Slipping through the Cracks of Healthcare

Meera Singhal
9 min readMar 22, 2024


  • “4.5 billion people — nearly half the planet — lack access to essential healthcare, pushing over 100M people per year into poverty.”
  • “The rich were able to vaccinate their children and drink clean water while those who couldn’t afford to live in such areas, kept suffering for years on end. Insurance prices kept rising and once medicare/Medicaid was introduced, the gap between health and suffering kept increasing. “
  • “A 2018 Robert Wood Johnson Foundation analysis revealed that a resident’s neighborhood can influence their health as much as 20% more than their genetic makeup, pushing them to a healthier life initially or a deadly one.”

Table of Contents

  • History of Global Healthcare
  • The Beginning of the End
  • Economic Factors
  • Corruption & Politics
  • Wealth & Social Class
  • Environmental Factors
  • Societal Status > Healthcare
Credits: The Michigan Daily

Imagine a world where a sudden illness or blinding headache isn’t just you being forced to drink bad cherry-flavored cough syrup, but a financial hemorrhage. A staggering 4.5 billion people — nearly half the planet — lack access to essential healthcare. The cost is far steeper than just missed appointments and long calls trying to reschedule it; it costs 100 million people their financial well-being as they are pushed into poverty due to the overwhelming amount of medical bills.

This isn’t just a developing world issue. Healthcare spending in the US alone hit $4.5 trillion in 2022, consuming nearly 18% of the GDP. Globally, healthcare spending is projected to reach a staggering $8 trillion by 2030. While medical technology is constantly evolving, the proportionality of how it is distributed is nothing but unfair.

This isn’t a slow leak of money and people’s health — it’s a full-blown hemorrhage. The cracks in the base of global healthcare are widening, and the bleeding is accelerating. How did we get here though? How did we fall so fast? Especially with the technological advancements that we have been making in the past few decades, how does half the world not even have access to basic healthcare needs?

To answer the question of how we got to the fragile ecosystem of healthcare that we live in now, we must explore the history of global healthcare.

History of Global Healthcare

Starting way back before the 19th century, healthcare was primarily delivered by local healers, shamans, and midwives, relying on traditional remedies and practices passed down through generations. Treatments often involved herbal concoctions, spiritual rituals, and bloodletting culture. Ancient Egyptians used honey, mold, and various plants for wound healing, showing us early attempts at medical interventions. Life expectancy at birth hovered around 30–40 years due to a lack of understanding about hygiene, disease transmission, and effective treatments.

Then came the scientific advancements in the 19th century, specifically germ theory. The work was pioneered by Louis Pasteur and Robert Koch, who created the scientific theory that microorganisms, also known as pathogens or “germs”, cause disease. They proved that these organisms are too small to be seen without magnification, an idea that revolutionized medicine by showing humans the cause behind many of the unknown illnesses that plague them.

Smallpox was one of the biggest problems that they faced, an unknown, highly contagious, and often fatal disease that had been around for centuries. Germ theory provided a scientific explanation for its transmission and helped ideate preventative measures such as vaccinations.

The germ theory, by revealing that smallpox was caused by a specific microorganism, allowed scientists like Edward Jenner to understand how the immune system could be trained to fight the disease. This paved the way for the development of the smallpox vaccine, which exposed the body to a weakened form of the virus, triggering immunity without causing full-blown illness.

But that wasn’t all that the germ theory enabled scientists to do in the 19th century. It revolutionized the operating room by creating an antiseptic surgery. Before this, post-operative infections were a major cause of death, even for seemingly minor procedures. The germ theory revealed that these infections weren’t spontaneous, but caused by the invasion of microscopic organisms from the environment. Lister, understanding this principle, introduced carbolic acid as an antiseptic. By meticulously sterilizing instruments, dressings, and even the surgical site itself, he significantly reduced the presence of these harmful microbes. This drastically lowered the risk of post-operative infections, transforming surgery from a gamble into a more predictable and life-saving intervention.

The Beginning of the End

Credits: Harvard Health

Then came the rise of public health initiatives where, in my opinion at least, everything went downhill. They began to prioritize public health by pushing for sanitation measures and clean water, attacking the disease-causing microbes. It did wonders for stopping infectious diseases like typhoid and cholera, at least in the richer areas. They started with the richer areas, promising to get to the developing areas as their health budget increased, but of course, they never got around to it.

The rich were able to vaccinate their children and drink clean water while those who couldn’t afford to live in such areas, kept suffering for years on end. Insurance prices kept rising and once medicare/Medicaid was introduced, the gap between health and suffering kept increasing.

This isnt to say that these initiatives didnt help, but it enabled a gap that has grown to over half our world’s population, an issue that we can no longer ignore.

Economic Factors

Now that you know how we got here, i think we should define what “here” really means. The way I see it, is that there are four sides to this crisis- economic, political, social, and environmental. The gap started with an economic crisis, splitting those who could afford it and those who couldn’t, but it’s more complicated than that now.

