HEALTH CARE/Joan Retsinas

Ignoring the Pumphandles

In 1854 in London Dr. John Snow did the kind of epidemiological tracking that now seems routine: from a dotted map showing cases of cholera, he traced the probable source to one water pump. The Waterworks Company, which delivered water to the pump, drew the water from an especially polluted part of the Thames: at that time, people threw their sewage into the river. But since scientists did not recognize the germ theory of illness, Dr. Snow could point to no reason for the correlation. Nevertheless, he persuaded the skeptical Board of Guardians to remove the pump’s handle. The result: a drop in cases of cholera. Dr. Snow launched the modern public health movement, one that tied governmental action to epidemiology. The John Snow Society pays homage with an annual Pumphandle Lecture.

Although today we laud Snow’s action as obvious, it was hardly obvious to 19th century Londoners. Imagine the brouhaha. Scientists must have questioned the heretical germ theory. The Waterworks Company surely objected to turning off its pump. City fathers, reluctant to link cholera to the omnipresent sewage, must have hesitated. And surely the property-owners weighed in (though even before officials turned off the pump, people were leaving the neighborhood.)

Fast forward 160 years. In the United States, public health departments still amass statistics, still draw conclusions, still work to turn off the myriad pumphandles. We are all healthier for it. Yet those battles are not easy. Ironically, today many Americans want “less,” even “no” government: they want government to leave the pumphandles alone.

Consider a few of those pumphandle decisions, ones that generally garner little publicity, surfacing below the fold on an interior page of a newspaper, if at all. Scenario one: people grow ill with a set of symptoms, many commonplace. When epidemiologists recognize a clustering, or an upswing, of patients with these symptoms, they investigate. If they link the outbreak to a batch of contaminated food, they force recall of the item, plus issue public service announcements warning people not to eat the food. If they link the outbreak to a restaurant, they search for the source: contaminated food? An employee who transmitted a disease? They may force a restaurant to close temporarily, again with warnings to the public, alerting patrons who ate there. In the name of public health, the government – often an understaffed state department – is undercutting the income of private sector businesses. Sometimes public health officials link disease to the environment: shellfish from a contaminated shorefront, water in a polluted swimming pond, ozone-heavy air during an especially hot summer day.

In the spirit of Snow’s pumphandle, the government might close a beach to shellfishing, might close a pond to swimmers, might urge people with pulmonary diseases to stay home. More intrusion onto the private sector.

This government oversight – a modern-day “pumphandle” search — is built upon trust and competence. We need to trust in physicians, going to them when we are ill, following the prescribed regimens. We need to let physicians report data about us to researchers. Physicians for their part need to report not just the list of required “reportable” diseases, but unexpected outbreaks of symptoms. Those physicians must trust that government will safeguard their patients’ privacy. Citizens must trust the scientists who test possible contaminants. We all must trust the epidemiologists running the increasingly sophisticated computer systems. Finally, citizens must trust government to turn off the pumphandles in the public interest, even though the action hurts private sector entrepreneurs.

Ironically, 160 years after Snow shut off the Waterworks pumphandle, that trust is in question. A swathe of us distrust experts, especially governmental ones. And that swathe is forcing state and local governments to cut health and environmental budgets. Calculate your state’s dwindling number of inspectors — whether of restaurants, supermarkets, food trucks, swimming pools, beaches, nursing homes, hospitals, air quality. Look at the age and capacity of your state’s computer tracking systems. Check your state’s response time to possible crises.

With reduced budgets, we will be finding fewer pumphandles.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, October 15, 2013

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