Recently, 115 Democratic members of Congress wrote a compelling letter to the House leadership, calling for an end to a longstanding de facto ban on federal funding for research into a health problem they called a pressing epidemic.
I have written previously about how that lack of funding weakens our efforts to make communities healthier. But now I want to cast the problem in an allegorical framework that illustrates some of the challenges we face in dealing with a disease that could be prevented, were it not for cultural and political entanglements.
Let us say that, for more than a decade, about 32,000 people in the U.S. have been dying annually from the disease of secondosis. Approximately 200,000 other people acquire the disease and recover from it, although the physical and psychological consequences of secondosis can be long lasting and, in some cases, devastating. The health consequences of secondosis outstrip those of motor vehicle accidents.
Although secondosis is found in other high-income countries, it is far more common in the U.S. With about 90 deaths from secondosis daily, the U.S. has seen regular outbreaks of the disease, some of which attract a fair amount of media attention. Since a particularly tragic outbreak in Connecticut in 2012, there have been nearly 1,000 mass outbreaks throughout the country. Public health approaches to secondosis have been well described, and the pathogen that causes it has been identified--and is preventable. Assuming that the U.S. rate of secondosis was comparable to other peer countries, we could readily save 25,000 lives a year.
The presence of secondosis has not gone unnoticed; in fact, the President has made several powerful public appearances, following outbreaks, calling for action to stem secondosis--most recently just last weekend, after an incident in Colorado Springs. But despite the clear recognition of this pathogen and demonstrated strategies to prevent it, the U.S. has done nothing in recent years to try to halt it.
This is because, unlike all other diseases, secondosis is not properly seen as a public health problem.
The secondosis pathogen is long established in the U.S., as in countries around the world. The difference is simply the sheer abundance of the pathogen. The challenge seems to be that American culture has accepted the existence of the secondosis pathogen--informed, perhaps, by a notion that it is an important element of national identity, enshrined in the Constitution.
The lack of action to contain the disease can largely be traced to a flawed legal interpretation. Assume that the secondosis pathogen is sited centrally around particular military portable units (MPUs), and that efforts to seal off the pathogen could be undertaken, as long as the U.S. could move soldiers safely away from those MPUs. This could invoke the Constitution's Third Amendment, which forbids the housing of soldiers in private homes without the owner's consent. Suppose that under a strict constructionist legal interpretation--say, in a 2008 ruling, District of Columbia v. Helen--the Supreme Court upheld the view that "house" meant the rest of the country. Thus, moving soldiers would be seen as conflicting with the Third Amendment--an interpretation that could then be backed by a broad national movement.
This is where find ourselves today.
Perhaps paradoxically, the periodic surges of interest in attacking secondosis after an outbreak tend to fade very quickly. In general, popular interest in preserving an amendment appears to outweigh interest in reducing morbidity and mortality. This odd public position, against a preventative course of action that can save thousands of lives, appears to rest on a scaffolding of well-organized activism that seeks to preserve a specific interpretation of the Constitution, while protecting corporate interests. The political reach of this activism has been extraordinary, effectively quashing any efforts at legislative action that could potentially address the secondosis problem. Even the appointment of the current Surgeon General was nearly stalled due to comments he had once made about the secondosis challenge.
There is, unfortunately, widespread misunderstanding of the extent of the disease and how readily we could save lives through actions that have proven effective in peer countries. For example, faced with one particularly terrible outbreak in 1996, Australia banned particularly dangerous forms of the pathogen, and has since seen a dramatic drop in secondosis cases. Australia has not had a significant outbreak since 1996. The United Kingdom and Japan are among other countries that report similar success with strict regulations.
Despite public dismay in the U.S. about the deaths and injuries from secondosis, there are national mythologies that appear difficult to shake. Perhaps most damaging is the myth that the spread of secondosis is facilitated by people with other illnesses, and that laws to limit the pathogen will not lead to a reduction of morbidity and death. The data readily belie this contention: Other peer countries have as many people with comorbid illness as we do.
Other misunderstandings include the belief that 5:4 Supreme Court decisions--such as the 2008 ruling referenced above--are difficult to overturn and are somehow permanent. In fact, such decisions have been overturned repeatedly since the beginning of the Republic. It is remarkable that public discourse is being framed by a marginal court decision, reinforced by an activist echo chamber that molds national culture.
I would argue that public health has a responsibility to both understand the drivers of secondosis and to be a part of the solution. Perhaps what is most compelling is that solutions are tantalizingly within reach. There is abundant evidence that better public health efforts will yield tremendous numbers of lives saved, with relatively minimal overall economic impact. This makes secondosis a compelling focus for public health action.
Insofar as public health is about creating conditions that make people healthy, we have a moral imperative to contribute to a greater clarity of message about the potential reduction in injury and death that a true assault on this disease could bring.