Sunday, August 16, 2009

First and Third

We tend to do a lot of aggregating in international relations. While this is largely unavoidable, it's worth reminding ourselves from time to time that ascribing particular characteristics to the entities we study may cause us to overlook significant variations within them. States, which are still the entities we study most intensively, are commonly labeled "free" or "unfree," "democratic" or "authoritarian," "developed" or "developing," and so on. But a "free" state may have pockets of oppression (think of the period of racial segregation in the United States) and a "democratic" state may have subunits that fail to respect democratic norms (think of machine politics in Chicago or in South Texas a generation ago). Likewise, a "developing" state may have elites who control enormous wealth (think Equatorial Guinea) and a "developed" state may have pockets of poverty that mirror conditions in the developing world.

This point has been brought home by the visit of the Remote Area Medical Foundation to Los Angeles. For one week--August 11-18--an organization that began in 1985 with the objective of bringing medical care to distant parts of the developing world is offering free services to people in Los Angeles who, because they are uninsured or underinsured, have no way to pay for the care they need. Thousands of people have lined up each day at the Forum, the former home of the Lakers, to wait for tooth extractions, eye exams, diagnoses of illnesses, and treatments for chronic conditions.

Los Angeles Times columnist (and author of The Soloist) Steve Lopez has been spending some time at the Forum. In a column today, he reports that a number of the doctors who are volunteering at the Forum have noted parallels between their volunteer experiences in the Third World and what they are seeing at the Forum. One of them, Dr. Greg Pearl, when asked to note the differences between what he has seen in the developing world and what he is seeing at the Forum said, "Here, the patients speak English."

The United States is among the "rich fat few" rather than the "skinny poor many" (to use expressions I recall from a lecture by Inis Claude), but it has its pockets of Third World conditions. One of these pockets is populated by close to 50 million people without access to routine health care. Lopez's column--which is well worth reading--is aptly titled: "At free clinic, scenes from the Third World."