What do Russia, Zaire, Los Angeles, and--most likely--your community have in common? Each is woefully unprepared to deal with a major epidemic, whether it's caused by bioterrorism or by new or reemerging diseases resistant to antibiotics. After the publication of her critically acclaimed The Coming Plague
, which looked at the reemergence of infectious diseases, Laurie Garrett decided to turn her highly honed reportorial skills to what she saw as the only solution--not medical technology, but public health. However, what she found in her travels was the collapse of public-health systems around the world, no comfort to a species purportedly sitting on a powder keg of disease. In Betrayal of Trust
, Garrett exposes the shocking weaknesses in our medical system and the ramifications of a world suddenly much smaller, yet still far apart when it comes to wealth and attention to health.
With globalization, humans are more vulnerable to outbreaks from any part of the world; increasingly, the health of each nation depends on the health of all. Yet public health has been pushed down the list of priorities. In India, an outbreak of bubonic plague created international hysteria, ridiculous in an age when the plague can easily be treated with antibiotics--that is, if you have a public-health system in place. India, busy putting its newfound wealth elsewhere, didn't. In Zaire, the deadly Ebola virus broke out in a filthy and completely unequipped hospital, and would have kept up its rampage if the organization Doctors Without Borders hadn't stepped in, not with high-tech equipment or drugs, but with soap, protective gear, and clean water. Most of the world still doesn't have access to these basic public-health necessities. The 15 states of the former Soviet Union have seen the most astounding collapse in public health in the industrialized world. But during a cholera epidemic, officials refused to use the simple cure public-health workers have long relied on--oral rehydration therapy. Many of the problems in these nations can also be found in one degree or another in the U.S., where medical cures using expensive technology and drugs have been emphasized to the detriment of protecting human health. The result? More than 100,000 Americans die each year from infections caught in hospitals, and America has a disease safety net full of holes.
A Pulitzer Prize-winning journalist (for Newsday and others), Garrett has deftly turned what could have been a very dry subject into dramatic reportage, beginning with the eerie silence on the streets of Surat, India, where half the city's population (including doctors) fled the plague, while a thick white layer of DDT powdered the ground. Fascinating, frightening, and well-documented, Betrayal of Trust should be read not only by medical professionals and policymakers but the general public, and should galvanize a change in thinking and priorities. --Lesley Reed
From Publishers Weekly
On a par with Rachel Carson's Silent Spring, this chilling exploration of the decline of public health should be taken seriously by leaders and policymakers around the world. Garrett, a Pulitzer Prize-winning journalist for Newsday (The Coming Plague: Newly Emerging Diseases in a World Out of Balance), has written an accessible and prodigiously researched analysis of disaster in the making in a world with no functioning public health infrastructure. In India in 1994, neglect of public health for the poor led to an outbreak of pneumonic plague; the once-dreaded disease is now easily treatable with antibiotics, but the failure of Indian authorities to quickly reach a diagnosis and provide accurate information resulted in a worldwide panic. The former Soviet Union, for all its flaws, according to Garrett, assured every citizen access to health care. After the U.S.S.R.'s breakup, the Russian economy collapsed. With no funding left for health care, Russia was overwhelmed by a tuberculosis epidemic. Even the U.S., historically a pioneer in public health (this commitment was demonstrated by New York City's quick and successful response to an 1888 cholera epidemic, as well as the tenement reform movement of the early 1900s that helped eliminate diphtheria), is lagging today. During the Reagan administration, Garrett says, budget cuts dramatically weakened public health while also denying poor Americans access to medical care. The author believes that the medical challenges posed by the epidemic spread of AIDS in Africa, by drug-resistant microbes carried from one country to another and by the danger of biological warfare can be met only by a cooperative global movement dedicated to strengthening public health infrastructures. Garrett sounds the alarm with an articulate and carefully reasoned account. Author tour; NBC Today appearance. (Aug.)
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