Map of life expectancy at birth from Global Education Project.

Monday, November 29, 2004

Politics and Public Health: First Installment

Public health is in large part a public good. It is grossly undersupplied by the market between individual sellers and buyers. The public health paradigm, in contrast to the medical paradigm, encourages us to look at health, illness and human welfare from a social and political perspective, rather than the perspective of an individual consumer or supplier of medical services.

There are innumerable ways in which the public health paradigm reveals the profoundly false assumptions at the heart of free market fundamentalism. One area which is getting a lot of attention lately is infectious disease. The shortage of flu vaccine this winter has made a lot of people take notice of the threat posed by emerging infections, such as new strains of the flu virus that may jump the species barrier from birds or swine to humans and cause a new pandemic of dangerous influenza. Individual consumers will never create sufficient demand for flu vaccine to prevent an epidemic, and manufacturers would never make enough if they were only responding to consumer demand. This is because individual consumers' judgments about this may be misinformed, they may not be able to pay for it, and their own calculations are unlikely to take into account the public benefit derived from so-called herd immunity. (The term is used with people. In a nutshell, if I'm vaccinated, I won't infect you, which presumably makes you happy.) The Bush Administration screwed up (as it usually does) by failing to assure an adequate supply of flu vaccine.

But there are other serious threats to humanity posed by market driven behavior. One of the most important is the practice of feeding thousands of tons of antibiotics to livestock, so that "farmers" can keep them in crowded, unsanitary conditions. This creates drug resistant strains of bacteria. The mechanism of course, is evolution by mutation and natural selection, which the majority of Americans say they don't believe in. The consequence, the end of the antibiotic era, will be an almost unimaginable catastrophe for humanity. But the immense political power of the corporate meat industry and the pharmaceutical industry have so far prevented governments from ending this depraved practice.

How can we organize effectively around such threats to our health and welfare, that don't come from obviously scary terrorists, but from our own collective foolishness, the greed of wealthy and powerful corporate executives and shareholders, and the dangerous delusions of our political leaders?


Anonymous said...


I believe we can file this under "the tragedy of the commons."

I am so enjoying your writing and analysis--this is a high quality expert blog.

Cervantes said...

Thanks! Blogger doesn't give us any stats so it's good to know somebody is reading.

Of course, many people interpret the allegory of the tragedy of the commons is meaning that the commons should be privatized. But in the case of public health, that is a meaningless idea. What we need to do is recognize the value of the commons and get control over it through a democratic, accountable and responsive collective, otherwise known as government. Not, I'm sorry to say, the government we have now however.