Swine flu and global public health

The worldwide attention paid to swine flu is great, from a public health perspective.  If only we could equally effectively rally our country and the rest of the world about the many infectious diseases that ail millions of poor everyday.

In early September, in a few villages in Orissa, which is a state in India, about 40 people died and more than 200 were admitted to hospitals.  It was not because of the swine flu, which has so far claimed about 300 lives in that country.  The deaths in Orissa were because of diarrhea.

Diarrhea is a gastrointestinal infection that typically spreads through contaminated water or food.  A bad infection results in severe loss of fluids and even death, which was what happened in Orissa.  According to the World Health Organization, the deaths of nearly two million children every year in the less developed countries has one single culprit—diarrhea.   

The fact that many of the severe diarrheal deaths can be traced back to contaminated water should not come as a surprise given that more than 2 billion people, most of them in sub-Saharan Africa and South Asia, lack access to clean water and sanitation facilities.  Not having such facilities means a slew of other waterborne diseases such as cholera, typhoid, and hepatitis.   

The irony is that in such contexts, it is practically impossible to implement the typical swine flu prevention advice—to frequently wash hands.

When I was in India this past summer, as reports of swine flu came to dominate the news and conversations, I sincerely suggested to my parents that they should frequently wash their hands, and time it by humming the “happy birthday” song. 

As the words slipped out of my mouth, I knew it was a stupid and incongruous advice because of the water shortage in the city.  Apartment complexes were paying hefty amounts to private operators who supplied water by transporting them in special water-tankers.  When that was the condition for middle-class households, I cannot imagine the less affluent spending their precious money to wash hands in order to battle an invisible enemy.    Clean water is a super-luxury for the poor. 

I do not mean to minimize the risks of a global pandemic, particularly if the swine flu virus were to mutate into a highly virulent form.  But, I do want to point out that the global focus on the swine flu, which we have rightfully managed to accomplish, should remind us that being a good citizen of the world also means that we ought to pay attention to the priorities of the rest of the world—in particular, the sufferings of the poor, who are almost always voiceless in the international arena.

Unfortunately, our track record has not been one that we can proudly hold up when it comes to supporting public health programs for the world’s poor.  Even a couple of years ago, Congress and the White House bickered over allocating $25 billion for public health programs in Africa.  Soon after that, in what comes across as quite a surreal contrast, the same people quickly committed all of us taxpayers to a couple of trillions of dollars—that  we do not have—in order to bailout various economic institutions here in the US.  Well, the $25 billion for Africa that we fought over sure does seem like chump change these days! 

As the economist Jeffrey Sachs has pointed out “we’ve just been making choices to ignore the poor rather than calculations based on real resources available. We made a choice to let millions of people die and not honor our commitments.”

Changes in our attitude towards war and peace will certainly win over a few hearts and minds around the world.  But, we can easily and dramatically increase that number if only we spent even a fraction of our military expenditures on public health programs around the world that will immediately improve the everyday lives of millions of poor.  Here lies an opportunity for the “soft power” that Secretary Hillary Clinton often talks about.  Above all, it is the right thing to do.