Monday, May 12, 2008
Laurie Garrett, author of "Betrayal of Trust," talks about the policy battle in America that allows disease to spread and people to die.
Jul 31, 2000 | The world looks like a scary place through Laurie Garrett's eyes. In her 1994 book "The Coming Plague," she described the threat that a host of deadly microbes poses to human lives. And for the past five years, she has been working on another book about how governments allow diseases to spread.
In the new book, "Betrayal of Trust: The Collapse of Global Public Health," Garrett suggests that better public health measures -- as opposed to better individual medical care (though the two aren't mutually exclusive) -- can keep infectious diseases in check and prevent legitimate concern from turning into panic. She draws on a few extreme examples of poor public health systems: India, Russia and the former Zaire. But Garrett thinks America's priorities are also out of whack. Changes in the political climate have led to drastic cuts in the health budgets of New York and Los Angeles and to the near dismantling of a model public health system in Minnesota. So far, that hasn't led to disease outbreaks on the garish scale seen in the developing world, but Garrett suggests that our lack of interest in community health hurts us in subtler ways. While Americans are spending more money on individual healthcare than anyone else, life expectancy is growing more slowly here than in any other industrialized nation.
Garrett has been tracking threats of disease for years. A native of Los Angeles, she did graduate work at UC-Berkeley in bacteriology and immunology before leaving academia for journalism. She worked as a freelance reporter and as a National Public Radio science correspondent before joining Newsday as a science writer in 1988. She won the 1996 Pulitzer Prize for explanatory journalism for her reporting on the Ebola virus. Over the years, Garrett has gained a reputation as a dogged reporter who backs up her arguments with an avalanche of data. That's certainly true of her new book. "Betrayal of Trust" is thorough, detailed and meticulously documented, and its author clearly knows her subject backward and forward.
Salon caught up with Garrett by phone at her home in Brooklyn, N.Y.
What was your motivation for writing this book at this particular moment in history?
After I finished "The Coming Plague," people were asking me, What's the solution? How can we avoid having these massive epidemics overwhelm us? And the obvious answer is, you need a tough public health infrastructure that can spot the incursion of infectious diseases in the early stages and take appropriate steps to stop it before it becomes the next AIDS pandemic.
Here in the United States, I realized that for the last, say, 10 years of my career, without consciously focusing on it, I had been chronicling the collapse of our public health system. And that one thing after another that had been occurring in our country was a direct result of the fact that we had severely eroded ... the very concept and the political power of public health.
What kind of events are we talking about?
In many states in the last decade, public health officials have tried to create such things as birth defect registries to track whether in some neighborhoods there's a higher rate of birth defects. And if so, might there be something responsible for it? This has been refused by one legislature after another as if it were some Big Brother intrusion.
Another example is attempts to create a notification system for immunization ... Many states were seeing that they were beginning to have resurgences of measles, resurgences of pertussis and other epidemics in children and thought, well, let's just make it easy on families. Let's create an immunization registration system. And then we can notify parents -- your kid's now 2, and it's time for these shots. Virtually every time it's been brought up in any state, the legislature has said no way. They see it as some kind of government intrusion in private life.
That's one of the age-old questions of public health: How do you balance the individual's rights with the health of the community?
We didn't have any problem making those choices back when we had huge public health catastrophes all around us. In 1900, when waves of catastrophic epidemics would sweep through every city in this country, people didn't have a whole lot of problems with the idea that the government had a job, and that the job, among others, was to prevent epidemics and to stop these catastrophes from occurring.
When I travel around the world I rarely encounter this notion of individual rights vs. public health as a serious impediment to the ability of public health to do its job. It's a very American problem ... It's easy to be smug about it and to ignore the needs. The danger in a wealthy society is not as obvious as it was in your grandparents' day or as when as you get in an airplane and travel overseas.
What about some of the places where the danger is more obvious?
India is this enormous sprawling nation of a billion people of virtually every religion on the planet and highly contested and occasionally volatile political forces ... Several years ago, when the Congress Party was running India, the decision was made to relinquish virtually all responsibility for the public health of the people of India to the state level, but there was no increase in revenue streams to the states to cover that. As a result, public health virtually died overnight. When plague first broke out, it broke out in the state of Maharashtra. It went virtually unnoticed until some villages had bubonic plague rates exceeding 10 percent of the population.
When you arrive in Surat, you're the only one getting off the train, because everyone else is leaving.
They all thought I was out of my mind ... India has one of the highest illiteracy rates in the world ... It's very easy in such circumstances to have rumors take on a kind of life that exceeds anything we saw with the Monica Lewinsky episode in Washington.
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