|
 ot
since Outbreak was in theaters has America's public-health
system garnered so much attention. This time, however, the biohazard
suits are real, our enemy isn't a primate infected with a nasty
virus, and Dustin Hoffman is unlikely to save the day.
No, this time
Americans are going to be forced to take the issue of public health
seriously — something it's been exceedingly hard to do for
the last couple of decades. In recent years, the public-health establishment
in this country has occupied itself mainly with being a nuisance.
When the American Public Health Association hasn't been busy harassing
smokers and gun owners or declaring one or another pesticide a menace
to society, it's been issuing statements of solidarity with the
Communist Sandinista regime in Nicaragua.
Now, however,
the threat of bioterrorism has made public health a matter of national
defense, certain to see a huge influx of money and political interest.
This means a serious debate will be needed as to what exactly "public
health" is. What does public health mean in the context of
the war on terrorism? And what will it mean, once we eventually
find ourselves victorious?
Public health
has had a long and rocky history in America, and understanding that
history will be essential to shaping the sure-to-be-expanded system
over the coming months and years. While it has achieved much that
is impressive and noble, in the latter half of the 20th century
there has been a significant shift in emphasis away from the original
mission of preventing the spread of infectious diseases.
Public health
got its start in America not long after the Civil War. Of the 620,000
battle-related deaths in that war, more than half were caused by
disease. Smallpox, yellow fever, cholera, typhoid, and other diseases
were rampant in camps of men forced to live in close quarters, and
many of these traveled home with soldiers in 1865, causing epidemics
in communities around the country.
By 1869, the
first state health department was established in Massachusetts,
formed to improve sanitation, enforce quarantines, and cooperate
with the recently created local health boards. Such departments
sprang up in the latter half of the 19th century at the state and
local level, overseeing the creation of sewer systems, cleaner water
supplies, and safer production and preparation of food.
The ensuing
decades saw the greatest leap forward ever for public health, as
basic scientific ideas such as germ theory took hold (previously,
people had believed that disease spontaneously generated from filth
or poor living conditions). This, combined with the discovery of
vaccines, led to what can only be described as a revolution in human
health. In America and Europe, diseases that had long haunted mankind
in catastrophic epidemics were suddenly being brought under control.
Simple things, like people washing their hands, were creating dramatic
improvements. When an outbreak did occur, germ "detectives"
would trace how a disease was spreading, order targeted quarantines,
and halt it in its tracks.
Of course,
as any student of bureaucracy knows, success is often a government
program's worst nightmare. Bringing infectious diseases under control
is fantastic and all, but once you've picked the low-hanging fruits,
major budget increases are unlikely to come your way.
With the threat
of infectious disease looming less prominently, by the 1940s the
now largely federalized public-health establishment began turning
its attention to problems like cardiovascular disease and cancer.
Instead of protecting citizens from deadly microbes, public-health
workers were more and more concerned with protecting people from
themselves. Instead of food safety, attention was now given to what
people ate (or, God forbid, smoked). Instead of vaccination, the
focus was now on access to hospitals for the poor.
While these
new concerns were certainly valid, they increasingly married the
cause of public health to the agenda of the political Left. Instead
of acting as a sort of biological fire department, putting out an
epidemic here and there, public-health advocates now saw their job
as regulating Americans' habits and fighting a war against profit-driven
private medicine. By the 1990s, drug abuse, gun violence, domestic
violence, smoking, and the eating habits of Americans were all considered
to fall in the purview of public health — at least by many
professionals in the field.
So, after years
of politicization and mission-creep, the public-health system in
America must now come face-to-face with its long-forgotten founding
purpose. Infectious diseases threaten our shores, and must be dealt
with as in days of old.
Luckily, the
threat of bioterrorism was not completely unanticipated. The CDC
has long been preparing for such an eventuality, along with the
possibility of a disease such as Ebola finding its way into our
nation's population. We are not prepared adequately, however —
a nation with only 12 million doses of smallpox vaccine, when we
knew Saddam Hussein was in possession of the disease, is obviously
a nation that wasn't taking the threat seriously enough.
The question,
of course, is what we do now. In the immediate future, the government
is intent on strengthening the biological fire-department role of
the public-health system. More money for disease monitoring, testing
labs, decontamination units, and government purchases of antibiotics
will be rapidly forthcoming.
But there are
other questions. For instance, how will we treat private health-care
providers, such as the pharmaceutical companies? Right now Bayer
should be one of the most celebrated names in America — right
up there with Giuliani, Bush, and Beamer. Instead it's getting little
more respect than Jackson, Streisand, or Baldwin.
Bayer's Cipro,
an extremely potent antibiotic that's been on the market since 1987,
treating particularly nasty urinary-tract infections and virulent
blood-borne infections, now stands as the best barrier between life
and death for anthrax-infected Americans. The company has frozen
prices at pre-September 11 levels, ramped up their production of
the drug to around-the-clock status, and is even considering contracting
with other companies to make sure there's no shortage. Even so,
the Canadian government has decided to join the handful of looters
at the World Trade Center by breaking Bayer's patent. In America,
the estimable Chuck Schumer has encouraged the U.S. government to
join in as well.
Such lawlessness
is unnecessary, and ultimately destructive. It is not hyperbole
to say that such actions undermine our capitalist system, which
is the only thing that's allowed us to be able to respond so well
to the terrorist threat in the first place. Cipro was a drug created
by a private company to make a profit. The many lesser-known alternatives
to Cipro fit the same bill. The smallpox vaccine has long been a
project under the government's supervision, but the modern techniques
that will allow us to create millions of new doses in the next few
months are a product of the free market.
Augmenting
our biological fire department will be a necessary measure for this
new war, and is likely a prudent investment even during peacetime.
On this front, conservatives will have to get over their long-standing
aversion to anything labeled "public health." (Just try
thinking of it as national defense, and the shaking will stop.)
But we must remain vigilant to guard the free-market institutions
that have given our society the prosperity and dynamism we need
to quickly adapt and respond to the terrorist threat.
Beware, too,
the war-swollen bureaucracy. Once the current crisis has passed,
there will be armies of new public-health workers with budgets,
jobs, and turf to protect. Just remember: If cigarette manufactures
can be prosecuted under racketeering laws, your Marlboroughs could
be considered a biological weapon someday.
Public health
has become a more important and serious profession in recent weeks.
Let's make sure it stays that way.
|
