Map of life expectancy at birth from Global Education Project.

Monday, May 18, 2009

Shark attack!

If you are a regular viewer of TV News, a reader of newspapers, or a regular reader of Daily Kos, you will be surprised to learn that among the many afflictions of humanity, influenza is well down the list. You may be even more surprised to learn that it will still be well down the list even if the worst predictions of the ultra-scary H1N1 swine flu turning into a GLOBAL KILLER PANDEMIC come true. Finally, given that much of the raw material for these news reports comes from the World Health Organization, you may be most surprised of all to learn that I depend in substantial part on the WHO to provide the basis for these assertions.

Influenza is the missing white woman/shark attack story of the public health field. Don't misunderstand my point: there really are, from time to time, missing white women, there really are shark attacks, there really is a novel strain of flu going around. I don't think that coverage of these issues is any less factually accurate than coverage of anything else. The question is whether the amount of attention paid to them is proportionate, and whether these stories serve to distract us from what really matters.

For example, it was reported today on the front page of all the major cable news web sites, many newspapers (I can't read them all, but most of the ones I have seen), and Daily Kos, that a man in New York has died of swine flu. Oh no, the killer flu has come to New York! Not only that, but authorities have closed several schools in the city. These developments obviously vindicate the huge amount of attention given to this major threat to humanity, and prove that I have been wrong to try to ramp down the hysteria, right?

It has been reported that, like the vast majority of people whose deaths are ascribed to influenza, this man was already sick and debilitated. Doctors believe that influenza contributed to his dying at this particular time, but is that news? In fact, on average, 100 people in the United States die of complications of influenza every day, and about 100 more from similar infectious diseases (we call them Flu-Like Illnesses, FLIs, because usually nobody ever finds out exactly what the people had). So while this man's death was making the front page, we can guess that about another 200 people in this country were dying under similar circumstances. (It might be a bit lower number given that the peak of flu season has passed, but it's certainly in 3 digits.) So what is the difference? The difference is that H1N1 influenza, something which can be detected only by a laboratory test and which otherwise is entirely undistinguishable for the flu and FLIs that are going around all the time, is the missing white woman of today.

You might also want to know that as of now, in the case of the new school closings in NYC, they don't actually know whether students there had flu at all, let alone the DANGEROUS KILLER H1N1 SWINE FLU! They have FLIs; the school closings are precautionary. And what if they do in fact have the DKHSF? What will happen is that they will spend a few days at home with coughs and sniffles and chicken soup. Then they will be all better. So, should we perhaps be paying attention to other public health issues?

I have written previously about some of them, actual, real stuff that's happening right now, destroying millions of lives, killing millions of little kids, causing sickness and suffering all over the world and throughout the United States. We don't have to wait for a hypothetical worst case scenario, it's already here. And, if an unusually severe flu season occurs next year and ends up being credited with 50 million deaths -- which is extremely unlikely by the way -- the flu pandemic will end, in one year. And that other stuff will continue. While we were paying no attention to it.

So why do we get missing white women, shark attacks, and influenza, instead of more important stuff? Why do they avoid talking about subjects like illegal wars of aggression justified by lies, and millions of children dying of malnutrition and diarrhea? It's because it's much easier to avoid subjects that are politically meaningful and gall the powerful.

Contrary to what you may believe from reading Daily Kos, the WHO is not principally concerned with influenza. Today, the WHO released the long-awaited report of its Commission on Social Determinants of Health. The background given on the intro page is actually quite well written and substantive, but the executive summary is no problem to download, it's just a 40-page PDF. I could quote it forever, but I'll just pull this:

Our children have dramatically different life chances depending on where they were born. In Japan or Sweden they can expect to live more than 80 years; in Brazil, 72 years; India, 63 years; and in one of several African countries, fewer than 50 years. And within countries, the differences in life chances are dramatic and are seen worldwide. The poorest of the poor have high levels of illness and premature mortality. But poor health is not confined to those worst off. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.

It does not have to be this way and it is not right that it should be like this. Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. It is this that we label health inequity. Putting right these inequities – the huge and remediable differences in health between and within countries – is a matter of social justice. Reducing health inequities is, for the Commission on Social Determinants of Health (hereafter, the Commission), an ethical imperative. Social injustice is killing people on a grand scale.

The Commission wants us to "improve daily living conditions," "measure and understand the problem," and above all, to "tackle the inequitable distribution of power, money and resources." It is the latter which is responsible for most of the premature death, disability and suffering in the world. You may have heard that among the wealthy countries, the U.S. ranks last is indicators of population health. The reason is not that we are uniquely susceptible to influenza: it is that we have the most social inequality of the wealthy countries. Our poor people, less educated people, and members of disadvantaged racial and ethnic minority groups, bear the burden of our failures of social justice, in spite of our great wealth.

Influenza, however, is easy to talk about. It affects people indiscriminately, without regard to wealth or privilege. It does not challenge us to attack the power of giant corporations, or entrenched interests. It speaks no truth other than the universally understood frailty of life. That's why it is the perfect shark attack/missing white woman of public health. And that is also why the relentless, unending, feckless obsession with the subject on the front page of Daily Kos, to the exclusion of all other public health topics, constitutes such a tragic misuse of a scarce resource. And don't tell me well, there has been material about the health care reform legislation. Health care is not public health. It's what we do after public health has failed, after injustice has already taken its toll.

It is long past time to change the subject.


kathy a. said...

Our poor people, less educated people, and members of disadvantaged racial and ethnic minority groups, bear the burden of our failures of social justice, in spite of our great wealth.nail on the head.

Cervantes said...

Well that was effective. I got 7 tips and 10 comments before falling off the page. I've had it with Kos, it's a total waste of electrons.

kathy a. said...

i wrote off the big political blogs some time ago. there is too much noise, so many people piling on the noise of the day.

but i think you have a great point with this post. it takes more than 30 seconds to think about, though.