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Day 48 - Public Health and Public Health

07.05.2020

I’ve learnt more in these past 48 days than in most other 7 week spells in my life, not counting when I learnt baby-talk or how to crawl. Then again, those are natural.


One thing I’ve learnt during the pandemic is this: there are two different things called “public health” (or “lasante piblik”). 


And, though difficult for us in Mauritius to understand the difference, it is much more difficult for Americans to get their heads around it. They all, not just Trump, seem thick as two planks. 


Let me explain. I’m not saying it’s genetic or anything. I’m saying that their reality prevents them seeing the difference even more than ours does. And their extreme social handicap helps me explain our less acute problem.


In the USA, most hospitals are private, for profit, things. In Mauritius it is hard for us to imagine such a thing. You even have to pay for Covid-19 tests there. Except for military staff and veterans, there is no universal free health care system.


So, most people’s insurance in the USA does not cover what the insurance bosses call “pre-existing conditions” – so you pay as you suffer – and the insurance is, like a dankan house, tied to your boss employing you, and you contribute a handsome sum, an average a quarter of your pay. (Rs 60,000 per month, half in payments, half for what insurance deducts from your family’s bills and makes you pay). Workers laid off – even now during the lockdown – have just lost their health care.


This situation is what makes Governor Cuomo, who helps the rest of the world understand the misery of the USA, say there is no “public health system” in New York State, or in the USA for that matter. What he explained that he meant was that just about all the hospitals are privately run.


So, often when Americans talk of a “public health system”, they mean this aspect of what a society does in relation to the public’s illness, not the public’s health. Theirs is really only a very fragmented and unequal “public illness system”.


“Public Health”, however, as a domain in the study of society’s health is to do with preventive health care. It is a lowly area of study. Its doctors save most lives, and are usually invisible to the public. In Mauritius, we see public health in the work done by Biro Saniter. It is tracing-and-testing to control malaria and chikungunya. It is checking that drains, canals, stagnant water, and waste-water systems are not a public health issue. Public Health measures involve free school meals, and free school milk. It involves vaccines to prevent illness. It involves screening for non-infectious diseases to pick them up early. This part of the USA’s “public health” exists at a federal level in a whole list of institutions like the Centre for Disease Control that Dr. Fauci is in. 


The US system of care for sick people, and even its system of prevention, are dogged by the power of huge private pharmaceutical companies. Capitalism is not interested in public health or even care of the sick unless it makes a profit, or unless an epidemic threatens everyone. 


A good public health system also involves free health care for all, as a right. This means universal and equal health care.


So, in the pandemic we have learnt one lesson at least: sometimes in conversations we need to specify what we mean by “public health”.


Both public health as preventive health and public health as universal free health-care need to be promoted world-wide. That’s for sure.


 


Lindsey Collen


for LALIT, a personal viewpoint


PS Thank you for all the messages; my injured finger is doing well. I’m typing with 9 fingers now!