Betrayal of Trust: The Collapse of Global Public Health (Hardcover)

~ Laurie Garrett (Author) "No one else got off the train..." (more)
Key Phrases: public health safety net, public health leaders, public health catastrophe, United States, New York City, Los Angeles (more...)

Editorial Reviews

Amazon.com Review

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.)
Copyright 2000 Reed Business Information, Inc.

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Product Details

• Hardcover: 624 pages
• Publisher: Hyperion (August 16, 2000)
• Language: English
• ISBN-10: 0786865229
• ISBN-13: 978-0786865222
• Product Dimensions: 9.6 x 6.5 x 2.2 inches
• Shipping Weight: 3 pounds
• Average Customer Review: 4.1 out of 5 stars  See all reviews (48 customer reviews)
• Amazon.com Sales Rank: #775,293 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

20 of 20 people found the following review helpful:

5.0 out of 5 stars Extremely Worthwhile Reading as is The Coming Plague, December 8, 2000

By	Donna Goldman (South Florida) - See all my reviews (REAL NAME)

Yes, Laurie Garrett's books are lengthy, but what's does that have to do with the enormously valuable information she imparts to her readers. READ her books over time if you would rather. READ her books while you read another novel but READ them. I did enjoy The Coming Plague more but that was strictly due to my personal interest in that narrow topic. Betrayal of Trust covers Public Health and Medicine and its failings, setbacks, and the immediate future of our health. Betrayal of Trust is the result of her investigation of Public Health worldwide.

Ms. Garrett utilizes fascinating examples and historical data to demonstrate among other things that we have a limited community of researchers, doctors, and other health related professionals around the world that try to contain and remedy extremely serious threats and potential threats to our health and well-being.

Ms. Garrett sounds a major wake up call that the risk of a major epidemic or health crisis could strike at anytime and that we are absolutely not prepared to tackle the problem (for the many reasons she details throughout the book). We, Americans, go through our days feeling secure that the system is working when that is not reality. To merely say that the unavailability of financial support and treatment resources here and all over the world for containment and prevention of disease is an understatement of vast proportion. The spread of disease is a major problem that accompanies growing mobility of people and the unique illnesses they carry with them to other parts of the world.

I wholeheartedly recommend Ms. Garrett's books now and anxiously await her next publication - regardless of the topic.

52 of 61 people found the following review helpful:

2.0 out of 5 stars Overgeneralizations marr on-target basic message, August 29, 2000

By A Customer

Garrett has spent most of her career following the medical and public health beat, and her work has been awarded for it. Unfortunately, this magnum opus continues her treat of taking reportage, and packaging it like a scholarly work. The inclusion of 100 of footnotes implies a scholarly focus that is not there.

As reporting, this is perfect. The collapse of health in the former Soviet Union, the HIV/AIDS devastation of Africa, and the challenges to the minimal public health systems of China and India are all correct.

The book tries too hard, however, to make the case that you can find the seeds of similar decay in the state of the various US public health systems reviewed - NYC, LA, and Minnesota - and that there is a betrayal of trust going on in the US, also.

The fact is, there has never been more cash available for public health PREVENTION as there is today. The problem in the US is not a failure of the public health system, but of the health CARE system, that foists the provision of health services off on the prevention programs. In LA, the governmental system has to provide both public health protection AND services. In that case, the need for immediate services almost always trumps the long term view of public health protection.

A further indication of the distance between reportage and scholarly work is when you get the facts wrong. For example, the author states that one of the 'heroes' of the piece, Hermann Biggs, left the NY City Dept of Health in 1923, dispirited from the Tammany regime. In fact, Biggs left the NYCDOH in 1913, and was Commissioner of Health of the NY State DOH from 1914-1923, where many of his key public health innovations occurred.

Omissions are also common. While the NYC DOH is highlighted as an exemplar of 1990's public health, no mention is made of the fact that, during this period, mosquito and rodent control were markedly cut back. The connection to NYC's difficulty in controlling rats, and its playing catch up on mosquito control, should be obvious to as skilled a reporter as Garrett.

Summary, read the book, not as history, but rather as a clarification of just how fragile civilization's hold on health is, and will remain.

30 of 34 people found the following review helpful:

5.0 out of 5 stars A "Must Read" book if you are interested in Public Health, October 15, 2000

By	John P Moore, PhD (New York, USA) - See all my reviews

Laurie Garrett does not write short books. But it's worth the effort ploughing through Betrayal of Trust if you care about Public Health and what its decline could mean for our children and grandchildren if due care and attention is not given to this important part of contemporary life. The frightening problems caused by the collapse of the Public Health system in Russia are a potential lesson to us all who live in the USA; Garrett chillingly portrays the grim situation now faced by the Russian people. If such problems can happen in a relatively sophisticated country, then we need to think of the problems of less well developed countries. And again Garrett brings the message home with her writing. Nowadays, infectious diseases know no borders, and their spread can occur with frightening rapidity. Garrett documents this with her own observations of Plague in India and Ebola in Zaire. Add in a chapter on bioterrorism and it becomes clear that this is a book that can have a real impact on one's thinking. Sure, there are probably some factual errors here and there, which is probably not surprising in a book of this length. But look at the big picture - which is what this book is very much about.