The Free Press, Famines, and Disease Outbreaks

There are so many little nuggets in Amartya Sen’s book Development as Freedom that I really don’t know where to start, as there were so many little post-it notes stuck at passages that I thought were either entertaining or made excellent points, or contained interesting perspectives on points I’d thought about before that I stopped trying to keep track about halfway through the book. But certainly a key observation was that there has never been a famine in a functioning multiparty democracy which also had a working free press.

Lest you say that this is not a true correlation, as rich countries tend to be democracies, and therefore don’t have famines, Sen gives plenty of examples of poor countries, such as Botswana, which avoided famines, despite droughts and other calamities, as well as plenty of non-democratic countries which had famines, even during times of increasing food production. So the evidence that he presents, with copious endnotes to studies that back up his claims (I particularly like the commentary for each endnote–a pet peeve of mine is end notes with out commentary or further explanation) is convincing.

The mechanism is particularly straight forward, as famines are actually quite easy to prevent, through temporary job programs to empower nearly everyone to purchase food. (Contrary to popular beliefs, many famines are not related to decrease in food production, but caused by the lack of empowerment of many to purchase food.)

The role of democracy and the freedom of the press is instrumental, in that those in power fear that they will lose power if they don’t stop the famine and informational, in that those in power are kept informed of the famine as it develops. The informational role of democracy cannot be understated. In an interesting passage Sen quotes at length Mao, who (while certainly no supporter of democracy) observes that the communist government was unable to keep leaders informed of the famine as it developed, whereas in democracies, leaders are kept informed of such developments.

I would expand the observation that democracy and the free press can protect us against famines, to note that a similar mechanism can also work to protect us against disease outbreaks. I had observed in my post over at Freedom to Tinker that S.A.R.S., although it developed in China (and the disease outbreak was known within China) it had been kept under wraps until its expansion into areas where there did exist both a functioning democracy and free press. An item to consider, as Sen notes, is that famines very rarely affect more than 5 or 10% of the population. However disease outbreaks tend to affect more and to be less differentiated along class lines. So there are some motivational factors which should enable a democracy to react to disease outbreaks better than democracies have been able to respond to famines. However, this seems to be the only advantage in the ability to respond to disease outbreaks when compared to famines. There are many ways that responding to a disease outbreak will be much more difficult, chiefly the fact that a public health infrastructure, disease monitoring systems, etc, must be built before the disease outbreak occurs.

After S.A.R.S. did become known, concerted action did bring it under control, but in part we were lucky because of the short incubation period it was easy to control. So disease outbreaks are not as easy to control (See my related post on Steven Johnson’s book The Ghost Map, for a description of some of these difficulties. The podcast over at Science Friday is excellent) as famines.

This suggests that the free press, if it is to act in a similar way to prevent disease outbreaks, must engage in an especially robust public debate on issues of public health. On this count the press is getting, in my opinion, a strong “F” grade, in that public health is very far from the headlines, unless there is an outbreak. Of course, by then, it is too late to prevent. In particular, although there was a brief spate of articles in the press about the recent disclosure that the US is not prepared for a disease outbreak, let alone bio-terrorism, there has been virtually no follow up.

Certainly, after the next disease outbreak, there will be much finger-pointing at the Bush administration, whose abject neglect of the public health infrastructure has put us at great risk. However, even in the face of this neglect, there is much that can be done, but the press must fulfill its responsibility to engage in timely debate of issues of manifest public concern. It’s action during the recent Iraq war, of not questioning those in authority until dismal failure has clearly set in, must not become a template for its future role in our society.

It would appear that the Bush administration is endeavoring to avoid, as much as possible any public discussion or tranparency of the construction (or, I should say, lack of construction) of a robust public health infrastructure. In fact, it appears that its intention is to allow national security to run public health:

…the CIA has invested in a company commonly used to help manage health IT records in the United States and Canada. In-Q-Tel, a private venture group established by the Central Intelligence Agency, led a Series E investment round in Initiate Systems earlier this year. The group is charged with providing solutions to the CIA and the greater intelligence community.

Initiate Systems’ IdentityHub software uses a variety of identification protocols to determine whether records stored under similar names in different databases refer to the same or different patients. It also uses such demographic information as birthdays and address to match records to people who have used different names.

The software helps companies find stored information about clients or patients in real time, and it also helps to identify and delete duplicate records. It has also been used to quickly find prescription information when patients enter the emergency department.

See Full Story HERE

This piece of news, which should disturb us deeply in that the public health authorities are being removed from disease outbreak management, has received almost no press coverage. The press coverage it has received has been extremely poor, focusing on the privacy issues, without giving any air at all to the clearly dangerous step that this move represents. So I give the press on this issue a strong “F minus” To be sure we should be encouraged that disease outbreak management has entered into the concern of the administration. However, the national security apparatus brings many agendas to the table (such as secrecy) that run counter to the transparency that is essential for effective disease outbreak prevention and management. In addition, public health authorities have developed, over many hundreds of years of experience, expertise and (just as important) networks that they will use in handling a disease outbreak.

Only if the CDC, not the CIA, is the lead agency in any disease outbreak can the public safety be maintained. Additionally, the CIA needs to be a resource for the CDC, providing all information about potential public heath threats which it becomes aware of, providing timely complete information through a public process that is fully transparent and therefore accountable.

See also my article at Free to Tinker: Syndromic Surveillance: Twentieth Century Data Harvesting

Updated: 4 January 2007

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The Free Press, Famines, and Disease Outbreaks

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