Prof. Agnes Binagwaho

Patterns of marginalization and exclusion of the vulnerable in medicine and public health have become the norm. The vulnerable, especially on the African continent, have been left out of the distribution of life-saving medical and public health interventions. When included, they have always been last in line to receive such interventions. This inequity prevents Africa from stopping the spread of diseases, resulting in preventable deaths. The repercussions of this inequitable distribution are magnified in countries whose health systems have been weakened by centuries of colonization and unfair international policies such as the structural adjustment programs that hollowed out public investment in health systems.1 A prime example that illustrates the historical marginalization of the vulner- able is the distribution of antiretroviral therapy (ART). In the 1990s, powerful administrations such as the U.S. government strongly pushed for ART to be denied to HIV/ AIDS patients in developing countries as it was considered too expensive, too complicated, and not cost-effective.2 Instead, leaders around the world called for prevention as a cheaper means of reducing the spread of the virus, leaving the 40 million infected in Sub-Saharan Africa in 2002 with no treatment options at a time when treatment was available.3 This is just one example of the countless manifestations of injustice that have pervaded our society, leaving Africa to contend with diseases that have become an afterthought on other continents.