The Public-Health Establishment Has Diminished Its Credibility By Sally Satel
The Public-Health Establishment Has Diminished Its Credibility
M ere weeks ago, public-health experts worried about transmission of coronavirus sternly warned against large, crowded gatherings. That was before the protests sparked by the killing of George Floyd, a 46-year-old black man, by a white police officer in Minneapolis on May 25.
From that moment on, many epidemiologists and public-health officials have justified people congregating to demonstrate against police brutality. On June 2, for example, Dr. Tom Frieden, former head of the Centers for Disease Control and former health commissioner of New York City, tweeted, “People can protest peacefully AND work together to stop covid.” That same day, a senior epidemiologist at Johns Hopkins tweeted, “In this moment the public health risks of not protesting to demand an end to systemic racism greatly exceed the harms of the virus.”
An open letter signed by 1,288 public-health experts, infectious-disease professionals, and community stakeholders judged marching to be “vital to the national public health and to the threatened health specifically of Black people.” The signers, while counseling marchers to distance, disinfect, and wear a mask, made clear that similar risks should not be tolerated, “particularly protests against stay-home orders [that are] rooted in white nationalism and run contrary to respect for Black lives.”
Overnight, the risk calculus changed. Instead of expert advice on the danger of exposure to coronavirus when, say, riding a subway, sending your kid to camp, or dining out, now the social value of the undertaking became part of the public-health equation. The risk of thousands of marchers wedged together (many masked but many not) spreading the virus by singing and chanting was suddenly acceptable in the eyes of outspoken members of the public-health establishment.
Flashback to April, when public-health experts were quick to criticize Governors Ron DeSantis of Florida and Brian Kemp of Georgia for easing lockdowns. Apparently, the two politicians’ values of salvaging the economy and relieving social isolation, both causes of significant emotional distress, failed to “greatly exceed the harms of the virus.” Compared with marching for social justice, they weren’t deemed as worthy.
But the problem goes deeper than a double standard. It belies a pernicious mission creep whereby public-health experts project their own social values onto risk assessment. The origins of the mission, however, are less confused. They recall the spirit of the 19th-century German pathologist, physician, and statesman Rudolf Virchow. He called physicians the “natural attorneys of the poor.” But it was the effects that social conditions such as poverty and squalor had on fitness and health that concerned him as a pathologist and doctor.
The physicians he spoke of were those treating and trying to prevent the diseases and afflictions that were directly related to living and working conditions. In the early part of the 20th century, the “industrial hygiene” movement played an important role in public health by condemning the needlessly hazardous working conditions — of coal miners, factory hands, and other laborers — that could result in severe injuries, lung disease, or poisoning from mercury, radium, or solvents.
So many doctors and public-health experts are already the natural attorneys of the poor. They conduct research in social determinants of health, analyze and develop better payment systems to treat underserved patients, establish needle-exchange programs and mobile clinics. They set up practice in small rural towns or serve as physicians in jails. These and other initiatives make deep inroads into the needs of marginal populations. Taking on “systemic” bias as a professional goal entails — what exactly? Doing more of what they do well, and extending it to the deprived and disadvantaged regardless of race, will help improve the health of the nation.
In this current COVID moment, it is not the job of public-health experts to resolve risk tradeoffs based on their passions and social values. Their role is to give the best estimates of risk of infection based on objective parameters. At that point, informed individuals have to weigh the hazards of becoming infectious (and potentially infecting others) against activities that are important and meaningful to them.
For better or worse, government officials, too, will make judgments, reconciling the complex dynamics of infectious spread, consequences of lockdown, and the needs of their citizens, cities, and states. Downgrading the relative risk of infection when it is borne in the service of an epidemiologist-approved cause — in this case, a march against racism and police brutality — is fraudulent public-health practice.
Thus, it would be equally wrong if public-health experts, as a group, were sympathetic to pro-life cause, green-lighting anti-abortion rallies while deeming a Black Lives Matter March too risky. The public looks to public-health experts for an appraisal of risks, not whether they are worth taking. The response of the public-health establishment to recent protests has badly damaged its integrity. It matters now, when a virus still prowls the country, and it will matter later, when the next epidemic hits.
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