Preventive Medicine Column
Dr. David L. Katz
Election Day is imminent, and looks poised to be one of those “throw the bums out!” watershed moments. And, as you doubtless know, there is the dreadful if predictable outbreak of cholera in earthquake-ravaged Haiti. As I juxtapose the two, there is method in my apparent madness.
First, a bit about cholera. The disease is caused by Vibrio cholerae, with much of the damage attributable to a toxin the bacterium produces. The bacteria and their toxin lead to profuse, watery diarrhea. This, in turn, puts more of the bacteria into the environment- which, under less than sanitary conditions, leads to more infections. Cholera can sweep through a population.
And it can devastate it. In the absence of effective treatment, cholera kills up to 60% of its victims. Few of the most dreaded diseases in history can rival that. This is a very bad actor.
But- with effective treatment, the mortality rate can be reduced to just about nil. And effective treatment is not the stuff of modern medical marvels. While antibiotics can shorten the course of illness, the life-saving mainstay is replacement of fluid and electrolytes either by mouth, or by IV. That’s it.
And then there’s prevention. That, too, is pretty darn simple: sanitary disposal of all waste materials, and the availability of clean water for washing and drinking.
Now, back to Election Day. The vitriolic lead-in to these elections seems, in its heated rhetoric at least, to be something of a referendum on government itself. Certainly the Tea Party perspective- whatever the group’s motivations- is that the less government, the better.
The immediate cause of cholera in Haiti is the devastation of an earthquake that ravaged infrastructure. But the root cause is, in fact, dysfunctional government. Government that failed to provide stable and solid infrastructure in the first place. Government that failed to put adequate sanitation and public health on its priority list, and deliver.
Almost everywhere in the world, there are ways for people to get rich. The U.S. has no monopoly. There are rich warlords in Mogadishu. And in the Sudan, where much of the population starves. People find opportunities for wealth- and ways to advance their personal agendas- with this government, or that; less, or more.
But people with dysfunctional governments get cholera. People with functional governments, by and large, don’t. Period. A fact backed by epidemiologic data from around the globe.
What entity other than a functional government is going to attend to clean drinking water for all? Public sanitation? This is an area that any given corporate entity would look at and say: it’s not my job, man! At least, it’s not my job to look out for anyone other than my own. Trouble is, when anyone in a population gets cholera, all become vulnerable pretty quick. We need someone to take responsibility for the well-being of a population at large and say: that IS my job. That someone, of course, is government.
Familiarity does, indeed, breed contempt. We are increasingly contemptuous of vaccines in the U.S. because a life free of the many dread diseases vaccination has banished is so familiar. We are, it seems, contemptuous of government despite safe water to drink; fire departments that actually put out fires; buildings that survive earthquakes; and a military that fights to defend our rights rather than suppress them- because these are all familiar, too. We see what doesn’t work (and, admittedly, there is plenty there!)- but overlook what does.
One more way to state it, before summing up. Babies in this country can pretty reliably count on clean bath water, and our fundamentally functional government is to thank for it. Yet some look at government and fail to distinguish baby from bathwater, and seem inclined to throw out both. It may well be that some of us need to be prodded into draining the tub. But just as surely, others of us need to be prodded into seeing- and saving- the baby.
I am a Preventive Medicine expert, not a politician. I don’t need anyone’s vote. But preventive medicine is public health. Public health is public policy. And public policy is politics- or its offspring.
It’s from that perspective that I note that at times, the only way to protect the human body…is to protect the body politic. That’s what functional government does- often when no other entity would be willing.
As the election looms, here’s a question you may not have realized was pertinent: got cholera? If not- and whether you revere or revile government in general- you’ve got functional government to thank for it.
Dr. David L. Katz; www.davidkatzmd.com