Betrayal of Trust: The Collapse of Global Public Health

Christian Century, May 2, 2001 by Dan Beauchamp

IT WAS ONCE THOUGHT that democracy, with its traditions of individual freedom, property rights and the like, would limit the scope of public health, which typically advances through collective action. Yet over the long run democracies have a far better record of protecting public health than do governments like that of the former Soviet Union. Freedom of speech and discussion are more effective than a powerful state apparatus in reforming health practices, especially such practices as alcohol and other drug use or smoking. We have "talked" smoking rates down and, through democratic discussion and massive publicity, made an impressive start in checking alcohol consumption and decreasing HIV infection in the gay community. Our public and religious moralism, however, has hampered our efforts to fight the HIV/AIDS epidemic.

In state socialism, where everything is controlled, private behavior can become an act of defiance or even resistance to the powers of the state. This may partially account for the high rates of drunkenness, drag use and smoking in the former Soviet Union. Such risky behaviors can also be the recourse of those who feel defeated. A friend who visited Poland in the early 1980s noted that most of the country's public health workers smoked and drank heavily. When he asked why, people told him, "It is our only consolation."

We have tended to see humankind as immune from the laws of creation, as a power apart. While we have sought safety in steel and glass buildings and homes in gated communities, we share our dwelling places with viruses and other pathogens. In the biotic creation we are subjects, not rulers. We must resist intelligently and wisely the invasions of the unseen, for things invisible will always be with us.

There is a danger that the return of the age of plagues may drive us further into the arms of nationalism or of the global market. If we are to learn from the dangers ahead, we must see that we struggle not only for the health of ourselves and our communities, but for our souls. By soul I mean our capacity to transcend ourselves and connect to others--in biblical terms, to live in resistance to the powers of death.

Dan Beauchamp is a retired public health official and professor of public health who is now mayor of Bisbee, Arizona.