In college, I took a Latin American Politics and Development class. When discussing Latin American medical care, Professor Eldon Kenworthy presented a deeply countercultural idea. Echoing a journal article by the scholar, Robert Ayres, Kenworthy maintained that building hospitals there costs lives. If, instead of erecting, equipping and staffing gleaming medical centers, this same money and human effort were devoted to providing clean water, good food and sanitation, the public health yield would be much greater.
United States medical history bears out Ayres’s paradox. The biggest increases in US life expectancy occurred early in the Twentieth Century, when people had increasing access to calories and protein, better water and sanitation. Lives lengthened sharply decades before vaccines, antibiotics or nearly any drugs were available, and a century before hospitals merged into corporate Systems.
Incremental American life span increases during the past fifty years reflect far...
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