‘A year of miracles and setbacks’

Sir, – Fintan O'Toole writes that "inequality is the main vector of disease", and "injustice is a medical condition" ("2021: A year of miracles and setbacks", Weekend Review, December 24th).

When we consider not only the emergence of Covid-19, but its transmission and transformation into a global pandemic, multiple factors emerge: the way we create societies of such inequity that the health of millions suffers, as many lack access to sanitation, medicine, and vaccines; the way we unbalance our environment with urbanisation, industrial animal farming, and ceaseless global travel; and the way we reliably fail to coordinate early responses to all kinds of events, from floods to political instability, from climate change to pandemics.

The solutions are as much political as they are medical: addressing structural inequity in health and social care; living, farming, and travelling differently, with greater awareness of planetary impact, and coordinating global responses to emergent threats.

Rudolf Virchow, the 19th-century German pathologist, anthropologist and politician, argued that “medicine is a social science, and politics is nothing but medicine on a large scale”.


Closer to home, Charles Haughey concluded, in 1977, that “healthcare” is “about good government and cannot, in the words of the cliché, ‘be taken out of politics’”. – Yours, etc,


Professor of Psychiatry,

Trinity College Dublin,

Dublin 2.