Posts Tagged ‘Public Health’

The coronavirus and the test of reality

February 26, 2020

Passengers disembark from virus-hit Diamond Princess cruise ship

Photo via New York Post.

The first duty of any government is to assure the survival of its people.  The COVID-19 strain of the coronavirus is a test of how well the world’s different governments can perform this basic duty, and they will be judged on how well they perform that duty.

It doesn’t matter whether leaders call themselves conservatives, socialists or something else.  Are they able to act effectively and without panic to meet a threat?  Are they able to face facts or do they punish truth tellers?

Here in the USA, our President and Congress have mainly been fighting over problems generated by governmental policy and a couple of things that don’t really exist—the alleged Trump-Putin collusion and the imaginary Iranian nuclear weapons program.

Now, along with the rest of the world, we face a real external threat—one that can’t be made to go away by means of public relations or changing the subject.

The Trump administration’s budget priorities are its nuclear weapons modernization program and the new Space Force.  In contrast, as Nicole Wetsman of The Verge reported—

The administration’s proposed 2021 budget for the Department of Health and Human Services (HHS) cuts $25 million from the Office of Public Health Preparedness and Response and $18 million from the Hospital Preparedness Program. The administration also asked for over $85 million in cuts to the Emerging and Zoonotic Infectious Diseases program.  [snip]

Housed at the Centers for Disease Control and Prevention (CDC), the Office of Public Health Preparedness and Response is charged with responding to public health emergencies.  It also coordinates public health responses with local and international partners and manages the Strategic National Stockpile, which squirrels away critical medical supplies for use in emergencies.

The Hospital Preparedness Program aims to ready hospitals for emergency surges of patients, and it’s already under-equipped to handle situations like the ones currently seen in China.  Right now in the US, hospitals are already swamped by the flu and are counting their supplies of protective equipment.

Cuts to the Emerging and Zoonotic Infectious Diseases program would further hamstring the CDCs ability to do research on diseases like coronavirus and to gather the scientific information that lets it prepare for outbreaks like this one. [snip]

The 2021 budget request did ask for an additional $50 million for the CDC’s Infectious Diseases Rapid Response Reserve Fund.  That fund, which was established in fiscal year 2019, is currently being used in the ongoing coronavirus response.  That money, though, is activated only after a public health threat appears.

==The Verge.

The coronavirus has not yet reached our shores.  There is still time for the U.S. to rally.  There is still time for President Trump to assume leadership.  There is still time for Democrats in Congress and on the Presidential campaign trail to make an issue of this.  Will they?

It is not just an American issue, of course.  All the world’s leaders—Xi Jinping, Narendra Modi, Vladimir Putin, Angela Merkel, Emanuel Macron, Boris Johnson and the rest—will be weighed in the same balance.


The coronavirus threat makes two other things clear—the need for internationalism and the perils of globalization. Let me explain what I mean.


Baltimore begins 25,000 water shutoffs

April 13, 2015

The City of Baltimore is in the process of cutting off water to some 25,000 residents with unpaid water bills of $250 or more.

They will be unable to bathe their children, wash their hands or flush their toilers.  Evidently the city government has forgotten the reason to have a public water supply in the first place, which is to prevent the spread of disease.

PRTHUMB_WaterAccessStreet1City officials like Department of Public Works director Rudy Chow claim that residents using water without paying are to blame for the $40 million in overdue water bills.

In fact, the Baltimore Sun found more than a third of the unpaid bills stem from just 369 businesses, who owe $15 million in revenue, while government offices and nonprofits have outstanding water bills to the tune of $10 million.

One of those businesses, RG Steel (now bankrupt) owes $7 million in delinquent water bills all by itself.

via ThinkProgress.

The City of Detroit started similar water shutoffs, but backed down after an international outcry.

People are obligated to pay their bills if they are able.  But there should be better ways to collect than depriving people of a necessity of life or, for that matter, creating a public health hazard.


Baltimore collects $1 million in unpaid water bills by Yvonne Wenger for the Baltimore Sun.

Don’t shut off our drinking water, a Baltimore Sun editorial.

This City Could Become the Next Detroit by Carl Gibson for ThinkProgress.  (Hat tip to Avedon’s Sideshow)

The Inequality of Water by Sam Ross-Brown for The American Prospect.

Behind the Kitchen Door

October 12, 2013

Many Americans who dine out in restaurants ask questions about the food they eat—whether it is wholesome, whether it is locally-grown, whether it is organic, even whether the meat animals have been raised in humane conditions.

beyond-kitchen-doorSaru Jayaraman, in her book, Behind the Kitchen Door, which I just got finished reading, argued that we diners should be equally concerned about the people though whose hands our food passes.  It is short and highly readable, and told mainly through personal stories.

