Covid 19 - You Can't Heal a Sick Society
Jay Kaufman, McGill professor of epidemiology, writes that science alone cannot heal a sick society.
The story begins in 1828 when a young Prussian pathologist was tasked with investigating a typhus epidemic in Upper Silesia. The doctor, Rudolf Virchow, wrote a 900 page report blaming poverty and social exclusion for the epidemic.
“I am convinced that if you changed these conditions, the epidemic would not recur,” he wrote.Dr. Virchow was only a few years out of medical school, but his report became the foundational document of the new discipline of social medicine. His vision for health went far beyond individuals and the pathogens lurking inside them: He pioneered the careful epidemiological examination of social conditions such as housing, education, diet and lifestyle, and he denounced the rigid social stratification perpetuated at the time by the Catholic Church.
Today, Virchow's theories are again put to the test with Covid-19.
...Countries that had fewer deaths than would be expected based on prepandemic trends, on the other hand, are often richer, but also distinguished by high levels of political cohesiveness, social trust, income equality and collectivism, like New Zealand, Taiwan, Norway, Iceland, Japan, Singapore and Denmark. Many investigators have reached similar conclusions in research within and among countries on measures of political polarization, social capital, trust in government and income inequality.
...The United States is the dominant biomedical research entity in the world, and so its flagrant political dysfunction became a global problem. This infused everything that we epidemiologists did with doubt, suspicion and the whiff of partisanship.
Politics has dogged us at every turn in these past 18 months — astonishing failings at the C.D.C. and F.D.A. under political appointees, the politicization of proven interventions like masks and vaccines, and more.
...Science is a social process, and we all live amid the social soup of personalities, parties and power. The political dysfunction that holds America hostage also holds science hostage. Dr. Virchow wrote that “mass disease means that society is out of joint.” Society’s being out of joint means that epidemiological research is out of joint, because it exists inside the same society. This is not a new problem, but the dominant “follow the science” mantra misses the fact that the same social pathology that exacerbates the pandemic also debilitates our scientific response to it.
The wheels are coming off the peer review system, university research is plagued by commercialization pressures, and so on. But all of these are the symptoms, not the underlying disease. The real problem is simply that sick societies have sick institutions. Science is not some cloistered preserve in the clouds, but is buried in the muck with everything else. This is why, just eight days after his investigation in Upper Silesia, Dr. Virchow went to the barricades in Berlin to fight for the revolution.
Professor Kaufman's NYT op-ed brings to mind "The Spirit Level," a book written several years ago by two prominent British epidemiologists, Richard Wilkinson and Kate Pickett. This post is from 2010:
The authors digest half a century of data from the industrialized democracies of Europe, North America and Asia and similar data from each of the United States. The nations and the states are ranked from least to most-inequal and against that are charted their respective performance on everything from mental health, drug use, physical health and life expectancy, obesity, educational performance, teen births, violence, imprisonment and punishment and social mobility. Whether it's a comparison of individual states or of various nations, the results are consistent. Societies with the greatest income inequality always have the poorest performance records. As wealth gap narrows, performance improves. As it widens, conditions worsen.
What's most impressive about Spirit Level is the depth of the research and the manner in which the authors foresee and pre-empt rebuttals about causation, ethnicity and historical influences. They examine and dispose of each of these at length relying not on professional opinion as much as half a century of observation and study.
A dysfunctional society is a weak society. It is a vulnerable society. Weak or failing societies and enormous social upheaval are expected to be the hallmarks of the 21st century. Even the Pentagon and the CIA have warned this is our future whether we acknowledge it or not. Canada needs a strong, healthy and resilient society even if the United States sees the situation differently.
"A dysfunctional society is a weak society," true enough. It is also a society that cannot effectively cope with challenges such as the Covid-19 pandemic. It is not the preserve of impoverished nations. Even the richest, most powerful country regularly demonstrates that its society is every bit as sick as any other's.
We have become increasingly selfish and self absorbed, Mound. And we are therfore incapable of fighting disease.
ReplyDeleteWe're witnessing the malaise you describe in the emergence of the anti-vaxx/anti-mask crowd and in those who turn out for the purpose of disrupting a candidate's public appearances. There's a pure malevolence in those people and many Canadians thought we were above those things. Social media has done its work in Canada as it has elsewhere.
DeleteAt the risk of sounding like a conspiracy nut myself, I do wonder if the emergence of these groups and the concurrent decline of social cohesion is really inadvertent. If the U.S. model holds true, some groups seem to exist to wage a form of internal insurrection that both hobbles governance and undermines public trust in their institutions. Cui bono?