Is There Still a Role for Public Health?

By SAM URETSKY

Tedros Adhanom Ghebreyesus is an Ethiopian public health researcher, and official who has been Director-General of the World Health Organization since 2017. He has been quoted as saying “We’re not just fighting an epidemic; we’re fighting an infodemic. Fake news spreads faster and more easily than this virus and is just as dangerous.”

COVID-19 dominated the headlines in 2020 and on Jan. 9, 2021, WHO announced a mysterious Coronavirus-Related Pneumonia in Wuhan, China. For many of us, probably most, with the obvious exception of Trump acolytes, were scared. Very. And Barbara Tuchman’s remarkable history of the 14th century (“A Distant Mirror”) noted that “so lethal was the disease that cases were known a person’s going to bed well and dying before they woke, of doctors watching the owner at bedside and dying before the patient. So rapidly did it spread from one to another that to a French physician ... it seemed as if one sick person quotation could infect the whole world ... both the malignity of the pestilence appeared more terrible because its victims knew no prevention and no remedy.”

The Black Death (also known as the Pestilence, the Great Mortality or simply, the Plague) was a bubonic plague pandemic occurring in Afro-Eurasia from 1346 and essentially disappeared in the 1350s although there were occasional outbreaks into the 1350s. In the 1600s. the European explorers brought a series of infectious diseases to the Americas. Some estimates suggest that 90% of the indigenous population in the Western Hemisphere was killed off by illness brought by the Europeans. In 1725 the Great Plague of Marseille probably killed 100,000 people. Perhaps the most virulent of recent epidemics was the Spanish Flu of 1018, with an estimated 500 million cases and a 20% death rate.

It was not until 1946 that the United States organized the CDC, Center for Communicable Disease Control (Centers for Disease Control and Prevention, now divided into a series of specialized offices with specialized functions). The US has become the world standard for medical care, diagnosis and treatment. More than 140 nations reply on the US Pharmacopoeia which, in January 2020, celebrated its 200th anniversary as the gold standard reference for medication standards, including assay and safety. But, while the US sets the standards for diagnosis and treatment, it fails in terms of ability to maintain the general well-being. According to a report in the Journal of Healthcare Leadership (11/19) “United States (US) health care expenditures are much higher than other developed nations yet we are ranked 37th among the world’s health care systems in overall performance, trailing behind in a number of key indicators including infant mortality, and overall life expectancy. Too many Americans still do not have access to quality health care and costs continue to rise – amounting to 17.1% of the GDP.”

What we’ve seen is that the US has slid backwards, and forgotten its role in the world and its place in the future – and more than that, how terribly fragile that role can be. It took only one misguided administration to neglect all we had learned about the needs of the people, and the need for constant vigilance.

In our pride we believed that the plague and other epidemics and pandemics were things of the past, consigned, as per Leon Trotsky said, “the ashbin of history.” Then, in 2017, Canadian Medical Association Journal reported “Massive cuts to science and medicine in Trump budget.” Every year of the Trump administration saw further cuts in the CDC budget. The Nation’s Health, a publication of the American Public Health Association, noted at the end of Trump’s term of office, adjusted for inflation, the public health sector was at least 10% below the last year of President Obama’s term, while trust in government and professional guidance has eroded badly: “The COVID-19 pandemic has contributed to greater mistrust in public health institutions, leaders and guidance. But even before the outbreak, declining trust in science and government was a barrier to protecting and improving health.”

President Biden proposed a massive bump in the budget for public health, and surveillance of emerging communicable diseases must be replaced, but by the time President Biden took office, too many people had been convinced that masks and vaccines were useless, and now more than one million Americans had died. It’s difficult to see how we can replace the lost respect of the world when we can barely restore the respect of our own nation.

Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sdu01@outlook.com.

From The Progressive Populist, June 1, 2022

Populist.com