Map of life expectancy at birth from Global Education Project.

Tuesday, September 13, 2005

A View From Afar

The British medical journal The Lancet (warning: highly annoying registration process required) tells us what the corporate media here in the U.S. still haven't completely figured out. Subverting public health to the so-called War on Terror is killing us.

From the lead editorial:

Since 2001, fears for the future safety of the US population have focused on one thing alone: the potential dangers a bioterror attack could unleash. This obsession catapulted the issue of America's decaying public-health infrastructure from a state concern to a crisis that involved the entire nation. The worry was justified.

A damning report issued in 2002 by the Institute of Medicine claimed that governmental public-health agencies had long suffered “grave underfunding and political neglect”. It criticised the country's “obsolete and inconsistent laws and regulations” governing public health, and derided the fragmentation of health responsibility, shared among officials at all levels of government. The uneven distribution of resources within the “increasingly fragile” health sector meant, the report claimed, that the health system would be unable to manage a large-scale emergency.


Significant boosts to funding for public-health infrastructure followed 9/11, along with plans to better coordinate emergency responses and improve communication between all levels of government. Crowning these efforts was a National Response Plan purporting to provide “the means to swiftly deliver federal support in response to catastrophic incidents”. It was released in January this year, under the auspices of the Department of Homeland Security and its subsidiary the Federal Emergency Management Agency.

Last week marked the plan's first real test. It failed. While the central themes of the plan strongly emphasise fighting terrorism and national leadership, three key areas of administrative difficulty have been all but ignored.

[The editorial describes the jurisdictional problems between federal and state authorities, and civilian and military leadership, which were revealed by the disaster.] The reason behind this bureaucratic tangle is that health responsibilities are dispersed through numerous federal departments. Key emergency health responsibilities come under the jurisdiction of the Department for Homeland Security, rather than their perhaps more natural home at the Department for Health and Human Services.

The third, and perhaps most concerning issue, is the ongoing confusion over what public-health preparedness should be preparing for. Public-health officials are divided over whether to prioritise all-hazards preparedness or specific plans to counter a bioterror attack. Bioterrorism is clearly the government's priority, but this focus, and the funding bias that goes with it, limits states' flexibility to choose a broader approach to protecting public health. States also claim that if priorities are set nationally, their specific vulnerabilities will be ignored and responses will be slow and unwieldy. They are probably right.

Would Hurricane Katrina's aftermath have been less fraught had these issues been addressed? It is impossible to say. For not only did the USA shy away from a national priority list of public-health threats, it also failed to define what should constitute “prepared”. Assessment criteria to test states' compliance with national obligations have been criticised as meaningless and impossible to measure.

A well functioning public-health system protects human life when disasters occur. Just how much the neglect of the US system hindered an effective response to Hurricane Katrina should weigh heavily on the shoulders of George W Bush, as he views images of stadia crammed with New Orleans' many homeless and hears the final counts of the dead.

I will simply add that it is very doubtful that anything will ever weigh heavily on George W. Bush's shoulders. His life is nothing but a relentless litany of failure, for which other people have always paid the price, and he has never been accountable. That our political system elevated an ignorant, incompetent sociopath to its highest office is our real national disgrace.