Public Health: Same As It Ever Was

It is not often when the Washington Post and I agree on something, but today I found an example of a case where this happens. The Washington Post reported, as if it was a new and unusual insight, that the contemporary response to Covid by governments is not so different from the reply of societies in the Middle Ages to the plague. Presumably, the Washington Post meant this as an insult to governments, as it is understandable that a reflection of how little public health efforts have changed in the past few centuries [1] is likely to reflect poorly on those people whose responsibility it is to best ensure the public health. Yet considering in general that health as a science has long lagged behind other sciences because health and disease are far less well understood than nonliving sciences, in large part because living beings are generally quite a bit more complex than those things which are governed by far simpler laws of physics, chemistry, and geology, this is not so surprising. If as late as the Civil War health care was stuck in the Middle Ages, it should not be such a great shock that even today Public Health is positively medieval.

In fact, it may be even older than medieval, the more one reflects on it. One of the more consistent techniques in the arsenal of those who seek to promote public health is some variation of the quarantine order, whether it is called by that name or given some sort of euphemistic expression like “stay at home order.” This is far from new. In the Middle Ages, families and communities where the plague was found were forced to engage in quarantine as a way of preventing the spread of infectious disease once someone had become symptomatic. Yet it should be noted that this particular approach to public health was already ancient by the time of the Middle Ages, and can in fact be found in Leviticus, as one of the tasks a priest had was to assist in the preservation of public health through the quarantining of individuals with infectious disease as far back as 3500 years ago. The fact that there remain few more powerful ways of preventing the spread of disease than attempting to force those with such disease into isolation for a period of time until they are no longer threats to serve as disease vectors suggests the deeply primitive means of public health.

This is even true when one looks at what seem to be more modern means of dealing with disease. The destruction of malarial swamps goes back at least to the Roman world, as it was long recognized that certain areas were responsible for carrying certain sorts of disease and plague and so those areas ought to be disturbed to preserve the health of people. Chinese efforts in the early 1900’s to stop the marmot plague from spreading around the world amount to variations on the theme. And there is substantially nothing different in the arguments over quarantine and herd immunity in 2020 than there was in the influenza epidemic of 1918, except that it was a far more deadly disease then than it is now. For all of our claimed expertise in disease modeling, we are left with very limited techniques to try to stop the threat of infectious disease, especially when we first meet virulent strains of novel diseases for which no one has any particular resistance.

Public health reminds tied to ancient methods of limited efficacy and considerable controversy because the conflict in public health is between mankind (and other species) against viruses against whom we have no defense. Our options in such situations are very limited. We can urge difficult behavioral actions like telling people to wear masks of limited to nonexistent effectiveness, or to avoid touching their face. We can tell people to stay at home when it is not necessary and then struggle with the mental and emotional health issues that result from prolonged isolation. If a disease is not too dangerous, we practice herd immunity through ensuring that everyone gets exposed to it so that everyone has some degree of future immunity, which is a fancy way of describing the sort of behavior that occurred in the past when people would throw measles parties so as to expose everyone in a neighborhood to measles when people were children, as opposed to getting the disease when they were older and where it was more dangerous. Similar efforts occur, often unintentionally, when schools have served as vectors for colds and flus that have given people what immunity they have to such things as a result of having been exposed to so many rhinovirsues on a regular basis.

It seems impolite, though, to condemn government officials for the measly tools at their disposal for the preservation of public health from threats of disease and pestilence. After all, I firmly belief that, for all of my criticism of public health officials, that they do the best that they can. That they cannot do very sell is lamentable and sometimes very dangerous, but aside from cases as in New York where sick patients were forced in areas of very vulnerable elderly who died, as one could have easily predicted, at alarmingly high rates, most efforts to preserve public health as of recent have been well-intentioned if hardly very modern or very efficacious. Where blame can be assessed is in pretending by anyone that any other health officials would in many cases be able to do a better job. Blame can also be assessed, as is frequently the case, on those who seek to blame others for doing the best that they can in the face of contradictory guidance and a general lack of ability that anyone has in dealing with massive and novel diseases in a climate of general mistrust and suspicion against authorities of any kind, including public health authorities. And to those who have thought that such suspicion was worthwhile to target in a narrow and partisan matter, it is far less pleasant when people view cynicism as a default position, and when those who should know better think that any of this problem in public health measures is anything new. Indeed, the problem is as old as the hills, maybe even older.

[1] See, for example:

https://edgeinducedcohesion.blog/2020/04/07/book-review-the-public-health-primer/

https://edgeinducedcohesion.blog/2020/04/07/book-review-evidence-based-public-health/

https://edgeinducedcohesion.blog/2020/04/07/book-review-public-health-laws/

https://edgeinducedcohesion.blog/2020/04/04/on-the-legitimacy-of-public-health/

https://edgeinducedcohesion.blog/2019/02/23/on-the-implications-of-public-health-arguments/

About nathanalbright

I'm a person with diverse interests who loves to read. If you want to know something about me, just ask.
This entry was posted in Biblical History, History, Musings and tagged , , . Bookmark the permalink.

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