon State Football on Thursday and Michigan beating Wisconsin. Then, Florida loses to Mississippi and now ‘Bama will might lose to Georgia after being up by 31 points at halftime. Wow you kidding me? How can this happen?

Well, it happens very easy and occurs daily. Individuals and ethnic populations are vulnerable and slighted by big institutions and government policies. Of course, we need to help the little guys against powerhouse domains. But what makes a certain population deserving or non-deserving?

In the Roma population, it does not help that Italy and other countries look down upon Gypsies due to stereotypes of thieves and con-artists. Could the need of health for Roma population just be another con from the Roma population? How can countries help a distrustful population? There should a be a fair way that government and organizations with assets to assess and help this population. If it was up to me, I would agree with Yasmin that I would help as much as I can. But that is just me, I want to help and ensure equality in health services to provide to vulnerable population. There is always a controlling measure, and here it seems to be money and negative perception of the population. But even perception is not an excuse, actually there should be no excuse on helping individuals for health services, yet we as a global society allow it to happen daily. An international service and policy should be available for these vulnerable populations on at least getting quality bare necessities on living.

Song of Blog: The All-American Rejects - Give you Hell

The Right of Health

It is not our job as health professionals to deem whether a group of individuals is deserving or non-deserving of health care. Good health is a right of every human being and it is our obligation as professionals in public health to ensure that vulnerable populations are given this right. The indifference from the Italian citizens on the death of the 2 young gypsy girls is sickening. It is astonishing that they could allow their corpses to lay unattended to on a beach for 3 hours, while vacationers enjoyed a picnic and others a game of frisbee! Where is the humanity?

For those of us in public health, it is our job to give a voice to these vulnerable and discriminated populations because they lack the power and resources to represent themselves. Whatever their lifestyle may be, we do not have the authority to deny care. If we can provide health care to some of society's most cruelest criminals in prisons worldwide, how can we discriminate and withhold care from these helpless groups?

In the globalized world we live in today, the socioeconomic and health status of these individuals affect their host country and the world politically, socially, and economically. This correlation needs to be recognized worldwide and programs that improve the lives and health of vulnerable populations must be developed and implemented.