Philip Alcabes discusses myths of health, disease and risk.

Public Health Crisis or Publicity Crisis?

At Effect Measure today, revere draws a valuable distinction between the position of CDC and that of New York’s municipal government regarding the closing of schools to prevent the spread of flu.  Pointing out that “it’s a strain to which there is no natural immunity in the school population of students or staff,” revere notes that  CDC’s “first instincts were sound, and to their credit they have not engaged in the tendency to minimize the seriousness of the situation that [Mayor] Bloomberg and [Health Commissioner] Frieden have yielded to.”

Nobody knows how dangerous this flu strain might become, of course, but you can’t argue with revere’s logic from a contagion-control standpoint.  But is this really a matter of contagion control?  No, it’s not.

The Queens and Brooklyn school closings were announced amidst a political battle being fought on what, in New York, is always the bitterest of ground:  public schools.  The mayor took control of the public school system when he took office, but he needs legislation now to maintain that control  Parents are up in arms about the school system’s incapacity to provide seats in local schools for children as young as 5 years old.  The mayor can’t risk alienating any more parents — it would only take one child contracting flu in school and dying of it to provide fodder that could be fatal to the mayor’s effort to retain control of the schools.

Plus, the mayor is up for re-election.   Plus plus, the mayor is bringing in a new health commissioner (Dr. Thomas Farley) on short notice — one who is strongly allied with outgoing commissioner Frieden’s view that a good health official is a moralistic meddler in people’s lives.  Bloomberg needs to make sure everyone believes that the flu situation is dire so that his decision to forego a careful search and precipitately appoint as commissioner a Frieden colleague will seem wise.

By closing schools, Bloomberg resolves two legitimation crises, the disgruntled parents of mistreated grade-school children are deprived of one weapon to use against him, and — since the flu is mild and as summer is coming it will undoubtedly retreat soon anyway — Bloomberg is going to come out of this looking smart and proactive.

So be careful about interpreting the NYC school closings as a public health measure.  Politics and publicity are still the bottom line.  Welcome to Bloomberg’s New York.

Myth Making and Health: New York’s Health Commissioner Will Head CDC

New York’s health commissioner, Dr. Thomas Frieden, will be leaving town to become director of the federal Centers for Disease Control and Prevention in Atlanta.

Frieden tried hard to reconfigure the role of the health official in 21st-century America.  He seemed to have recognized that health is on the main stage now in the policy theater.  And he’s been searching for a new role for the public-health physician.  As DemFromCT points out in yesterday’s DailyKos, Frieden handled the swine flu crisis well.  All good.

Still, it’s hard to applaud Frieden for his work during his tenure as commissioner here in NY.  Perhaps he couldn’t stand in the way of the moral juggernaut driven by mayor Mike Bloomberg.  Or maybe Frieden’s medical focus makes him share some of Bloomberg’s fervid disdain for the nasty bits of urban life — the smoking, the quick noshes, the hook-ups — even if not the bluenose moralism.  What can’t be denied is that Dr. Frieden and Mayor Bloomberg together promoted the myth that bad health is purely a matter of bad behavior.

The myth was an alarming break with the reality of the real causes of poor health, but it played well.  There was the ban on smoking in bars, the ban on serving trans fats, the constant hectoring about what we eat and how much of it, and the finger wagging about AIDS “complacency” and our failure to use condoms.  There were the restaurant closings on account of violating the health code (that was after the City’s health department had been embarrassed by media reports of rats in a number of food establishments).  Those were aspects of the stagecraft that has characterized the Bloomberg reign in NYC, but none of them had much impact on the city’s health.

What there wasn’t, under Bloomberg-Frieden, was any discussion of how to improve health through providing better housing – and Dr. Frieden seems to have raised no objection to the mayor’s new plan to charge homeless people rent for staying in city shelters. In fact, housing was off the health agenda entirely – although it has always been on Bloomberg’s, usually in the form of deals that would sell to developers middle-income housing or the land it stands on — even though decent housing would arguably have made more difference to the health of more people than trans fats ever would.

Neither did Dr. Frieden ever publicly argue for funding for public schools or prep-for-college programs on the grounds that education translates into better health.   Great opportunities for real change were passed up in favor of preserving the myth of behavioral risk.

In the recent crisis over swine flu, Frieden was statesmanlike – and we have to hope he’ll show similar circumspection and gravitas as CDC Director.   At Effect Measure, revere points out the need for good management at CDC.  But we also have to hope that, once free of Bloomberg, Dr. Frieden doesn’t bring the same moralistic sermonizing to the matter of disease control.

Diagnosis: Dread, at Neuronarrative

A few weeks back, I had an interesting conversation with David diSalvo, who’s interested in health, the environment, and how we think.  He’s written it up and posted it at his thought-provoking blog, Neuronarrative.