Epidemiology Agog

Louis R Godena louisgodena at ids.net
Sat Oct 12 17:53:47 MDT 1996

Nestor Miguel takes exception to my remarks characterizing the attitude of
public health experts in both the first and third worlds:    He writes:

>"Resigned despair" does not seem to be the most appropiate term. Not at least
>down here in Argentina, where twenty years of continuous neo-liberal policies
>(with a few uneffective lapses of mild liberalism) have deteriorated health
>conditions to the limit of anguish and rage.

>Formerly, and even under the heavy fire of gorilla governments, the public
>health structure built during the first half of the 20th century had
>been able to cope with our major sanitary problems (though it was more and
>more difficult for an attacked health system to increase the already good
>sanitary standards already obtained). But after 1976, due to decreasing
>health care budgets, inadequate administration of increasingly scarce budgets,
>increased social marginality, lack of research on local infectious diseases,
>rejection to any large public health initiatives, private medical lobby,
>idolatry of market as resource allocator, etc., cholera has returned a few
>years ago (and to remain), some researchers report a steeping rate of
>tuberculosis, Chagas-Mazza disease (a tropical heart disease disseminated by
>hematophagous insects that only can be quelled and stamped off by massive
>housing plans) remains one of our most serious sanitary problems.
>Since these problems can be dealt with by means diverse from those available
>when there were no antibiotics (large parks, vast sanitation plans, healthier
>environments for workers so illnesses did not cross social boundaries and
>affect the well-to-do...), ruling classes and local IMF agents don't care
>much about the infamously increasing suffering of the lower strata of our
>society. Cholera can be dealt with, provided you live in a fairly clean
>environment and are sturdy built/well fed, tuberculosis -if you perchance
>get infected- is easily cured, Chagas-Mazza will hardly beat someone who
>does not live in a rancho (poor rural house), so why care?
>I cannot draw Louis's conclusion easily. I suppose conditions for new
>plagues will never appear. Plagues will be socially segmented, and while
>ruling classes are not affected, who will mind? As they say when looking
>at the long queues of people searching for jobs, "Gente? Gente es lo
>que sobra!" (People? That's something we have too much of!). No, dispair
>does not seem to be the word for us down here.

Nestor Miguel seems to be arguing here,  but I,  for one,  am unclear as to
what.    Is he saying that "resigned despair" (or some equivalent) is
inappropriate as a descriptive phrase for what is occurring within the
public health establishment generally?    Or is he declaring his opposition
to such sentiments,  regardless from which quarter they emerge?     He quite
correctly points out that the neo-liberal policies of the Argentinian junta
down through Carlos Menem have ravaged the social infrastructure--including
those sectors charged with maintaining public health--and generally weakened
that society's capacity to successfully resolve a myriad of health problems
that are beginning to emerge even as we speak.

On the other hand,  and leaving aside for the moment the question of new
anti-bocy resistant infections,  how can one avoid pessimism after decades
of exploitation,  poverty,  war,  famine,  and corrupt governments have all
played their part in ensuring that 5,000,000 children under five perish of
diarrhoeal diseases and millions succumb to other preventable infections
such as measles?

Louis Godena

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