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What’s Wrong With Public Health?
The Ebola infections in Texas have shown a bright light on fundamental flaws in our public health establishment. The Centers for Disease Control tells us that they have been fighting Ebola for 20 years, know what is needed to stop its spread, yet evidently never anticipated the entirely predictable crisis we now face. We are learning that hospital workers in Dallas were ill prepared, poorly trained and badly equipped to protect themselves when caring for a man sick with Ebola. Now a second first responder is threatened with a miserable death.
Public health, as a discipline, traces its roots to the famous London cholera outbreak of 1854 that John Snow interrupted by removing the handle from a community water pump that was the source of the bacteria. Snow was a physician, surgeon, and scientist. He didn’t hold much with the then popular “miasma” theory of disease. He looked for a germ.
Since those early days the scope of public health practice has expanded to the point of being almost unrecognizable. It has become a mind boggling array of — shall we kindly say — “miasmic” activities: funds given by taxpayers to treat AIDS patients are spent on gender empowerment initiative; stigma elimination programs and are channeled through politically controlled planning mechanisms that pit physicians against the “community” ensuring that medical science usually looses; etc.
If you wonder where all the great society programs of the 1960s went, you need look no further for your answers. The formula is simple: can’t find funding for your pet initiative to save the world or nanny your neighbor? Define it as a public health issue and you will have better luck.
With complicity of academia, public health has become the last refuge of social engineering. What’s more, everyone is welcome and lack of a basic of medical understanding is no barrier. Don’t want to tackle chemistry and biology? No problem, there is a career in public health for you. Have never cared for a sick patient? Welcome on board. Majored in human rights but don’t know the difference between a virus and a shovel? There is a home for you too.
So, is it any wonder that when Ebola emerges as a real public health threat our nation’s prime public health agency drops the ball? There is probably not one physician in a hundred employed by the CDC that actually cares for patients. If there were, they would have mobilized themselves to Dallas at the first sign of trouble and those nurses would have not had to figure out how to protect themselves by reading a flyer.
Published in General
Having worked in both radioactive & hazardous waste clean up for decades I was appalled at the lack of proper PPE & training for those hospital workers. In my industry, if that had happened on a job site the site’s managers would have been fired immediately.
Omg.
I disagree with the word “outbreak.” “Onset,” perhaps, but “outbreak[?]” C’mon, the “outbreak” was in those third world
nationsplaces.Standing in front of Harvard Medical School, one can see off to the left a building of equal size the Harvard School of Public Health. To the right, across and down the street is a second building, as big as the other two, the second half of the School of Public Health.
“Public health” used to have a different meaning than it has today for some reason.
The urgency to save lives doesn’t seem to be there, and it leads to a bureaucratic complacency, I think. Perhaps there is a crisis in idealism.
fair enough, thanks
Frieden worked for Bloomberg in NYC. He’s the doofus responsible for the war on fat New Yorkers. He’s a know nothing. Should be fired. Yesterday. Has no business running the CDC. Obviously.
The opposite, I think. There is plenty of idealism especially among young people – the issue is, I think, that our academic/ public health establishment channels that idealism to dodgy activities and wooly goals. When a real public health threat emerges our institutions find that they are bloated, lack focus, and have not equipped themselves to meet the challenge.
In the day, if you were hired to work in an eatery or other public kitchen the first thing you did was hustle down to the county courthouse, sit through a class and take the test to get a public health certificate. When my son was hired by a restaurant I found out that this is not required anymore. I think it shows a general lack of appreciation for public health standards. If this filtered up or down or from overall apathy, I don’t know.
Public health standards are racist and bigoted so they must be done away with for fear someone will feel less than adequate. Or something like that.
What’s wrong with public health? The “public” part. The government screws up anything it touches.
And here I was, thinking he knew nothing!
What’s surprising to me is that the nurses are the ones getting sick. It’s usually the doctors who ignore hygiene protocols.
Public health is more than just treating patients, which is why a lot of docs get post-graduate degrees in public health management. One of the biggest challenges to public health is the management of resources. As we’ve seen with the VA crisis, it comes down to resource management. In the case of the VA, many VA doctors have low productivity, because they are spending more time at the university affiliated hospital than at the VA hospital. Doctors aren’t the sacred cows some people like to make them out to be.
Like.
There is a difference between “public” and “government”.
The 1854 cholera epidemic wasn’t halted by government action, but it was still a public health problem. The organization Dr. Snow founded (the Epidemiological Society of London) wasn’t a government agency, but it still dealt with public health.
Even in the absence of a government, there is still a public.
What I meant was that the lack of idealism is the reason there is no commitment to change course and solve the problems you mentioned.
