We’re off this evening to Ukraine and Poland, for a trip involving family heritage and some literary-historical exploration (as well as visiting with friends).
The CDC’s travelers’ health website recommends vaccination against typhoid (as well as hepatitis A and B, and routine childhood immunizations) for travelers visiting small towns and villages in Ukraine. Since we expect to be doing exactly that, we opted to be immunized.
Picking up the oral typhoid vaccine at a pharmacy in the Bronx made us reflect on inequities in health, and inequalities of opportunity. How odd, to stand in an air-conditioned pharmacy on a busy street in New York City and prepare to fortify oneself against a disease that, here, we consider of historical interest. Typhoid makes us think of the sad episode of Mary Mallon, the infamous typhoid carrier, and the struggles of Almroth Wright to develop a vaccine that would limit the terrible toll that typhoid took on British troops in the Boer War. All a very long time ago.
That typhoid is still a public health problem in much of the world attests to real differences in opportunity. Clean drinking water, and the sanitary systems that allow water to stay clean, being aspects of opportunity.
The American conversation about health uses the grammar of risk. Our health professionals talk about the possibility that illness will ensue if people persist in some behavior (smoking, inhaling others’ cigarette smoke, using certain pharmaceuticals, driving while intoxicated, etc.), if authorities fail to inform, if vaccine isn’t produced on time. But a sense of scale is lost.
Flu preoccupies the risk conversation right now, for obvious reasons having to do with the current outbreak of H1N1 influenza. The risk conversation sometimes appeals to the terrible pandemic of 1918, the worst single-strike disease outbreak of all time. But it doesn’t often recall that, in the United States, the 1918 flu spared over 99% of the population.
The talk of risk, the sometimes-lurid conversation about what might happen, almost always occupies itself with the tiny tail of the broad distribution of health – the minuscule proportion of the population that, even in a frightening outbreak, actually dies from it.
What’s left out is the real situation that confronts most people, most of the time. Not the sudden outbreak, but the persistent struggle to stave off more mundane problems that rarely appear in the media.
Junkfood Science this week reminds us to keep the care in health care. Care seems relevant here. The risk conversation gives us clues – sometimes valuable ones – about how to diminish somewhat the number of people who are sickened or killed by a threat, like flu. But to really get at people’s health – to offer a more thoroughgoing and humanistic form of care – will mean moving past the narrow conversation about risk, and asking about opportunity.
It isn’t risk that keeps most people from achieving capabilities — from escaping poverty, living comfortably, or being free of disability. It’s more usually bad water, bad food, or just bad government. A broader and more effective health conversation would start with the conditions of living, and not be preoccupied with the risks of illness alone.
