Who Should We Let Die?: How Health For All Failed, And How Not To Fail Again

Image of Who Should We Let Die?: How Health For All Failed, And How Not To Fail Again
Release Date: 
April 5, 2022
Atmosphere Press
Reviewed by: 

Paying for universal health services? How could we pay for it? “Stop to think of it. We’re never asked how we were going to pay for our years of wars choice. The Bush Administration and his enablers didn’t sit with us in town halls to ask how they were going to spend a trillion dollars in Afghanistan and Iraq.”

At first glance Dr. Oyerinde’s book appears to address the terminally ill, but refreshingly his treatise reflects health care on multiple continents and is about creating health through primary care systems. Though this Nigerian-born pediatrician and global health advocate has many wonderful personal experiences to share, this book suffers from poor editing, which makes it difficult to enjoy the read. The nomenclature wanders back and forth between the stilted Queen’s English, various African patois, and American terminology, without a single defining voice.

This will not be a popular read, but the good doctor has some great health policy insights and the occasional wry observation of culture clashes. It is informative to glean the perspective from an immigrant and especially this globe trotter. However, the book misses the most compelling aspect of Oyerinde’s story: He lives and practices in Minot, North Dakota. North Dakota is a very conservative state and not known as a bastion of cultural integration, so opening with this would have been a stronger pull for the reader.  

In particular his nuanced comparisons of certain aspects of U.S. primary health care to African nations is refreshing. In his native land of Nigeria, he found the health care had diminished drastically from his youth to the present day. “When governments got bad and become unaccountable to the electorate, public services such as education and health care services are the first to deteriorate.” One can easily draw comparisons to the Blue/Red divide in America today. Blue states have expanded health care services to those in need, and the red states for the most part have restricted them. Oyerinde speaks of his experience watching totalitarian regimes allowing health services to deteriorate and lose any semblance of value while the jet setting junta fly off to Dubai or Turkey or Switzerland for care.

Americans so often recite theirs is the best healthcare in the world, but from what vantage point are they drawing this conclusion? Certainly not from care coordination, affordability, or access to primary health care services for all. This is the meat of his work: The provision of accessible and affordable primary health care can improve health and avoid the reliance on more expensive secondary care in hospitals. “The primary health care system is not a treatment system but a system in which prevention of disease and death and the promotion of wellbeing are paramount.”

An irritating aspect of Oyerinde’s book is his constant referencing of conferences and global health entities for which laypersons will be unfamiliar, and the absence of an acronym dictionary, chapter notes, bibliography, or index, make it difficult to follow seamlessly. Halfdan Mahler, a Danish world health executive decades ago, is not a household name, for example. Alma Alta Conference? Again, no reference for most readers outside of the global health intelligentsia.

Who Should We Let Die has moments of political intrigue, because who knew that the Obama Administration used a doctor and a vaccine ruse to gain access to Osama Bin Laden?

Overinde’s knowledge and understanding of maternal health is welcomed, especially in light of the recent spate of male legislators who ponder why they, as males have to pay for a woman’s childbirth costs. I particularly enjoyed this sanguine observation, “It is time to wish health insurance middlemen eternal rest; may perpetual light shine upon them.”

“Once again, as you cross the threshold from a free citizen to in-patient, you lose most of your control over the cost of your care.”

Lest you think this treatise is all about bashing US health care, you will be glad for our coordinated and vaunted emergency 911 services, highway safety standards, and controls to protect the distribution of counterfeit drugs compared to Africa. Expat Africans working in health care and policy wonks will enjoy his practical view on health care. His astute observations on the unintended complexity and consequences of nongovernmental organizations trying to apply industrial fixes to rural communities in Africa is so true. “Why don’t we ask the locals?” he opines, infuriating a Scottish advisor. He speaks of the importance of trust in a health care system, and this has certainly been demonstrated in the vaccine hesitancy in the U.S. Finally, his definition of the U.S. health system as GoFundMe would be hysterical if it weren’t so true.

“In the U.S. we have rationing by staffers motivated by company profits.”