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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 29; 335(7621): 639.
PMCID: PMC1995516
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US doctors must become the voice of the poor

The US has a dismal record on health, despite outspending by a considerable margin every other developed nation in the worldworld.. Americans and their elected politicians are generally complacent about this sorry state of affairs, writes one leading doctor. Healthcare professionals are probably the best people to unite and shake them out of their complacency.

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The political culture of the US is one that values entrepreneurial spirit above egalitarianism, which has led to serious and entrenched differences in health between the rich and the poor. Unlike other developed nations, the US has no universal health insurance and no active labour movement to advocate for the poor in government. So the health agenda is run by and for the middle classes, whose concerns crystallise around single problems such as breast cancer and autism, while the poor die young from complications associated with risky behaviour, such as smoking and substance abuse.

This must change, he writes. Large gains for the whole population will come only after a concerted effort to deal with the needs of Americans at the lower end of the socioeconomic spectrum. Health professionals should go back to basics and become champions of the public health. To do nothing is to accept the US position at the bottom of the league tables on health, when in so many other areas only first place will do.


  • N Engl J Med 2007;357:1221-8

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