BETRAYAL OF TRUST Part 6 - final

The final section of BETRAYAL OF TRUST
The Collapse of Global Public Health
by Laurie Garrett is the Epilogue
which basically summarizes her
findings and conclusions.

Let me say upfront that I agree with
probably 80% of what Ms. Garrett says.
If she were to put forth a platform of
what she thinks should be done to
improve public health, I'd probably
agree with about 4 out of 5 agenda
items.

I'd probably also think that another 10%
were worthy goals to work for.

I disagree with some of her fundamental
assumptions.

I don't believe big government is
inherently good or that public health is
some kind of trust bond between
a government and its citizens.

I don't believe that reducing the gap
between rich and poor is inherently a
good thing. The Soviet Union accomplished
it -- by making everybody except high
ranking Communist party members poor.

A given country and the world as a whole
will get the public health system it can
afford and which people can demand.

Her history of public health in New York
City demonstrates that. New York City was
able to pave streets and install running
water and sewer pipes precisely because
its economy was booming.

Which means that yes some people were
getting very rich -- but the poor were
living better too.

She seems quite critical of business and
capitalism but those are the forces in
the world that create additional
wealth -- which is the developing world's
only hope for improving its public health
systems.

Yes, some people will get very rich in
the process. Some of them may use their
wealth to directly benefit public health
(as Bill Gates does). Others won't.

But they get that rich by producing value --
that is, creating wealth. And yes, it
DOES trickle down and increase the wealth
of the poor.

"Poor" people in the U.S. live better than
most of the middle class in the rest of
the world.

She's certainly correct that dictators such
as Mobuto, wars, revolutions and other social
chaos wreck public health.

What can we do about that -- except address
the root causes, which include poverty,
which can only be gotten rid of through
increasing world commerce?

Unless, of course, we want the entire world
to become like the old Soviet Union. We'll
all be equal in poverty except for the elite
which enforce that poverty on the rest of
us.

We won't solve the many social, economic
and environmental problems of the world by
erasing the gap between rich and poor -- by
making everybody poor.

The poor of the world will be better off
the more rich people there are. The more
billionaires, the better for everybody.

And the poor won't become middle class or
rich by protesting or spending all the cash
they do have on drugs or alcohol.

They'll have to look at places like Hong
Kong and Singapore and learn how those
places used hard work and brains (both are
necessary) to go from post World War 2
desperate poverty to a now high level
of affluence.

Africa is rich in minerals and natural
resources in an age when such items are
again becoming scarce and expensive,
in part because such poor countries as
China know they must use those materials
to upgrade their infrastructure.

Ms. Garrett also downplays the significance
of advances in genetic research.

From my own position as a fan of alternative
medicine, I tend to be deeply skeptical
of prescriptions. Yet even I have to admit
that there are many advances going on,
where they can use high speed computers
to pretest how substances will affect
diseases, and therefore save a lot of
time by screening out everything that
certainly won't work, to better focus
on what might.

Some future medicines might be quite
effective at actually curing (rather
than clumsily "managing") chronic
diseases.

I do agree that even if there is a safe,
magic bullet cure for cholera, I don't
want sewage in my drinking water -- so
the advances of medical science don't
conflict with public health.

However, I do believe that alternative
health will be a component of both
medicine and public health in the future --
or SHOULD be. This could give people in
poor countries the benefits of affordable
medicine and also a cash income in
raising herbs that are indigenous to
their local areas. I think that some
herbs are already being commercially
raised in some areas and thereby helping
some poor farmers.

Overall, this is an immensely valuable
book, though not so much as her earlier
THE COMING PLAGUE. I hope it does alert
many more readers to the problems of
public health in the world today.

Probably you'll disagree with some of
her points too, though not the same
ones as me.

But you'll learn a lot and hopefully
we will make progress.

And hopefully it's before a bird flu
pandemic makes us pay a high price for
the very real deficiencies she documents.