Bored of Health

Avian flu is not as much a risk as the public health infrastructure in the United States itself. Because of Pax Americana, I fear this bureaucratic model has been adopted by many other nations, making this an even greater threat.

Public health began in America in New York city around the turn of the 20th century. A massive wave of eastern european immigrants were flooding into the country and New York was inadequatly prepared for this spike in the population. Hence, slums sprang up and this encouraged the spread of diseases such as tuberculosis.

Typhoid Mary was an Irish immigrant who arrived in New England late in the 19th century. A domestic servant and cook, she had been employed by a number of wealthy families, but frequently had to find a new job when typhoid fever killed her employer's children. The director of the New York state board of health conducted an epidemiology study and correlated Mary's employment history with an increase in the number of cases of typhoid fever. Mary was outraged when confronted by state authorities, since she herself had never been ill with the disease. Curiously, she was a very rare example of a typhoid carrier with natural immunity. Mary continued to evade the authorities until, after several more deaths, she was arrested and spent the rest of her life in quarrentine.

This senario set the precidence for laws enacted which give the states the jurisdiction to enforce public health programs and prosecute offenders if necessary. Because of the new laws, diseases such as tuberculosis were diminished simply because it was now illegal to spit openly in the street. Advances in medicine and modern public health made great strides during the first half of the 20th century. Diseases like polio, small pox and a host of sexually transmitted afflictions now seemed to be relics of the past.

Unfortunately, things have changed.

As bacterial diseases began to aquire a progressive resistance to antibiotics (due mostly to overdosing), viral pathogens reaped the benefits of not just trans-genetic travel but transcontinental travel as well. The menace to public health has increased, but after nearly a century of quiet on the disease front, public health institutions have become little more than grossly overstaffed bureaucracies managed by politicians reaping the benefits of party support. Conflicts of interest arise when the director's political campaigns are financed by local industry. Hence, any health risks associated with environmental laws are often muted in favor of the appointee's future campaign financing.

The most incidious flaw in the bureaucracy arises from a deplorable tendancy to promote incompetance in order to maintain a rigid chain of command. This enforces loyalty due to the fact incompetants can easily be demoted or replaced should they question their superior's orders. Those willing to participate in this system are encouraged by future promotion, along with the added perk of being able to maintain one's authority while passing on one's responcibilities to subordinates. This is a business model which rewards loyalty and punishes dissention.

This "kiss up kick down" management style arose out of the "business as usual" environment public health has existed in for the past century. Granted, hudge bureaucries operating as cogs in a political machine are the most efficient means of maintaining the status quo, but what these juggernauts gain in stability they loose in manuverability. I fear public health in America (and the world!) is an overloaded freight train speeding down a track which hasn't been repaired in decades. Unless something is done, the day will come when the bridge connecting public health to the public collapses. State health employees can then only watch in horror as they hurtle through space twoards an abyss. Denial is always a soothing narcotic, but is getting hard to come by. Governmental institutions are increasingly showing how ineffectual they are at managing natural disasters. As usual, an incompetant resigns (for personal reasons) and it's soon back to business as though nothing's happened....

Roger L. Sieloff , Indiana State Board of Health