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A TRAINED EYE

Tragedy of individual Haitians risks overshadowing chronic health problems

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By Alfred Sommer
Special to The Washington Post
Tuesday, February 2, 2010

For the first two weeks, we watched the aftermath of the Haitian earthquake with a combination of horror and hope: horror over the widespread devastation and hope whenever one more living soul was retrieved from the rubble.

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Captivated as we'd been by the individual rescue, we also learned that as many as 20,000 people could be dying in Haiti every day. That was an estimate, put out by a group that provides health care in Haiti; the actual figure may be lower. But what if it's 2,000 or even just 200 people dying unnecessarily and largely unnoticed?

We care about the one in spite of -- and sometimes at the expense of -- the many.

Those of us in public health refer to this as the "girl in the well" phenomenon. The world will watch with bated breath through a four-day rescue ordeal, while at the same time hundreds of millions of people go to bed hungry each night, more than 6 million children die unnecessarily every year, and the Millennium Development goals go unmet in those countries that most need to achieve them.

So it goes in Haiti. After the search for survivors slowed and the humanitarian operation intensified, questions began mounting about the adequacy of our response and whether it can be sustained. Our focus on those being rescued stimulated an outpouring of aid. But now, as with past disasters at home and abroad, we are beginning to forget.

Public-health investments protect health and save lives, but as D.A. Henderson, who led the worldwide eradication of smallpox, often notes, "No one wakes up in the morning grateful that they haven't died of smallpox." Nor do most Americans wake up grateful that our basic sanitation has kept us from contracting cholera and typhoid fever, or that the vitamins and minerals we consume in our (sometimes bloated) diets protect us from pellagra, scurvy and going blind or dying from Vitamin A deficiency.

Haitians, like the inhabitants of most poor countries, face these problems every day, as they do malaria, tuberculosis, AIDS and other preventable diseases. Those same factors now put Haitians, with their further-weakened public-health system, at even greater risk of new waves of disease -- perhaps cholera or typhoid -- that could kill thousands more.

We accept the problems of the masses as just so much background noise; but it is background noise that causes immense, entirely unnecessary misery the world over and contributes in our own country to spiraling health-care costs.

Even though we live in a wealthy country, where malaria and similar infections have been contained, more than 400,000 Americans die every year from diseases caused by smoking. American women -- great advocates for "conquering" breast cancer by "running for the cure" -- seem unaware that every year more American women die from lung cancer, which is almost entirely preventable, than from breast cancer. Thousands more Americans suffer and die from tobacco-related pulmonary emphysema, chronic bronchitis and coronary artery disease. This unnecessary carnage could be reduced beginning today, by more-stringent disincentives to tobacco use.

America needs to invest in the development of better tools for improving Americans' health-seeking behaviors and pay our fair share of overseas development assistance, which is only a fraction of per capita GDP provided by Europe. The budget blueprint President Obama submitted to Congress Monday included timely support of programs to tackle such global scourges as HIV/AIDS, malaria and tuberculosis. Every bit helps.

Haiti's masses may seem far away and their experience distant from our own. But we have a shared interest in looking beyond the harrowing sight of a single child being pulled from Haiti's rubble, just as we need to look beyond the girl in the well.

Having participated in delivering relief following another disaster -- the cyclone that washed away nearly a quarter of a million Bengalis in 1971 -- I have some sense of the chaos in attempting to provide the right kind of aid to the right people at the right time, of the need to serve the needs of both the individual and the many.

Pay me now or pay me later. Investing in public health, both here and overseas, is an investment in the future. A mountain of disease is rolling forward; it needs to be noticed, and dealt with, before an economic and human tsunami engulfs us all.

Sommer is dean emeritus of the Johns Hopkins Bloomberg School of Public Health. His book "Getting What We Deserve: Health and Medical Care in America" was recently published by the Johns Hopkins University Press.


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