Priscilla Wald, my friend and colleague, is the epitome of the publicintellectual who translates her specialized research into a form thatcan make a difference far beyond the walls of academe as well as withinit. Her most recent book is Contagious (published by DukeUniversity Press) and shows how narratives of epidemics and globalpandemics obscure the real cause of such health problems: globalpoverty. The idea that disease can be spread should remind us that weare all one touch away not from "carriers" but from the impoverishedwho live blocks away, who inhabit our buildings at night when we gohome (and make them clean and bright), who do not have health insurancenor adequate health care. Instead, we focus on the spread of diseaseand right wing pundits use pandemics as a way to scare up fear andhatred of the impoverished, not an awareness that we all share thisglobe together. Priscilla's op ed piece, reblogged here, makes thesepoints eloquently.
Priscilla Wald's work reminds us that the reason the humanities are so important is that they encourage us to take a take a giant step back from present crises in order to see these in larger cultural perspectives, with historical long view, so that we can see not the muddled, murky outline of present overreaction but understand a pattern of such overreaction as it recurs, and then recurs again, with the individual cases different (Typhoid Mary, HIV, SARS, Avian Flu, etc.), but the outlines the same and representative of a persistent problem. In this case, the persistent problem is the inequal distribution of wealth and the inequal distribution of health (not just health care but good health) that is the real epidemic. The recurrence of the "outbreak narrative," in Wald's terms, is the intermittent tug of the impoverished at the hem of the privileged. But, as she so eloquently concludes in her thoughtful and provocative book, the real problem of "contagion" is not that we might get sick but that poverty is a sickness that, most of the time, middle-class first world peoples are not only immune to but also inoculated against. The outbreak narrative in its recurrent forms reminds us of the urgency of our connection. Wald urges us, this time, to look not at the current manifestation but at the persistent problem, and to cure it and not simply its most recent symptom.
Priscilla Wald: Pandemic threats call for a focus on global poverty
By Priscilla Wald : Guest columnist
Apr 30, 2009
Panic sells newspapers. It keeps our televisions on. It is exhilarating in its way. Even addictive. And it has consequences. People, places and behaviors are stigmatized. Panic affects economies. Travelers cancel trips to Mexico, California and New York. Movies, concerts and sports events are postponed.
In the midst of a threat of pandemic, the media do not remind us of the national health insurance crisis or of the lack of access to health care that is truly a global disaster. Mid-crisis, the problem of global poverty seems too large to address or even comprehend. We have more immediate concerns.
Yet, the threat of a pandemic is precisely the moment for such reminders -- that access to health care should not be a luxury, but a basic human right and a priority, at home and abroad.
In 1978, representatives of 134 nations meeting in Alma-Ata, now Almaty, Kazakhstan's largest city, declared access to health care to be a basic human right. They signed an agreement to work toward a goal of universal access to health care by the year 2000. We are currently farther from that goal than ever -- more people live in poverty and there's no greater access to health care.
As I have found in my research for a book about how the mainstream media tell the stories of communicable disease outbreaks, pandemics are fueled by poverty more than any other factor. That's not to say that quarantine and vaccine are not very important in responding to a pandemic, but we should not lose focus on the fact that nothing will go farther to contain the spread of disease than a healthy population with access to health care.
The outbreak story is a familiar one, seen in fiction, film and the news.
It goes like this: a new microbe surfaces, and people begin to get sick.
The illness is mysterious and doesn't respond to treatment. Some people die. Then the illness begins to spread. Quickly. Microbes know no boundaries. The world is shrinking. No one is more than a plane ride away from "Ground Zero" of the pandemic.
Then, medical experts race to identify the microbe. They prescribe treatments. They work to make a vaccine. They advise hand washing and avoidance of crowds. Images of people in surgical masks mark the danger.
Those are the actions that we can take as we wait for the experts, the quarantines, the vaccines and Tamiflu to solve the problem.
In the telling of the outbreak story, the media present the pandemic as solely a medical problem. But it is a social problem as well. Poverty and inadequate health care are the most effective vectors for the spread of disease. Malnourished people are more likely to get sick; overcrowded living quarters are a microbe's haven.
The eradication of extreme poverty and hunger is the first of the U.N. Millennium Development Goals. The World Bank estimates the number of people in developing countries living in extreme poverty in 2005 to be 1.4 billion. The United Nations believes the goal of cutting in half the number of people living on less than one dollar per day is reachable by 2015.
Current World Bank estimates put the cost of a worst-case pandemic as high as $3 trillion. More staggering are the estimated costs in human lives, which would exceed 70 million deaths during the course of the pandemic.
Those lives are, of course, not measurable in economic terms, but there is little doubt that a devastating economic crisis would follow any worst-case scenario.
To be fair to the media, some journalists work hard to inform the public without fueling panic. Their reports on the pandemic mention poverty and lack of access to health care as factors that explain why the illness is worse in some places than others. However, these are almost never flagged as the factors that explain the pandemic itself.
The problems of poverty and inadequate health care are overwhelming.
There's nothing we can do. So we wait for the experts. And we wash our hands.
I am grateful for the experts. And I wash my hands. But I also marvel at the lack of discussion of health-care spending, especially when facing the threat of a pandemic.
There is no better time than a moment of heightened awareness and fear to be mindful of the social causes and consequences of pandemics, and of the responsibility that belongs to all of us to work to address them. As human beings, we cannot afford to wait for the experts. The media has a responsibility to remind us of that fact.
Priscilla Wald, an English professor at Duke University, is the author of the book "Contagious" (Duke University Press, 2008).