It is not known when the pandemic will end. What may be an even bigger question is whether the United States will be ready for the next one. The past year and a half suggests the answer might be no.
Like a medical anthropologist who has spent the past 20 years studying how the Chinese government responds to infectious diseases, my research may provide insight into how countries, including the United States, can better prepare for epidemics.
Researchers agree that a good answer begins with a strong public health system. But it’s something that has been sidelined by the United States neoliberal system, which places more value on free markets and deregulation than on public welfare.
As American neoliberalism evolved, public health devolved
Neoliberal economic policies became popular in the 1980s during the Reagan and Thatcher eras. This new approach aimed to make government leaner and more efficient through measures such as market deregulation, privatization and reduction of government supply of public services like health and education – resources that do not necessarily lend themselves to commodity production.
While neoliberal governments always strive to promote the health, well-being and safety of their citizens, they place the responsibility for providing these services in the hands of private entities such as health insurance companies and healthcare providers. non-governmental organizations. This gives the government the opportunity to focus on economic performance.
But giving responsibility for a public good to a private company turns that good into a commodity that people must buy, rather than a product. service accessible to all.
Health spending in the United States, including hospitals, drugs, and private insurance, has more than tripled over the past 60 years. But the public health system that helps the nation prepare for the unexpected has been overlooked.
U.S. spending on local health services that help prevent epidemics and protect the health of populations decreased by 18% between 2010 and 2021. Two and a half cents of every medical dollar goes to public health, a figure that has risen from 1930 levels of 3.3 cents of every dollar. This has enabled the United States to manage health risks as chronic diseases that threaten the health of the individual. But this leaves the nation insufficiently prepared for major health threats at the population level which have a much greater effect on the economy and society.
Cuts to public health have left the United States with a skeletal workforce to handle the pandemic. Therefore, the responsibility fell into the hands of individuals. For example, without mandatory COVID-19 workplace safety guidelines, essential workers have been exposed to the coronavirus on a daily basis with insufficient or no protective equipment and disinfectants. They had to protect both their own health and that of their families when they returned home, a difficult task without the right resources and support.
How Asian Nations Learned Their Lessons
The story was different in many Asian nations where people enjoy the same types of individual freedoms as those who live in neoliberal societies. The difference is a collectivist kind of mindset that guides these societies and encourages people and government to take responsibility for each other. In his book Flexible citizenship, anthropologist Aihwa Ong argues that this leads to a model of society where citizens can be independent and autonomous while also being able to rely on a state that supports the collective. Countries like Taiwan and South Korea may have been better prepared to respond to the pandemic because most people are used to protecting themselves and their communities.
Like China, these countries have also learned from their recent experience with a pandemic. In 2003, China and much of Asia were caught off guard with the emergence of SARS. As in the United States, China’s public health system had took a back seat investing in market reforms for over 20 years. As a result, it could not follow precisely individual cases of infections.
After the SARS epidemic ended, however, the Chinese government improved the training of public health professionals and developed one of the disease surveillance systems in the world. This allowed China to respond more quickly to the 2009 H1N1 pandemic and COVID-19 outbreaks at the end of 2019, once it was able to move beyond the initial stage. bureaucratic and political obstacles which prevented local doctors and government officials from sounding the alarm bells.
Some have attributed this rapid action to the authoritarian form of government that allows greater control over the lives of individuals. But prioritizing public health is nothing new in China. It has become an official practice from 1910 when he adopted the methods of quarantine, surveillance and masking to respond to an outbreak of pulmonary plague.
Could this work in the United States?
Much like SARS did with China, COVID-19 has exposed huge gaps in America’s public health infrastructure.
Take for example contact search. SARS has taught China and other affected countries the importance of a robust system to identify and track people who may have been exposed to the COVID-19 virus. The Chinese government sent more than 1,800 teams of scientific researchers in Wuhan to trace the virus, which aided their efforts to quickly bring the virus under control.
In the United States, by contrast, poorly funded and understaffed public health services struggled to test and educate people who had been in direct contact with infected people. This crippled the ability of the United States to prevent the spread of COVID-19.
In my home state of Massachusetts, the local government partnered with the World Health Organization Health partners to start a contact search operation. But even then, people were on their own. This became all the more evident as people scrambled for vaccines after their initial approval, through Facebook groups and informal volunteer networks who worked to help people get dates. Those who had the resources learned to take advantage of the system while others have been neglected.
This is typical of the United States health care system which is consumer-oriented and market-based. Americans are often convinced that the solution to a health problem must be technical and expensive. The focus has been on developing vaccines and therapies, which are critical to ending the pandemic, while ignoring lower-cost solutions.
Corn masking and social distancing – non-pharmaceutical interventions that have long been known to save lives in epidemics – have been abandoned. Adoption of these simple interventions depends on strong and coordinated public health messages.
As seen in several Asian nations as in Taiwan and South Korea, a well-thought-out public health communication plan is the key to a unified response. Without clear and coordinated guidelines from a public health system, it becomes difficult to prevent the spread of an epidemic.
What it takes to be prepared
Anthropologist Andrew lakoff describes preparation as more than just having the tools. It is also about knowing how and when to use them, and to inform the public well.
Such preparation can only occur in a coordinated manner organized by national leaders. But the United States has seen little of this over the past year and a half, leaving the response to the pandemic to individuals. At a time when emerging viruses pose a growing threat to health and well-being, the individualism of neoliberal policies is not enough. If neoliberalism can be good for an economy, it is not so good for health.
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