Personally, I think the medical profession is a little lost at the moment. Too many fads. Too much emphasis on preventive medicine, which has led to a “this is your own fault” attitude (like all things, the sentiment is accurate, but only to a point) so why should anyone else care. And then there is the whole psychology “this is in your head” influence. And the “are you worth the cost of your care?” and the pulling-the-plug influences. The feeling that there is a state of overpopulation. The cost of care.
There is very little that is clear and without some controversy and negativity in medicine anymore.
The optimistic mood the country was in after World War II when it built and expanded these huge and miraculous medical care complexes like the Harvard Medical School neighborhood and the Mayo Clinic is nowhere to be found.
And so there is no will to solve the problems. Just keep the bureaucracy going so I can go home and have dinner and watch TV.
Here is an admiring description of Frieden from someone who nonetheless thinks that he should resign:
Early on, as you can see here, he really did do good work in epidemiology. But, by the time that Obama hired him in 2009, he had embarked on a career of micro-managing human behavior. The President knew what he was getting. That is what he wanted.
I happen to think state wide smoking bans are perfectly constitutional, but nonetheless meddlesome and oppressive. I would not count it in his favor.
Don’t you think a lot of the problem with “public health” is simply bureaucratic drift?
The CDC appears to have done a really good job with a number of diseases. So good that working at the CDC must have gotten really boring.
So they started looking for new things to do, and lost sight of the old ones.
One can have a debate about the best way to carry out the CDC’s mission: be it public or private. But I think without a doubt that we need an organization that does the CDC’s mission, and does it well.
The downside to society from a runaway infectious disease is too huge to not have such an organization.
Both the CDC and WHO seems to be suffering from the same mission creep and loss of focus.
< devil’s advocate mode = on >
Of all the diseases which used to terrorize mankind but have now been either eliminated or brought under control, how many would not have been eliminated or brought under control if the Centers for Disease Control had not been created in 1947?
Can the CDC take genuine credit for eliminating and/or stopping the spread of any diseases over the course of it’s 67-year history?
If yes, how can we know those diseases would not have been eliminated or halted without the CDC’s existence?
The Wikipedia page for the CDC has lots of information about the organization’s mission, mandate, facilities, resources, and activities, but it does not have much information at all about the organization’s results.
< devil’s advocate mode = off >
Entirely predictable crises to have Ebola in Dallas??????
A year ago, if a story had come out that the CDC was preparing average hospitals in the US for…ebola…it would have been exactly the same people we see here today claiming that this represented waste of money by the CDC on useless things that have no chance of happening in the US…and undoubtedly accused the CDC of using our taxpayer money to causes outside our border.
Apropos of nothing:
The annual budget for Public Health of Canada: C$560 million
The annual budget for the Centers for Disease Control: US$6.9 billion
I agree entirely.
Hey, I’m a Libertarian, basically, so advocating this position isn’t a natural one. :)
I’ve been thinking about a post titled “Libertarians and the Tragedy of the Commons” to cover cases like this.
“A public health effort to eliminate all cases of poliomyelitis (polio) infection around the world, begun in 1988 and led by the World Health Organization (WHO), UNICEF and the Rotary Foundation, has reduced the number of annual diagnosed cases from the hundreds of thousands to 291 in 2012—a 99.9% reduction, though recently there has been a bounce back in some countries towards more cases.[1]“
Note, two public and a private organization.
Here’s the CDC’s history with polio:
“While the global push to eradicate polio is the latest chapter in CDC’s polio efforts, the fight against polio has been part of CDC’s mission since the 1950s. Shortly after the agency’s creation, CDC established a national polio surveillance unit (PSU) headed by CDC’s Epidemic Intelligence Service (EIS) founder Alex Langmuir. CDC worked collaboratively with Dr. Jonas Salk, of the University of Pittsburgh, who developed the inactivated polio vaccine (IPV) in the early 1950s, and Dr. Albert Sabin, who developed the oral polio vaccine (OPV) in the early 1960s. CDC’s PSU staff and EIS officers worked to administer both the Salk and Sabin polio vaccines in the field, and also gather and analyze surveillance data.”
http://www.cdc.gov/polio/why/index.htm
If the CDC hadn’t been doing this, would the private sector have stepped in? I presume so. Rockefeller, not the State, started the notion of mass disease eradication, after all.
http://rockefeller100.org/exhibits/show/health/eradicating-hookworm
I don’t particularly care who gets it done, but I think it’s a job that needs doing.
Well, really, it’s two quasi-public non-governmental organizations funded by governments and private donations, and one private fraternal organization.
Really? People give WHO money? I know UNICEF gets private funding, but I didn’t know WHO did.
Regardless, the first two are State-run, the third is not.