Inequality is a Global Health Issue: My Experience in My Unequal Country

By Lucia Abascal, MD, IGHS master’s student

Mexico is a country of inequality. Nowhere does there exist such a fearful difference in the distribution of fortune.
— Alexander Von Humboldt, 1811

More than 200 years have passed since those words were printed, and my country seems to be stuck in history. In Mexico, where and how you are born determines who you will become. Socioeconomic differences are a major indicator of inequality, which manifests as disparities in health, security, education, and opportunities. Such disparities directly affect each other, turning poverty into a trap from which few can escape.

Lately, I have been thinking a lot about this, reflecting on my life and the lives of many Mexicans I have encountered through the years. It’s easier to look back from the outside, especially from a more educated perspective. Being in the master’s program at the Institute for Global Health Sciences (IGHS) has enabled me to name many of the problems I experienced and their implications for individuals and populations.

As a medical student in Mexico City, I witnessed what this inequality meant for millions of Mexicans. But I truly learned the implications of these differences when I went with five friends from medical school to spend our last year of school as community physicians in a rural NGO clinic in the State of Mexico. Many patients couldn’t read or write, which made prescribing medications an everyday challenge for me and my friends. Lifestyle modifications were almost impossible for many diabetic patients: how could we change their diets when tortillas and beans were all they had and Coca-Cola was more available than drinking water? Many patients were lost to follow up or appeared months later in terrible condition because gas prices had gone up and the limited public transportation that existed was too expensive for them.

My friends and I realized that we could find ways to overcome some of these situations. For example, we came up with ways to draw on the patients’ medicine boxes the number and time they should take each pill. We created menus, organized classes and visited the homes of patients who couldn’t come to the clinic. We couldn’t change the health outcomes of every patient, but a normal glucose level was a victory… though not enough.  What frustrated me the most was not having the power to do more.

A recent New York Times article, ´The Social Contract Is Broken´: Inequality Becomes Deadly in Mexico, makes a point that inequality is deadly not just because wealth buys health but because, today, security is also a private commodity. Last year was the deadliest year in Mexico during my lifetime, and 2018 doesn’t seem to be starting any differently. Violence and homicides in Mexico are a public health concern. Violence doesn’t only result in increased mortality and morbidity but in other unfavorable health outcomes, such as poor mental health. As violence spiked in recent years, those who could pay for private security did so and went on with their lives. The problem is that most people can’t afford security and have to live with the consequences of the growing violence. The daughter of one of my patients was kidnapped and sold as a sex slave for six months. Since the authorities didn’t help, my patient sold the little she had and looked for her daughter herself. However, when an important businessman was killed in crossfire from a bullet his bodyguard shot, the president was quick to give a press conference.

As a community physician in Malinalco, Mexico, Abascal visited this home of a patient who could not walk to the clinic.

Poverty gives you an increased risk of having more communicable and non-communicable diseases, as well as being a victim of violence and homicide. Last year 80 people were killed every day in Mexico, and those people didn’t live in the nice neighborhoods and gated communities of Mexico City. Inequality is fueled by the corruption and impunity that exist in the political system and by the indifference in which many upper-class Mexicans live. I believe that the roots of most of the problems in Mexico are in the immense inequality that divides my country. We are the ones building walls between ourselves. And Mexico is paying the price.

In the master’s program, I’ve learned that Mexico has gone a long way to increase social development with programs and policies that are applauded internationally. I feel proud when professors talk about Prospera/Oportunidades — the first national conditional cash transfer program for the poor—or the tax on sugared beverages, or simply when Mexico is mentioned in class. And every time I talk to IGHS Executive Director Jaime Sepulveda, I see what I want to become in the future. I choose a career in Global Health because I want to be part of the change that so many, Dr. Sepulveda included, have been working for. All my skepticism has changed to assurance that things can and will change in my country. We still have a long way to go, but IGHS has given me the tools to envision that future.