Can we imagine a world that is more kind, more equal, more just? This question drove me to write my book When Bereft of Care: Equity, Justice and the Human Right to Health.
In this book I seek to understand what governments around the world have and have not done and must do to ensure health services reach those who need care the most while preserving their dignity.
The right to health is a moral imperative
Two moral talismans guided the writing of this book. One is Margaret Mead’s luminous, if possibly apocryphal, insight that the truest marker of civilization is that a society assures care and kindness to persons in need.
By this yardstick, humankind still has a long way to travel to achieve true civilization. Approximately 4.5 billion people, or half the people inhabiting the globe today, cannot depend on affordable and adequate quality health care.
The second talisman is mindfulness of the fact that every human life has equal value. As physician and writer Atul Gawande declared, “The foundational principle of medicine, going back centuries, is that all lives are of equal worth. This is a radical idea . . . [that] we are all created equal and should be respected as such.”
In practice governments do not treat every life as equally worthy. Far from it. They value some select lives while deeming the large majority dispensable. In the words of Norman Bethune, the legendary Canadian physician who devoted his life to fighting tuberculosis, fascism, and inequality, the cruel reality of our world is that “the poor (wo)man dies because (s)he cannot afford to live.”
Structural violence is health policy’s greatest challenge: Caste, class, gender, and community identities determine who lives and who dies. Social conditions like housing, food, work, sanitation, education, and discrimination critically shape who falls ill and who can recover. Poverty is the deadliest disease, as Bethune saw so clearly. Medical advances fall far short of their full promise if people cannot afford to live with dignity and security. Marginalized groups face layered exclusions. Older people, persons with disabilities, women, LGBTQ+ people, migrants, and precarious workers experience systemic neglect and bias in health care.
Effective care is incompatible with the profit motive
I argue that health care is not a market commodity. Unlike other services, health care requires trust, ethical commitment, and equity, all of which the profit motive undermines. For-profit private health care often exacerbates inequality: It tends to serve wealthier populations, prioritize profitable services, and further distances the poor from accessible, quality care. Privatization weakens the social contract in health. When care becomes a commercial transaction, solidarity and universality (both essential attributes of the right to health) suffer.
In When Bereft of Care I describe the rapacious and extortionist practices of corporate private hospitals, largely in India, that not only charge avaricious fees but also frequently prescribe unnecessary tests, drugs, and potentially harmful procedures. Unethical and harmful practices, such as inflated billing, cut commissions, and false diagnoses have become widespread and normalized, leaving patients to bear the full burden of a profit-driven system. From price gouging to insurance fraud, the powerless suffer while health care transforms into a luxury marketplace.
Profit and care are in fundamental conflict. Health care cannot be both a right and a commodity. In India’s privatized system, profit motives routinely override patient welfare, and image and income often take priority over the integrity of treatment.
Questions of private profit also dominate the challenge of ensuring the affordability of medicine. The conventional wisdom is that pharmaceutical companies must be allowed to reap high profits because these profits subsidize the research and development that advances scientific and technological knowledge.
But in practice, patents often block, rather than promote, access to essential medicines. Monopoly pricing under intellectual property regimes routinely places life-saving drugs out of reach for the poor across the globe. Global IPR regimes like TRIPS serve corporate interests. Wealthy nations back these frameworks and trade deals that entrench Big Pharma’s control, often at the cost of human lives.
I argue that tax-funded public provisioning is the most just and effective model. Progressive taxation directly supports universal access, equity, and quality when channeled into strong public systems that have the mandate, the financial and human resources, and the infrastructure to provision the entire population with health care without discrimination and free of charge. Such a model ensures that people pay based on their capacity to do so and receive health services based on need and not income and social standing.
Rebuilding an ethics of care
At a time when the policing of national borders violently excludes people in desperate need, When Bereft of Care argues that the right to health care must transcend citizenship. In a just society, access to health care should be grounded in human dignity and need, not legal status or identity documents. In this book, I return again and again to the collapse of the ethics of social care as a profound moral failure. This failure drove me to write this book as a way to search for methods to repair our broken moral compass.
This is why the book is ultimately a call to rebuild a politics of care. This will require both reimagining public health as a moral and rights-based responsibility and addressing the massive shortage of trained health workers around the world. Crucially, medical education must reorient its focus toward primary care, community engagement, and social justice. Beyond infrastructure or skills, health systems need professionals who see medicine as a moral vocation, not a commercial enterprise.
Addressing the moral failure that is the denial of health care now requires not only more resources and better management but also a new politics of justice and care that centers the most excluded and reclaims health care as a legally enforceable right.
Imagine a world in which it does not matter whether I am a citizen, I am disabled, I am poor, I am trans, I am a criminal, I am homeless, I was born into a persecuted group, I have no family, I survive amid war. In this world I can still walk (or be wheeled) into a health center with my head held high and demand with dignity the same treatment that the richest and most powerful person in the world would expect.
It is this dream of a world more kind, more equal, more just—and the resolve to make it real—that gave wings to the writing of When Bereft of Care.
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I owe a great debt to my sterling research associate, Rishiraj Bhagawati, an exceptionally talented and reflective public health scholar who, working outside his day job, tirelessly helped me carry out the research for writing this book.
I am also grateful for research support from Jessica Ewing, Suparba Sil, Syed Rubeel Haider Zaidi, Omair Khan, and Sahaj Singh.
I am immensely grateful to the Friedrich-Alexander-Universität Erlangen-Nuremberg in Germany, which honored me with its inaugural Human Rights Award and through this supported the writing and publishing of this book.