In mid-2021, an estimated 18.8 million Venezuelans lacked access to health services, including 10.4 million with chronic diseases. Like every shocking statisitic, it starts years earlier, when the problem doesn’t seem as big. Their economic collapse began in the mid 2010s, drivine by falling oil prices and government mismanagement. Their economy worsened, with an inflation rate of 1,300,000% in 2018, eroding the value of currency, and making it nearly impossible for healthcare providers to purchase essential medical supplies and equipment. Without the right sense of money, the world cannot keep spinning. 76% of hospitals don’t have access to basic medicines and 22,000 registered physicians left Venezuela due to lack of money and access to resources in 2022 alone. Hospitals aced power outages, inadequate sanitation, and broken medical equipment due to a lack of maintenance and funding. Consequently, this leads to higher infant mortality, an increase in infectious diseases, and higher death rates overall.

Corruption & Politics

While economic factors can be unintentionally harmful, politicals are the opposite. Political agendas have disproportionally affected those vulnerable high healthcare costs. The fragile ecosystem of our global healthcare has become a pawn in politics. Im not here to write a scathing expose on how politics have ruined our world (not yet at least) but to show you how millions of lives have suffered at the hands of others trying to rise to power.

The Flint water crisis, which began in 2014, is a blaring example of how political decisions can have devastating consequences for public health, particularly for marginalized communities. In a cost-cutting measure driven by the city’s financial emergency and overseen by a state-appointed emergency manager with significant control, Flint switched its water source from Detroit’s system to the Flint River. However, the Flint River water was not properly treated for lead, a highly toxic metal that can leach from old pipes. This politically influenced decision resulted in lead contamination of the city’s drinking water, disproportionately impacting Flint’s predominantly African American (48.8% in 2014) and low-income (41.5% below the poverty line in 2014) population, according to the US Census Bureau. This environmental injustice exposed residents, especially children, to potential long-term health problems like learning disabilities, behavioral issues, and developmental delays. Yeah, a real Erin Brockovich type-story.

Wealth & Social Class

A common thread between economic and political factors is the idea that peoples social and wealth class can determine their health, for better or worse. The role of social determinants like poverty, education, and discrimination have astronomical effects on healthcare. Statistically, people in the lowest income bracket live 10 years less than those in the highest. Its not just the ends of lives, but the beginnings of them too.

The racial disparities in infant mortality rates has risen, especially with non-Hispanic Black infants who have an infant mortality rate of 10.4 deaths per 1,000 live births which is a staggering 2.4 times the rate of non-Hispanic white infants (4.6 deaths per 1,000 live births). American Indian/Alaska Native infants also face a higher risk, with a rate of 8.2 deaths per 1,000 live births. Thse with lower income are 50% more likely to experience death in the first two years of their life, specifically due to infectious diseases. I guess it all come back to germ theory and how it started with the disproportionate spread of resources in healthcare.

Environmental Factors

The reality only gets worse with time. As the industrial revolution hit in the 20th century, so did the first big wave of global warming. These two plus the already spiralling disaster that we call healthcare, people were suffering.

Specifically, pollution negatively affected peoples health. In areas like India, where dust is as common as air, people cannot afford to keep filling their inhalers. A 2021 study by the Lancet Planetary Health journal found that air pollution in India contributes to an estimated 2.1 million premature deaths each year. This translates to a staggering 17.8% of all deaths in the country being linked to air pollution. The financial burden is also significant, with the World Bank estimating that air pollution costs the Indian economy $150 billion annually. These costs stem from healthcare expenses, lost productivity, and the impact on agriculture.

Even developed nations like the USA are not immune. The American Lung Association’s 2023 State of the Air report reveals that over 200 million Americans live in counties that experience unhealthy levels of ozone or fine particulate matter pollution on at least one day of the year. This exposure to air pollution is linked to a variety of health problems, including asthma, heart disease, and lung cancer.

The financial burden of air pollution is felt in the USA as well. A 2018 Environmental Protection Agency (EPA) report estimated that the annual health costs attributable to air pollution in the US range from $143 billion to $407 billion.

Societal Status > Healthcare

People’s lives, money, everything is going down the drain, while most of the world is oblivious to what others are going through. We have an oversimplified view on healthcare as whole, where we treat it like a singular issue. Its like putting a band-aid on a gaping wound when we say “just diet or exercise a little more”, hoping that it will solve every problem. Some people cant afford that while others suffer from much deeper issues, ones that go all the way down to the system itself.

Studies have shown that factors like zip code can have a greater impact on health outcomes than some of the medical care you recieve. A 2018 Robert Wood Johnson Foundation analysis revealed that a resident’s neighborhood can influence their health as much as 20% more than their genetic makeup. This highlights the critical role of factors like access to affordable nutritious food (over 23.5 million people in the US live in food deserts according to the USDA), safe neighborhoods for physical activity (a 2022 report by the Trust for Public Land found that one in three Americans lack access to nature), and quality healthcare (nearly 30 million Americans remain uninsured according to the Kaiser Family Foundation).

The next time you get a cough or a cold, just think how lucky you are that you have to drink bad cherry-flavored cough syrup. Just think how lucky you are that you even get to drink it.

~Meera Singhal