The Difference of 50 Years

I was reading my public health journal when I came across a poignant interview with Laurie Garrett — who recently won a Pulitzer for her book. To be honest, I hadn’t heard of her or of the book until I read this interview. I was refreshingly impressed by the what she had to say, including her answer to the interviewer’s question of “do you think global public health efforts are winning?”

[What a dumb question! 100 million people are expected to be infected with HIV by 2010. We are certainly not winning anything other than job security.]

Regardless, her thoughtful response:

“Winning, to my mind, has on obvious goal post — life expectancy. And by that measure, we have a paradox. Since 1948 when the World Health Organization was created, average life expectancy for the people of planet Earth has risen by 40 percent. This has overwhelmingly been due to a combination of public health infrastructural interventions and rising personal wealth and education.
But, if you break that 40% down, remember that is an average, something very disturbing pops up. The long-lived societies are getting more long-lived, while the short-lived societies are either failing to improve, or thanks to wars and HIV, are going backward. So, today the life expectancy gap is the widest in human history with a disparity of five full decades. What this means is that a very long-lived society like Japan now offers, as a matter of statistical probability, a child born in 2007 the probability of living long enough to know his/her great-grandchildren. In contrast, very short-lived societies like Sierra Leone, Nepal or Zimbabwe now offer that same child only a remote possibility to live long enough to see his/her children reach adulthood. That is a crime.
The ‘win’ as far as I am concerned, would be closing that gap.”

Bravo! This sums up exactly why I love working in international public health.


8 Replies to “The Difference of 50 Years”

  1. What you do in internation public health has been amazing to watch, even in the short time I have been reading. You are an amazing and inspiring individual.

  2. What most people in this country don’t understand is that the number one reason for the spread of AIDS is stigma. People don’t get tested because they don’t want to be abandoned by family and friends, and so goes the spread of the disease. My son worked with AIDS patients at the 200% poverty level in his internship for social work, and the biggest battle that they fight is getting the patients to come in for their screening and meds. They fear being found out by others. And in most cases, their other problems are so complex, that the AIDS situation is like a grain of sand in the social services they need. Now imagine this same scenario in a third world country. Kelli- you are to be applauded for your commitment to this issue.

  3. We certainly are not winning at all. Thank goodness for people like you who have the skills, the heart, and the interest in helping research, heal, care, and educate.

  4. when I read the title and the first few words of the post, I jumped to the conclusion that you were going to write about the difference in public health in the US between now and 50 years ago. This being my 56th birthday, I reflected back on what public health was like in my elementary school in Hoopeston Illinois (I’d have been in first grade).

    If I remember correctly, and I may be off by a year or so, that was when the mass polio and smallpox inoculations were being administered. It was the first concerted effort to defeat epidemic-type diseases of my generation. The common practice was to line all the kids up in the gymnasium, in their underwear, and go down the line inoculating everyone. Seriously, everyone standing in line in their underwear, while nurses and doctors (which I guess made the underwear part ok, because it was all clinical and everything) did their thing.

    But, your post wasn’t about that at all. It was about something ultimately more meaningful. I just thought I’d add my two cents from 1957 (which is probably worth even less in 2007).

  5. Fascinating! I sometimes wonder if we can ever win…but the struggle to make life better, even marginally, even for a few, is *so* worth it. The loss would be NOT working to improve the world.

    An aside: this is a good example of why we should all have a basic understanding of statistics – averages and means and medians don’t necessarily equate to what we think they do! I try to understand what goes into the numbers, ’cause otherwise it’s really easy to have the wool pulled over your eyes.

    Thanks for sharing this.

  6. Bravo! I know that the reason I am alive today, and can expect to live for a few more years with chronic cancer, is that I live in the USA, and have good health insurance.

    I remember when we lived in Kenya, and my husband reported that one of the young farmers he worked with had lost his wife because “her lungs rotted.” We may never know what killed her, but I suspect it was either cancer or TB. They simply did not have access to the care that we have. It is a crime.

    And, here in the USA, the Indian Health Service often does not treat cancer. Some service.

  7. I’m just catching up on blog reading because I was at the American Public Health Assoc meeting in DC. I am hoping to go back to school for my MPH in a year or two; my interest is in maternal/child health. I didn’t realize you worked in public health, although I started reading your blog when you began collecting bags to take to Mozambique. What kind of organization do you work for?

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