Rethinking responsibility in global health: a case from Ethiopia

Bram Peter Wispelwey


The social determinants of negative health outcomes in the northern Tigray region of Ethiopia have aspects both unique and common to poor regions of the world. Using personal experience from my global medicine clerkship, I explore the historical, global, and local factors that lead to the continuation of poverty, ill health, and distrust in government and health systems among the poor of Tigray. In addressing a specific social determinant of health, in this case the decision of patients to abandon care to avoid death fees, I show that an accurate conception of the problem must be preceded by a broad and deep analysis of historical structures and actors. I argue that the direct responsibility and indirect complicity of the West engenders an obligation to the poor that goes beyond charity or compensation toward creative solutions and structural changes.


poverty, social determinants of health, social justice, structural violence

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M. Griffin and J. B. Block (eds), In the Company of the Poor: Conversations between Dr. Paul Farmer and Father Gustavo Gutiérrez (Maryknoll, NY: Orbis Books, 2013).

R. Kapuściński, The Emperor (New York, NY: Vintage, 1989).

M. B. Bishku, “Israel and Ethiopia: from a special to a pragmatic relationship,” Conflict Quarterly 14/2 (1994), pp. 39-62.

F. K. Tiba, “Mass trials and modes of criminal responsibility for international crimes: the case of Ethiopia”, in K. Heller and G. Simpson (eds), The Hidden Histories of War Crimes Trials, (New York: Oxford University Press, 2013), pp. 306-324.

E. J. Keller, “Drought, war, and the politics of famine in Ethiopia and Eritrea,” Journal of Modern African Studies 30/4 (1992), pp. 609-624.

M. Zenawi, “Paul Henze’s conversations with Meles Zenawi,” Addis Voice (June 5, 2011). Available at

Africa Watch, Evil Days: 30 years of war and famine in Ethiopia, (New York: Human Rights Watch, 1991). Available at

K. Deribe, K. Meribo, T. Gebre, et al., “The burden of neglected tropical diseases in Ethiopia, and opportunities for integrated control and elimination,” Parasites and Vectors 5/240 (2012).

T, Pogge, “‘Assisting’ the global poor”, in D. K. Chatterjee (ed), The Ethics of Assistance: Morality and the Distant Needy (Cambridge: Cambridge University Press, 2004), pp. 260-288.

P. Farmer, Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley, CA: University of California Press, 2003), p. 157.


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