Thursday, March 16, 2006

What is Effect Measure all about? Part II

In Part I we paused to reflect on what this blog is all about. The reflection was prompted by comments from some of our readers that we should stick to bird flu and leave the politics out of it. We declined as we have countless times in the past when this has come up. But we also thought some explanation was useful. This post and its predecessor are an attempt to do that.

Recall that we consider public health in its broadest meaning and we explicitly acknowledge its political character. At the same time we have taken some pains to provide facts and scientific explanations we thought would be helpful to a wide range of readers. We believe strongly that people take satisfaction in understanding things and that understanding is needed to make wise choices, including political choices.

One thing that has brought many people to the site over the last year was our early and unusual treatment of a looming public health catastrophe, a pandemic from influenza A/H5N1 (aka bird flu). We were among the earliest in the blogosphere to discuss it in depth and have continued to do so. Now, however, we have much excellent company and the need to report each news item is diminished. Instead, we try to draw lessons and provide perspective on the current news, often concentrating on only one item among many. But why bird flu in a political blog?

Here is an excerpt from one of our earliest posts on the subject (November 29, 2004), that explains the original motivation:
This post is ostensibly about avian influenza A (H5N1). It's really about how we are going to cope without effective public health leadership. Avian flu is a freight train coming our way. Whether or not it hits us will just be a matter of dumb luck one way or another and is probably out of our control by now. How badly we are hurt if we are hit isn't. But it isn't just a matter of an effective plan or manufacturing a vaccine, although both are part of it. As much as anything it is about a public health system that is leaderless, uninspired and dispirited.


I don't see much that our public health officials are doing to plausibly prepare for this. We go through an endless cycle of "needs assessments," contingency plans and appropriations that never find their way to the street level. Most knowledgeable people don't believe we are in much better position to cope with an emergency than we were a few years ago. We have no more surge capacity in our hospitals than before. Even a slightly worse flu season than usual overwhelms them. And there will be a serious shortage of nurses and other care givers, not to mention undertakers. It isn't as if this hasn't happened before. It has. But we aren't really in better shape. There is neither the political will, the political vision, nor the political public health leadership. We are drawing up plans on paper on how to get to the life boats when the ship hits the iceberg. Even if that works in an orderly way (and there isn't enough room for everyone), there is precious little thought what to do when we are set adrift.
Bird flu was a metaphor for a huge leadership void in public health. We wrote this more than 15 months ago, but most of it could have been written yesterday.

Finally, here's something from another post, written a day before the one just quoted:
Many people think of Gandhi as the exemplar of passive resistance. But as Jonathan Schell writes in a book I strongly recommend, The Unconquerable World: Power, Nonviolence, and the Will of the People, Gandhi was anything but passive. His philosophy was quintessentially one of action. In addition to his better known strategy of active non-cooperation, he was an ardent advocate of what he called "the constructive program." If the goal is the betterment of India, why not proceed to it directly? As Schell writes,
Why not pick up a broom and sweep a latrine--as Gandhi in fact did at the first Congress [Party] meeting he attended, in 1915....He frequently suggested, indeed, that the constructive program was as effective a path to political power as noncooperation. Political power, he wrote, would in fact increase in "exact proportion" to success in the constructive effort. (pp 140-141).
Gandhi's goal was not seizure of political power per se but the objectives that political power can help achieve: ending untouchability, cleaning latrines, improving the diet of Indian villagers, improving the lot of Indian women, making peace between Muslims and Hindus (as summarized by Schell, p. 142).

It is something to think about. Obsessing about the recent election loss should not obscure the possibility that in many areas of public health we can advance our own "constructive program" without waiting for the Messiah of 2008 and his/her Congressional Apostles. There is much interesting discussion about "framing" issues. Fine. Probably important, maybe essential. But let's not forget that we can sweep some latrines now and provide support for those who have been doing so for a long time. Since the latrines have been filling with crap faster than we have been removing it, perhaps it's time to start thinking and implementing new and better ways to sweep, whether it be the state, local or neighborhood levels.
A few months later, along with my blogging colleagues DemFromCT of The Next Hurrah and Melanie Mattson of Just a Bump in the Beltway we started The Flu Wiki to begin to harvest the wisdom of the community in constructing newer and better ways to sweep should a pandemic come our way.

These are all things that tie together bird flu, war and peace, religion, and moral outrage over policies and people who cause the deaths of innocents for some geopolitical objective. Do we miss the mark sometimes? Undoubtedly. Do we value our conversation with you in the process? Absolutely. Will we stick to bird flu and forego the politics? Guess.