Rethinking responsibility in global health: a case from Ethiopia


  • Bram Peter Wispelwey Brigham and Women's Hospital


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


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.

Author Biography

Bram Peter Wispelwey, Brigham and Women's Hospital

Internal Medicine Intern at Brigham and Women's Hospital (2014-2015)


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Social Medicine in Practice