The Contagion Next Time

August 30, 2021
Galea (Well), dean of the Boston University School of Public Health, offers a revelatory new conception of public health and disease prevention in this trenchant study of systemic inequity. In the first two sections, Galea argues that maintaining health requires more than just medical care; people must also invest in their communities in ways that prevent sickness in the first place. Primarily, this involves lifting people out of poverty and repairing the social harms that remain a legacy of Jim Crow legislation. He examines failures in public health based on such metrics as life expectancy, addiction, mental health, and noncommunicable diseases, exploring how food deserts, low wages, and homelessness ensure that some communities are less healthy than others. The last two sections focus on solutions, including concrete actions (invest in housing and safe transportation, for example) and a realigning of values in America toward a more just society that will minimize the damage of future public health crises. Galea powerfully demonstrates how inequities are detrimental to public health on a grand scale, affecting everyone: “As long as any part of our world remains vulnerable to poor health, we live, collectively, beneath a sword of Damocles,” he writes. Policy makers, take note.

September 15, 2021
The Covid-19 pandemic is not a one-off catastrophe. An epidemiologist presents a cogent argument for a fundamental refocusing of resources on "the foundational forces that shape health." In this passionate and instructive book, Galea, dean of the Boston University School of Public Health, writes that Covid emerged because we have long neglected basic preventative measures. "We invest vast amounts of money in healthcare," he writes, "but comparatively little in health." Readers looking to learn how governments (mainly the U.S.) mishandled the pandemic have a flood of books to choose from, but Galea has bigger issues to raise. Better medical care will not stop the next epidemic, he warns. We must structure a world "that is resilient to contagions." He begins by describing the current state of world health, where progress has been spectacular. Global life expectancy has more than doubled since 1900. Malnutrition, poverty, and child mortality have dropped. However, as the author stresses repeatedly, medical progress contributed far less to the current situation than better food, clean water, hygiene, education, and prosperity. That's the good news. More problematic is that money is a powerful determinant of health; those who have it live longer. Galea begins the bad news by pointing out the misleading statistic that Covid-19 kills less than 1% of those infected; that applies to young people in good health. For those over 60, it kills 6%, for diabetics, over 7%, and those with heart disease, over 10%. It also kills more Blacks than Whites, more poor than middle-class people, and more people without health insurance. The author is clearly not just interested in Covid. He attacks racism, sexism, and poverty in equal measure, making a plea for compassion toward stigmatized conditions such as obesity and addiction. He consistently urges the U.S. government, which has spared no expense and effort to defeat the pandemic, to do the same for social injustice. An oft-ignored but fully convincing argument that "we cannot prevent the next pandemic without creating a healthy world."

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September 15, 2021
Reflecting on the COVID-19 catastrophe, public health expert Galea believes the path to preventing future pandemics requires a ""restructuring"" of society that ardently promotes health for all. Health is influenced by many nonmedical forces political, economic, environmental, and social. Spending massive amounts of money on medical treatment is not sufficient to advance the overall health of society and individuals. Unless health inequalities, economic hardship, and racial injustice are effectively addressed, the world will remain seriously susceptible to pandemics. Fortifying health and constructing an improved world requires compassion, justice, humility, and a reaffirmation of the importance of science. Galea points to the many missteps occurring throughout the pandemic and the damage done by mistrust and scapegoating. He considers concepts of vulnerability, uncertainty, and ""collective sacrifice."" Even in a post-COVID-19 world, other dangerous viral contagions will lurk in a tropical forest being razed, a wet market, perhaps even a laboratory. Galea offers a basic blueprint to help society better prepare for viral onslaughts. He wisely surmises, ""We are all attempting to navigate life in the same fog--none of us know nearly enough.

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