The future of public health looks like the unequal past

The Atlantic has an article up right now by a writer living in rural southwest Michigan on how, in his part of the country, most people are ignoring covid:

Where I Live, No One Cares About COVID

I think that's probably a pretty accurate report of how things look from that POV. I'm headed to a different part of the midwest myself over the holidays, and the views there line up with those of the article writer. A lot of people really are just not ignoring the pandemic, but aggressively choosing to dismiss it. This, even as the pandemic still is very much a thing, with huge numbers of people getting sick and dying.

What this called to mind for me was how public health in general is sharply worse outside what I suppose we can label the "metropolitan core". For example, here's a map from the Washington Post of where opioid pills where over-prescribed:

https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/

Look up other health issues, such as alcoholism, and you'll see similar patterns. The hot spots for particular health issues differ somewhat, but broadly it holds true that public health out away from the prosperous metropolitan regions is worse. And this attitude of just kind of ignoring this, or even actively fighting against measures that would improve the situation, also follows the general pattern.

It also reminds me of earlier history. For instance in reading about early NYC, I recall learning how during times of outbreaks of yellow fever or typhus or other such diseases the wealthy would flee out to suburban areas such as what is now the west village. It wouldn't surprise me if early 19th farmers up in Westchester or the wilds of Jersey scoffed at calls to do things like build aqueducts, or saw such public works as something that only mattered for urban areas even as poor sanitation picked off family and neighbors in their communities.

We seem to be going back to that bifurcated public health landscape, where the middle class and wealthy enjoy better health, supported by better health infra and technology, while outside of that people just accept poor public health as their lot in life and resent the wealthier, healthier regions.


PVW said:

The Atlantic has an article up right now by a writer living in rural southwest Michigan on how, in his part of the country, most people are ignoring covid:

Where I Live, No One Cares About COVID

I think that's probably a pretty accurate report of how things look from that POV. I'm headed to a different part of the midwest myself over the holidays, and the views there line up with those of the article writer. A lot of people really are just not ignoring the pandemic, but aggressively choosing to dismiss it. This, even as the pandemic still is very much a thing, with huge numbers of people getting sick and dying.

The author of that piece in the Atlantic is indulging in a dangerous fantasy. A real reporter has a very different picture to show - 


nohero said:

The author of that piece in the Atlantic is indulging in a dangerous fantasy. A real reporter has a very different picture to show - 

Yes, they are -- but my point was that this is a) a dangerous fantasy shared by many, b) not a new fantasy, c) depressingly, really not a new dynamic.

The pandemic has cast all this in stark relief, but it's not necessarily just about the pandemic.


The play "Enemy of the People" by Ibsen written 140 years ago, very closely follows the covid drama that is playing out in real-time in the US and the world.  Fauci is now the bad guy to many people.   I recall back in the 1980s that Fauci became the target of harsh criticism by AIDS activists.   But he is one of my heroes since he kept on advocating for AIDS prevention actions and now we have some really good medications for HIV-infected people but no vaccine.   (By the way, HIV infection is still present and I am going to check the numbers on this.)    We all want immediate cures and 100% percent effective vaccinations, but the science is not there yet, so prevention and risk reduction are the best we can do right now.  I think I read that Fauci commented that if there was as much opposition to the polio vaccine 55 years ago as there is now to covid vaccine, then we would still be having outbreaks of polio in the US.  The younger generations simply do not have the collective recognition of the many deadly, disabling communicable diseases that are now prevented by vaccination.  

PS, if you have read or seen the play Enemy of the People, I would like to hear your take on it.  


RobertRoe said:


PS, if you have read or seen the play Enemy of the People, I would like to hear your take on it.  

Need to add that to my reading list -- my reading of drama is really woefully lacking.


As a consideration from Peter Wick so as to not add any politics to the Omigrom thread on the regular MOL, I would like to add a couple of thoughts about public health and covid and politics.    Public Health is often an arena where science and health and the economy and politics meet.    I was very happy to see that Governor Murphy would have up a banner in front of his covid press conferences saying that public health is economic health. 

   Making human health issues and environmental issues into public law and policy needs special skills and this is somewhat like an art.  Good intentions for improving public health and the environment can easily go astray and not accomplish the intended goals.  One of my favorites is the Superfund toxic site clean-up fund that was championed by the late NJ US Senator Lautenberg.  The plan he favored and was passed into Federal law was to have all chemical companies pay into a toxic waste Superfund cleanup fund since all chemical companies benefited from all sorts of chemical manufacturing.   Thus, we had a ready and reliable fund to clean up toxic waste sites without waiting for years and decades of legal wrangling to be completed  This plan worked and thousands of toxic waste sites were cleaned up in a timely manner. 

Dr. Fauci often says that his priority goal is to protect public health first.  His opponents favor economic goals first and they villanize Fauci.  Some people have little regard for public health except when it directly affects them.  So, public health and economic health and politics, and all the complications and varieties of human personalities intersect.   I very much applaud the elected officials who in a caring, humane, and thoughtful manner try and sort through these complicated issues.  I am glad to see vigorous debate on how to best make policy and laws for public health. And of course, there is constant debate over where to best put our limited money resources. But I am really saddened and disheartened to see those political groups and pundits whose only goal seems to be in power, money, slandering, and demeaning any opponents. 



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