Amartya Sen and the Organization of Endovascular Stroke Treatment

• DOI: 10.1161/strokeaha.117.017136
• Publication Date: 2017-07-14T01:10:37Z
• Authors: Mayank Goyal; Alexis T. Wilson; Noreen Kamal; Ryan A. McTaggart; Mahesh V. Jayaraman; Marc Fisher; Michael D. Hill
• Keywords: 2. Zero hunger; Health Services Needs and Demand; Endovascular Procedures; Urbanization; 1. No poverty; Nursing Staff, Hospital; Health Services Accessibility; Brain Ischemia; Stroke; 03 medical and health sciences; 0302 clinical medicine; Humans

See related article, p 2042 The term famine refers to an acute period of widespread death resulting from starvation. The traditional thinking is that this occurs because of shortage of food. However, in Poverty and Famines: An Essay on Entitlement and Deprivation , Nobel Laureate Amartya Sen argues that, when examining starvation and famines, individuals’ ability to acquire food (what he calls entitlement) is a distinct and equally important contributor to hunger.1 This claim underpins his criticisms of the Food Availability Decline view of famines, which attempts to explain famines in supply terms only. Sen’s original study examined the 1943 famine in Bengal, which resulted in the deaths of >3 million persons. The findings of the contemporaneous Famine Inquiry Commission attributed this famine to a major shortage of rice. After reevaluating the available data, however, Sen concluded that the overall quantity of rice in Bengal was not exceptionally low, even surpassing the supply of previous years. This famine demonstrates that people’s ability to acquire food is dominantly related to distribution rather than the absolute total amount of food available in a region. With recent advances in acute ischemic stroke treatment leading to endovascular treatment becoming the standard of care,2 there has been much discussion on shortages of availability of this treatment. Similar to Sen, we need to have a better understanding of the underpinnings of this perceived shortage to develop relevant and long-term solutions to the problem. One could naively assume that increasing the number of neurointerventionalists or the number of biplane angiography suites would solve the problem. This may be far from the truth. It is possible, even probable, that the current perceived shortage may be principally a problem of distribution rather than an issue of overall availability of angiography equipment or trained personnel. If this is …