The most shocking chapter was the one entitled “Serving While Sick.”  Most restaurant workers do not receive paid sick leave, and cannot afford to skip work because they depend on tips for most of their income.  Employers expect them to come to work even if they have ‘flu or other infectious diseases.  Jayaraman told the story of Nikki, who was forced to continue serving food in a Washington, D.C., restaurant after coming down with conjuntivitis, and Woong, a Korean-American who served food in an upscale French bistro even after contracting swine ‘flu (H1N1).

A 2011 survey by the Centers for Disease Control indicated that one in eight restaurant workers continued to work on two or more shifts during the previous year while suffering from ‘flu symptoms, vomiting or diarrhea.  In summer 2011, thousands of people had to be vaccinated after being exposed to hepatitis by an Olive Garden worker who couldn’t take a day off without losing his job.

Jayaraman said that restaurants who require employees to work while sick are the same ones that cheat employees on wages and tips, demand they work in unsafe conditions and discriminate against dark-skinned and women employees.

The federal minimum wage is $2.13 an hour for restaurant workers, which has been unchanged for 20 years.  Workers are expected to make up the rest in tips.  In the United States, a tip is not a gratuity—something extra on top of the wage.  It is what workers are expected to live on.  A tip does not go just to the server.  It is supposed to be divided up among all the workers, including the kitchen workers.

Some states do have higher minimum wages than the federal minimum, and California and six other states set the same minimum wage for all workers.  But the median wage in 2010 for restaurant workers nationwide was $9.02 an hour, including tips.  Restaurant workers’ annual income is about a third of that for all U.S. workers.

In many restaurants, according to Jayaraman, the managers don’t pay them for all the hours worked, and they take a share of the tips, even though both practices are illegal.  Racial discrimination and sexual harassment are rampant in restaurants, she wrote.  Typically the wait staff are white, the bussers are brown-skinned Latinos and the kitchen staff are black.

We Americans sometimes speak of racism in the past tense, but many restaurants treat employees as they did in the Jim Crow era, and with the same rationale—that white customers wouldn’t like to be waited on by black servers.

Reading this book made me realize what a sheltered life I have led.  During my career, I had bosses I didn’t like, but I never had a one who threw things at me, cursed me out in public or refused to pay my wages, let alone one who demanded sexual favors or denied me the possibility of promotion because of my race.

Not all restaurants abuse their employees.  I eat out a lot, and I would hate to think my favorite neighborhood diner treats its employees like the ones described in the book.  Jayaraman gives examples of restaurant owners who treat their employees fairly, and still make a profit.  Her organization, the Restaurant Opportunities Centers United, which she co-founded with Fekkak Mamdouh, helped found worker-owned restaurants in New York City and Detroit which eventually made a profit.

Nor is a sub-minimum wage necessary for a thriving restaurant industry.  Restaurants are prospering in California and especially in San Francisco and Los Angeles, which have strong minimum wage laws.

Jayaraman said restaurant diners can help by being as concerned about the conditions under which their food is prepared as they are about the conditions under which it is produced.  And they can help by supporting legislation to give restaurant workers the same protections as other workers.


One reason I’m glad I’ve lived when I have

May 20, 2013
Death rates per 1 million people.  Source: CDC

Death rates per 1 million Americans.   Click to enlarge.  Source: CDC

I came across the top chart when I was looking for something else.  It reminded of my childhood in the 1940s, when it was common for children to be laid up with measles, whooping cough, chicken pox and other “childhood diseases.”  I was lucky.  The only one I got was measles.  I also was lucky in that these diseases were rarely fatal, which was not the case everywhere, either then or now.

The chart shows the death rate from infectious diseases starting to creep back up a little after 1980.  I couldn’t find charts of infectious disease death rates in the 21st century, but my guess is that the death rate has continued to rise, because of natural selection producing disease germs that resist antibiotics and because of new forms of infectious disease such as AIDS.  This doesn’t mean that progress is an illusion, only that it requires a continuing effort.

I still feel lucky to have lived when I have.


Click to enlarge.   Source: New England Journal of Medicine

One reason for the lowering of the American death rate during the last century is that public health has been regarded as a public responsibility.  If availability of vaccination and sanitation had been limited to those who could afford to pay for it, the improvements shown on these charts would not have taken place.  It also is a fact that the big breakthroughs in medicine, such as Alexander Fleming’s discovery that penicillin is an antibiotic or Jonas Salk’s development of the Salk vaccine for polio,  came from researchers working in the public sector.

Hat tip for the top chart to Ezra Klein.