After obsessing about Phailin for a couple of days, I'm very happy to see that the government and the people affected responded so effectively. As I noted earlier today, the long, undramatic recovery is going to be the hard part: finding work and housing for the homeless and dealing with the predictable aftermath of dengue, malaria, diarrhea, and leptospirosis. (Ironically, dengue in India seems to thrive in messy, muddy construction sites—just like those that will soon be springing up in the storm-hit areas.)
Meanwhile, no new MERS cases have been announced in Saudi Arabia and H7N9 has not yet returned to China. It's a quiet weekend on the public health front, so this is a good time for a quick scan of public health issues that worry me precisely because they don't get much attention.
One reason for the quiet, of course, is the silencing of the American public health system by the folly of a few Republican politicians. The consequences, both in the US and around the world, will be felt for a long time—and the folly will be paid for not by the Republicans but by the people who get sick and die because of inadequate surveillance and response.
I worry also about the long-ignored violence and dislocation in regions where the western nations have no particular political or strategic interest. Sudan and the Horn of Africa spring to mind. Whenever I feel undue optimism, I visit Radio Dabanga and its endless litany of raids, rapes, and refugees. The Democratic Republic of Congo is another horror show, but only humanitarians care.
The media of the north temperate zone tend to ignore the endemic diseases of the tropics and subtropics unless, like dengue, they move north. The idea of shutting down such diseases at the source, as sheer self-protection, seems not to have occurred to the northern authorities.
The same is true of cholera, which in its three brief years in Haiti has made excursions to the Dominican Republic, Venezuela, Cuba, and now perhaps Mexico. But too much in global health depends on North American perception of a threat to North Americans: If it's not about to start ravaging our suburbs, it's not serious and therefore not politically important. (And if flu or measles, for example, really does ravage our suburbs, some suburbanites will resist vaccination with the grim determination of the Taliban.)
No doubt an era of true global health would pose its own problems. What would we do with a generation of big, strapping, healthy, educated and well-fed kids growing up in South Sudan and Haiti and Uttar Pradesh and Yemen and Zimbabwe? What would they do for a living, and what about the big families those kids would have, especially as the climate keeps warming and more Phailins and Katrinas and Sandys keep coming ashore?
This would at least be a better class of problem than we now face, and it would involve much less diarrhea. But it would be a problem nonetheless.
Public health has inevitably become the World Alligator Wrestling Federation, and as such its harassed practitioners have little time or energy to think about their post-alligator careers. At least we in North America have the shutdown to thank for a little down time, if only for a quiet Sunday night, to reflect on how the damn swamp might finally be drained.