Public Health, by Alexander Cockburn

The first illusion to chase off the stage is that the great debate here has
much to do with health. So far, as public health is concerned, many of the
biggest battles were fought and won a hundred years ago, at the end of the
nineteenth century, with better nutrition, birth control, the change from
wool to cotton clothing, the introduction of modern sanitation in the urban
environment and – most important – clean water.

Between 1900 and 1973, American life expectancy went from 47 to 71, but most
of this rise had taken place by 1949, when the average life span reached 68.
Much of the upward curve could be attributed to improved survival rates for
infants and young people. Prohibition helped, since people drank less
alcohol, ate more, and hence TB rates dropped sharply, well before the
introduction of sulfa drugs.

Health in America is class-based, naturally. The poor die sooner, starting
with black men who tend to drop dead in their middle 60s, usually from
stress and diseases consequent on diet. The better-off folk drink less than
they did in the 1950s, take a bit more exercise, and sometimes live longer.
The poor get fatter and fatter. A real health plan would start with public
executions of the top thousand CEOs and owners of the major food companies
and fast food franchises. It would continue with serious penalties for
health workers not washing their hands or merely holding them under the tap
without using soap.

The plagues of America today are beyond the reach of the modern medical
system, and that system is itself a peculiarly outrageous example of
antisocial imperatives: high technology health care which serves fewer and
fewer people. Part and parcel of this system are the drug companies, working
in concert with the hospitals and insurance industry. Doctors have long
since been shoved to the side as major players.

Mostly shunned in all this are the major causes of modern disease, which are
environmental. Between 70 and 90 per cent of all cancer is environmental in
origin. Heart disease and stroke – the largest killers today – are largely
caused by hypertension and stress, which are derived from social conditions.

Health reform in the 1930s, in the Roosevelt era, came mostly in the guise
of the Wagner Act – a better deal for unions and workers – and Social
Security. Old people got something to live on in their later years. Health
reform in the 1950s and 1960s came with better wages, a shorter working
week, more leisure, plus Medicare – the federal health plan for older people
– driven through Congress by the most consummately cunning and accomplished
politician of the postwar era and maybe of the twentieth century (unless you
make the case for FDR), Lyndon Johnson, who really did care about poverty,
having seen a lot of it up close in Texas.

Since then, we’ve gone nowhere.


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