I have been following the Ebola outbreak since June. However, in studying it, writing about it and talking with others – experts, press and friends – I have been struck at what seems to be a very clumsy reaction to a potentially predictable problem we theoretically are capable of handling. I do not say this out of criticism at all. The issues surrounding the Ebola response including the cultural barriers, lack of infrastructure in the affected countries, lack of knowledge about this rare disease have all been significant hurdles. But I think the drama of this outbreak and the narrative of the world’s response is illustrative of some basic underlying issues about which we as a global society, and as Americans, need to have a serious conversation.
The first and most obvious issues are clean water and the effects of extreme poverty. 2 billion people in this world are without access to clean water and 40 percent of the world population is without access to a toilet. That is a set up for disaster whether the culprit is Ebola or an earthquake.
Poverty also begets poor initial health. Even in the U.S., a person in the lowest income bracket is about three times more likely to die before the age of sixty-five than someone in the wealthiest bracket. Extrapolated to the developing world, this statistic is even starker. In those countries people are still dying from diseases we cure easily and even cheaply in the U.S. They include pneumonia, for which we need generic antibiotics, diarrhea due to unclean water, malaria preventable by mosquito nets, and measles for which we have a vaccination that costs $1. And sadly the people most affected by this are children. Over six million children die per year before they reach their fifth birthday, which is over 750 children per hour. And half of these deaths are from the preventable causes I just mentioned.
Education is also a significant barrier. And this is not just for the people impacted by the disaster but also around the world. We saw cultural barriers as well as general panic around the disease in the U.S. Dissemination of correct information is also made worse by illiteracy causing superstitions and distrust.
If this isn’t enough of a handicap add over crowding due to a burgeoning population, in part due to lack of access to a scientific and compassionate approach to education around and provision of acceptable birth control methods.
When an earthquake hits Haiti, when flooding overruns Bangladesh, or when Ebola hits West Africa the impact is magnified because of the challenging conditions in which the people were living before the disaster struck.
Lack of food, lack of economic opportunity, lack of education—all contribute to a much worse impact from any natural or man-made disaster. These are “slow motion” disasters—just as devastating, but taking place over a longer period of time. When we add an acute disaster like Ebola, we become Sisyphus pushing the boulder up the mountain.
But I do not think it has to be like this. As with medicine, the better approach is prevention. However, in cases like this “prevention” actually means global action to improve the basic living conditions, health and ultimately the fate of our society. And I believe we can do this with compassion.
Compassion for populations without our American advantages is a strong component of our national character. Our founding citizens came from a place of repression and fought for the right to not live under such tyranny making their values a part of our national identity. While some may argue we have lost this national compassion, I believe it is still firmly rooted in who we are.
I recently got together with a couple of friends, entertainer WK “Big Kenny” Alphin and Dr. Randy Wykoff to talk about American compassion and to make a list: a list of things we should really care about. We wish to start a national conversation to identify and address some of the greatest threats to our global community. We are too privileged and have the advantage of too many lessons from history to continue to ignore our current trajectory – to continue to let another Ebola epidemic unfold as it did.
For my part, I frame the conversation in terms of changing health. American rhetoric regarding our national pride and values has taken many forms over the years, and until recently, health has not been a part of that conversation. There were once no healthcare providers in politics and physicians were used to advertise cigarettes. But as you can see with the Ebola illustration, a focus on the social determinants of health, the basic tenants of our societal infrastructure, is imperative if we ever hope to build a society that can deftly and efficiently respond to and survive crisis.
This month, Big Kenny, Randy and I are launching a conversation for caring, for change, for action. #Conversation2015 will focus on twelve issues for the next year. Picking twelve items was a daunting task, but we looked for opportunities where a little progress aided by a lot of compassion could make a big difference. We chose:
- Safe food and water
- Environmental damage
- Poverty and inequality
- Natural and man-made disasters
- Epidemic disease
- The U. S. Criminal Justice System
- Creativity and freedom of the press
- The right to vote and the democratic process
- You and Me
The important message about this list is that the issues can be solved. To do that, let’s focus the dialogue on identifying those challenges threatening people’s health around the world, and how we can work together to address them. Join the conversation. Research these issues yourself and learn as much as you can and share what you learn with us.
Are you ready to take your place? Are you ready to care?
Read the full white paper at http://www.etsu.edu/cph/blog_articles/intro.aspx, and be part of the conversation using #Conversation2015.
Bill Frist is both a former U.S. Senate Majority Leader and nationally recognized heart and lung transplant surgeon.