Betrayal of Trust: The Collapse of Global Public Health

Christian Century, May 2, 2001 by Dan Beauchamp

The epidemic was checked by the arrival of Barbara Kiersteins, a physician with Medecins Sans Frontieres (MSF--Doctors Without Borders). She and epidemiologists from the World Health Organization with whom she worked grasped that what the hospital needed was simple public health protections--clean water, disposable syringes, soap, protective gear and the isolation of Ebola patients, as well as rest and food for frightened health workers.

Most gripping and sad is the story of the collapse of public health in the former Soviet Union, a collapse that probably began decades before the fall of the Berlin Wall. Though the Soviet Union drastically improved the health of its people in the first five decades after the revolution, that progress was reversed. Vast numbers now crowd Russian prisons, where poor sanitation, inferior antibiotics and widespread drug resistance have virtually created a factory for the production of diseases like tuberculosis and HIV. Many of the prisoners have illnesses that are resistant to all but the most sophisticated and costly of antibiotics. Much of this drug resistance is caused by the casual availability of antibiotics in every major Russian city. Russia's out-of-control HIV and AIDS epidemic is spread mainly by widespread drug abuse among young people, most of whom share used needles.

THE U.S.'S OWN FAILURES to safeguard public health stem from a populist embrace of the market. Big government is seen as the enemy of the common people, and the market as the workingman's best friend. Political movements that tout economic growth as the true friend of the poor and resist government regulation result in underfunded and weakened public health systems.

William Stringfellow and Walter Wink use the New Testament terms "powers and principalities" to describe the institutions and ideologies that undergird society and demand our ultimate loyalty and tribute. The powers have both visible structures and invisible or spiritual dimensions that are the source of their power and sway over people's ultimate loyalty. Such a worldview often seems to lie behind Garrett's analysis, though her background as a science reporter keeps her from using frankly spiritual categories.

Garrett's principal thesis is that the health of every nation depends on the health of every other nation. Places and communities where public health protections are weak become targets of and reservoirs for infections that threaten far-flung communities, now only a plane trip away.

Garrett presents a laundry list of needed responses: reforming a pharmaceutical industry more concerned with profits than people; restraining a profit- and technology-oriented medical system that overshadows the more effective public health infrastructure; slowing the development and settlement of vast areas of rain forest; and persuading rich countries to fund global health campaigns in poor countries.

Behind Garrett's list stands a deeply spiritual challenge: we need to give our loyalty to the welfare of humankind and all of creation, not to the powers of domination and profit. If suffering people most need disposable syringes and afibrdable vaccines, then shiny hospitals and huge profits for the pharmaceutical industry cannot be our primary goals.