Last year, I spent two weeks at a maternity and pediatrics hospital in South Sudan, where I now work full-time. During just those weeks, I signed death certificates for five children after unsuccessfully attempting resuscitation. As I was giving chest compressions to the first child, I fought back tears. She was about the size of my daughter.
In the United States, only 1 child in 100 dies before his fifth birthday. In South Sudan, it’s more like 1 in 10. What makes the difference?
Not parental love, that’s certain. The children who died under my care had parents who had tried to provide for their children as best as they could. The parents’ grief was as deep as mine would have been. And while medical care obviously makes a difference in individual cases, all these parents had managed to get to a doctor: me. I had access, in turn, to a reasonable supply of medicine and equipment—certainly equivalent to what many US physicians had a generation or two ago.
Every death certificate includes the cause of death. But the deeper causes of these children’s deaths wouldn’t fit in a box on a form. What was wrong had less to do with their individual health than with public health: the structures and environmental factors that many of us in the modern world can take for granted.
In a country like South Sudan, public health asks: Can your family access clean water? If you get sick from the water you drink, are the roads to the hospital safe enough for you to drive there in time? Is there a health professional who is trained well enough to give you the treatment you need? Can you afford the treatment? These are questions about government, policy, and institutions, not primarily about individual ...1
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