Blind Spot: How Neoliberalism Infiltrated Global Health

by Salmaan Keshavjee, Paul Farmer (Foreword)

Neoliberalism has been the defining paradigm in global health since the latter part of the twentieth century. What started as an untested and unproven theory that the creation of unfettered markets would give rise to political democracy led to policies that promoted the belief that private markets were the optimal agents for the distribution of social goods, including health care.

A vivid illustration of the infiltration of neoliberal ideology into the design and implementation of development programs, this case study, set in post-Soviet Tajikistan’s remote eastern province of Badakhshan, draws on extensive ethnographic and historical material to examine a “revolving drug fund” program―used by numerous nongovernmental organizations globally to address shortages of high-quality pharmaceuticals in poor communities. Provocative, rigorous, and accessible, Blind Spot offers a cautionary tale about the forces driving decision making in health and development policy today, illustrating how the privatization of health care can have catastrophic outcomes for some of the world’s most vulnerable populations.

Genres: Nonfiction, Medicine, Anthropology, Economics, Health Care, Health

288 pages, Hardcover

First published January 1, 2014

Reviews

[William · Rating 4 out of 5]

because of neoliberalism. basically.

[seo · Rating 4 out of 5]

"health and health care delivery are not neutral; they are intimately tied to political economy"

in "blind spot," salmaan keshavjee analyzes how neoliberalism shapes global health and humanitarian aid, specifically within NGOs. although most NGOs, especially those involved in healthcare, begin with good intentions, most end up becoming tools of capitalism across the globe due to free-market policies, the intentions of their donors, and a western blindness to the effects of neoliberalism on the globe. "blind spot" focuses on badakhshan, a province of post-soviet, post-war tajikistan, which has been deeply affected by poverty, famine, and lack of healthcare. keshavjee first begins by discussing the state of healthcare in the soviet union, how the collapse of the soviet union affected badakhshan, and the development of the bamako initiative, which was meant to be a neoliberal, western solution to the health crisis in badakhshan.

i found this book to be an excellent ethnography that focused on the privatization of healthcare and the dissemination of global health policy. although badakhshan may be a small place, their case study serves as an example of how neoliberalism can profoundly impact the health of poor communities. i think the most stark example of this was the story of misha, the dentist who requested immediate aid for his community and received it in the form of a loan.

will also add in the disclaimer that this is an ethnography, targeted to a more academic audience, rather than the general public. ethnographies and anthropological papers tend to be more repetitive than the average book, and "blind spot" falls under the same category. keshavjee even pulls the classic academic move of writing, "i argue that..." i'm pretty used to it by now, but i can see how it might throw other readers off. but altogether, a good read that i learned a lot from!

[Moira · Rating 4 out of 5]

The book felt just a little repetitive on occasion, but sometimes in order to explain concepts such as ones explained in this book, it takes a little repetition to nail in a point. Overall an enjoyable read - the final 30-40 pages tie everything together nicely. I think the subject matter is incredibly compelling - the author very gradually introduces the idea of NGO's and their role in perpetuating neoliberalism, regardless of the good intentions of folks who work in these organizations. How, on one hand, the IMF and World Bank are hitting countries with structural adjustment policies that eliminate the government's responsibility for their citizens, and on the other hand major NGO's are being funded (at a very controlled rate, mind you, for the amount of financial resources their are in the world) to make change to the "flawed" systems of health care in these same countries.

The change, however, is to a counter-intuitive healthcare market and places high value on change to fit neoliberal criteria over actual positive change in the health of the people. The organizations do good and have good intentions on the ground, but in this grand scheme of things, they undoubtedly perpetuate the dilution of government responsibility for citizen's wellbeing.

[Katelyn · Rating 4 out of 5]

enlightening and so informative.

definitely disagreed with a lot of the phrasing/ interpretations Prof. Keshavjee used, but the fundamental ideas are so important for anyone analyzing the current state of global health.

[Hannah · Rating 3 out of 5]

Philosopher Michael Sandel has argued that we have drifted from having a market economy... to being a market society - a way of life in which social relations are made in the image of the market.

[Charlie · Rating 4 out of 5]

It can be at times too academic for my test, I don't need references to Foucault so often, but as a witness to how the large winds of change affect people so disparate and how the big stories play out in the small stories, it's a book I'd recommend.

[Marie · Rating 4 out of 5]

Fascinating research about the transition from Soviet to Western medicine in Tajikistan in the 1990s. Keshavjee, if anything, underplays the lessons he learned while studying and working in the health system during this tumultuous time. We ignore these lessons to our peril.

[Michael · Rating 5 out of 5]

This is an extremely important look of the consequences of the global Neoliberal ideology in the realm of health development work. Must-read for anyone in this field.

[cassie · Rating 4 out of 5]

definitely a staple. fantastic, just a bit repetitive, which i think is hard to avoid with meta-analyses. so appreciative of the insight it provided regarding NGOs

[Lux Neptune · Rating 5 out of 5]

this book presents a really interesting and highly personal case study in healthcare distribution in post-Soviet Tajikistan. it’s a great read and i found it very stimulating, and i learned a lot!

[Sivananthi T · Rating 5 out of 5]

Though I took a long time to finish this, it was due to a hectic schedule rather than the book itself. This book recounts the experience of the author in Badakhshan, Tajikistan, where after the break-up of the USSR, a large NGO was contracted to roll-out health services in the country. The introduction of user fees in a country which was already poor caused ever worse health outcomes for the population. The author, also talks about how NGOs are utilised as service providers in poor countries and contribute to furthering the neo-liberal ideology in public health, and ultimately aiding to reduce the right to health for people. Well-written, easy to read and to the point.