- Hardcover: 624 pages
- Publisher: Hyperion; First Edition edition (August 16, 2000)
- Language: English
- ISBN-10: 0786865229
- ISBN-13: 978-0786865222
- Product Dimensions: 6.5 x 2.2 x 9.5 inches
- Shipping Weight: 2.7 pounds (View shipping rates and policies)
- Average Customer Review: 53 customer reviews
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- #974 in Books > Politics & Social Sciences > Politics & Government > International & World Politics > Security
- #5005 in Books > Politics & Social Sciences > Politics & Government > Public Affairs & Policy
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Betrayal of Trust: The Collapse of Global Public Health Hardcover – August 16, 2000
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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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As energy declines, fixing infrastructure will not be at the top of the list, just as it hasn't been for many decades despite the energy and money existing. Garrett explains where this money went in her book instead.
When oil declines, rationing will begin. In the 1980 oil rationing plan, agriculture was to get what it needed first, and clearly the military will also have top priority so that they can continue to fight wars to keep the oil flowing (mainly from the middle east, where two-thirds of the remaining oil is).
Meanwhile, cities will increasingly become unpleasant places to live as diseases spread unchecked from untreated human waste and garbage piling up...
Garrett covers other topics of interest to anyone looking for ecologically sustainable areas to live in the future (also see America's Most Sustainable Cities and Regions: Surviving the 21st Century Megatrends by John W. Day and Charles Hall). Clearly figuring out how to obtain clean water should be one of your top priorities.
What reviewers say about the lengthiness and sometimes meandering style is true. When I read her first book, I was reminded of a joke I heard when attending an exhaustive, three day long training about HIV/AIDS counseling and testing. One of the presenters quipped that you might feel like you were dying of AIDS even though you never had it.
Reading this book, you can feel wearied and overcome by the problems. But, if you go with her style, where she interweaves facts with stories of real pepole impacted by the very trends she cites, you get a greater sense of the dimensions of the problems and the reality of the issues.
As we watch our president dismantle so many care systems, I think the chapters on what happened to Russia when they did the same have extreme relevance.
The publish date of this fine book means that some of its data is aging but the representation of the problems and trend remain timely.
This new work is an informative and fascinating decent into a terrifying world in crisis, and Ms. Garret quickly exposes the dark side of the highly vaunted globalization process. For even while Asian economies prosper under the new prosperity, dangerous new breakout of old microbial enemies such as pneumonic plague threaten the population with devastating new pandemics. Meanwhile, multiple drug resistant (MDR) forms of Tuberculosis have appeared in epidemic proportions in Russia, combining with the ravaging effects of drug addiction, alcoholism, and malnutrition (as well as the regional exposure to radiation poisoning connected to Chernobyl in the Ukraine) to exact a treble toll on life expectancy and quality of life in the struggling provinces. And this is just the most obvious tip of the iceberg.
Domestically we face new emerging threats from MDR Tuberculosis, West Nile virus, and other new "superstrains" of microbial entities we were arrogant enough to believe we had permanently vanquished. This phenomenon, when combined with the rapid and increasingly popular modes of international travel now threaten us with a Pandora's box of so-called "Third world diseases" for which we have little of no natural immunity. As Garret reveals the results of her detailed investigation into the nature of the threat, the reader must take pause. We have, she suggests quite eloquently, suffered from a betrayal of trust from both our national leaders and the various local, state, and national public health agencies, which have deteriorated to such an alarming degree that they are now virtually unable to stem the tide now confronting us.
This is serious albeit absorbing reading, and is not recommended for squeamish or immature readers. It is a quite accurate and absolutely devastating look at the nature of a monumental public health threat that is emerging throughout the world even as we speak, one poised to cause catastrophic and tragic losses of life and irreparable social, political, and economic harm to the various nations in which it strikes, and one for which we have done amazingly little to prepare for. We now have the global village Marshall McLuhan warned about, and in such a community there is increasingly no place to hide from the frightening prospects of a wide range of microbial threats all too-naturally rising to confront us. This is a terrific book, a cogent, entertaining, and superbly documented foray into the horrifying realities of our looming public health disaster. I highly recommend it