Who precisely is the “common good” that the public health sector purports to serve?
It has been barely a year since the Ebola outbreak in West Africa released its grip on the frightened imaginations of the Global North, and already global health officials are in the midst of another viral panic. After spreading across the Pacific to Brazil and Puerto Rico, the mosquito-born Zika virus this summer is expected to continue its march to the mainland United States, where it will make landfall on the Gulf Coast. The message from global and American health authorities is the same as it was in 2003 with the appearance of SARS, in 2006 with H5N1 avian flu, and in 2014 with Ebola: Be very afraid.
“This could be a catastrophe to rival Hurricane Katrina or other recent miseries that disproportionately affect the poor,” writes Peter J. Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine in a recent New York Times Op-Ed. “If I were a pregnant woman … in an impoverished neighborhood in a city like Houston, New Orleans, Miami, Biloxi, Miss., or Mobile, Ala., I would be nervous right now.” Of course, Hotez is none of the above. So are those women nervous? Will controlling Zika end up helping them? And would Hotez listen if the affected women thought it wouldn’t? As we enter another round of emergency epidemic control, these questions are critical to ask.
Public health professionals felt it was their duty to manage this threat carefully in order to serve the “common good.” But who made up the “common”?
What I have found from my own research is that even when a global disease response appears to be effective, unintended consequences can emerge that threaten to undermine, rather than support, the long-term health and well-being of vulnerable communities most affected by the disease in question. In the urban Chinese settings I studied during and after the SARS outbreak, China’s enormous population of rural-to-urban migrant workers was seen as a public health menace capable of spreading the same dangerous diseases that threatened it. In the wake of the 2003 outbreak, Chinese public health professionals felt it was their duty to manage this menace carefully in order to serve the “common good.” But who made up the “common”?