A review of the pandemic suggests Americans have lost interest in public health

A review of the pandemic suggests Americans have lost interest in public health

Transcript¹

NPR's Steve Inskeep talks to Ed Yong, a staff writer for The Atlantic who won a Pulitzer for his pandemic coverage², about the failed public health response to the COVID-19 pandemic.

STEVE INSKEEP, HOST:

The pandemic exposed giant gaps in the American health system. That may be part of the reason the United States leads the world in COVID deaths. The analyst³ Ed Yong says the results have revealed a longer-term problem even larger than the pandemic, the generations-long decline of public health in the United States. Writing in The Atlantic, he says people in the U.S. once thought differently than they do now about the underlying⁴ causes of disease.

ED YONG: So in the late 19th century, public health was a much more dispersed⁵ field. It had scientists, sure, but also a lot of activists⁶, civil servants, a lot of public figures. The way they thought about health problems were informed by the social model of medicine, in which the factors that led to the spread of epidemics⁷ included things like poverty, poor sanitation⁸, hazardous⁹ working conditions, poor education, political inattention. And they were sort of possessed¹⁰ of this crusading spirit, this idea that these problems, though vast, required action and active efforts to address.

INSKEEP: As you're talking, I'm thinking of Jacob Riis, this journalist in the late 1800s, who wrote this book called "How The Other Half Lives." And he was arguing that crowded tenements¹¹ and windowless bedrooms and dirty alleys¹² and so forth¹³ made people less healthy, contributed to their poverty and their death.

YONG: Absolutely. And I think this was quite a common view at the time. But that view started to fall by the wayside at the turn of the century because of the rise of germ theory, the discovery that many long-standing illnesses that have plagued humanity were the work of microscopic¹⁴ organisms. That gave people an easy target, a villain¹⁵ to focus on. And it meant that those knotty¹⁶ social problems could be ignored even now. Like, if you think about COVID, so much of our attempts to control the virus, the SARS-CoV-2 virus, have focused on medical countermeasures like drugs and vaccines¹⁷. And there's been much less emphasis on things like paid sick leave, universal healthcare. That would address the sort of foundational social problems that were much more understood as drivers of poor health some time ago.

INSKEEP: Are you saying that this is a conflict between collective action and individual solutions?

YONG: Yes, partly. The idea is that you can collapse¹⁸ all the complexities¹⁹ about disease and the causes of poor health down to this battle between a host and a pathogen. And so you can treat it entirely²⁰ as a problem of individuals. Now this is, I think, the wrong way of looking at it. Social issues like poverty and so on affect the kinds of choices people can make to protect their own health. And if you don't think about that, then the biomedical solutions, like the vaccines and drugs, don't have the effectiveness that they seem to have on paper.

INSKEEP: Is there a fundamental ideological²¹ problem the United States has here? We know about conservative resistance to collective action. But honestly, as the pandemic has gone on, the tolerance²² for that sort of thing has eroded²³ in more liberal cities, as well. It does seem to be a universal thing that Americans don't like to be told what to do.

YONG: I think that is true. I have argued for a while now that America's particular breed of toxic²⁴ individualism is, you know, antithetical to an effective pandemic response. You cannot think about infectious diseases solely²⁵ through the lens of individual risk. They are fundamentally a collective problem because they spread and because people's circumstances constrain²⁶ their choices. So their health is profoundly influenced by the choices of everyone else around them. If you think about this in terms - entirely in terms of what individual people can do, you're going to fail at this specific kind of problem.

INSKEEP: So help me define the problem now. When it comes to public health, what is it that we're failing to do?

YONG: There are several problems. The field is struggling with long term disinvestment. There's simply not enough money going into public health. And there hasn't been for almost a century now.

INSKEEP: Money to do what things, exactly?

YONG: Money to do the basics of the work, which are to prevent diseases in communities. So when COVID happened, the lack of testing, the inability to do contact tracing, the inability to really do community-based prevention work that some other countries did much better than we did, a lot of it comes down to lack of resources. Many people have rightly argued that public health needs to be more expansive. It really needs to start tackling these social problems, these social inequalities that are the bedrock of so many health problems, not just COVID.

INSKEEP: When we heard during the worst of the pandemic that poor communities were more affected²⁷ by COVID, which in America tended to mean people who were more diverse, more people of color, was that a public health failure?

YONG: Yes, it is. And I think it's sort of a failure for all of us, this idea that the social conditions that underpin²⁸ poor health persist over time, even though the threat of the day changes and even though medical progress is ostensibly made. And that's fundamentally because epidemics and medical interventions²⁹ flow in opposite directions. Epidemics flow downwards³⁰ into society's cracks, taking out the most marginalized people first. Medical interventions like drugs and vaccines rise up into society's penthouses. They go first to people with connections, power, privilege and money. And those people then move on from the problem before addressing the societal rot that actually made it worse. If you only look to drugs and vaccines as the solution to these problems without addressing the underlying inequalities, all you do is plaster over the problem for now and leave the same gaping³¹ wounds to get infected and fester the next time around.

INSKEEP: Are you suggesting that despite whatever we've learned in this pandemic, if there was another pandemic five years from now, it might go just as badly?

YONG: Yes. That is exactly what I'm suggesting.

INSKEEP: Ed Yong is a staff writer for The Atlantic. Thanks so much.

YONG: Thanks for having me.

(SOUNDBITE OF KONTAKTE'S "EARLY EVENING BLEEDS INTO NIGHT")

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

3 analyst   

n.分析家，化验员；心理分析学家

参考例句：

• What can you contribute to the position of a market analyst?你有什么技能可有助于市场分析员的职务？
• The analyst is required to interpolate values between standards.分析人员需要在这些标准中插入一些值。

4 underlying   

adj.在下面的，含蓄的，潜在的

参考例句：

• The underlying theme of the novel is very serious.小说隐含的主题是十分严肃的。
• This word has its underlying meaning.这个单词有它潜在的含义。

5 dispersed   

adj. 被驱散的, 被分散的, 散布的

参考例句：

• The clouds dispersed themselves. 云散了。
• After school the children dispersed to their homes. 放学后，孩子们四散回家了。

6 activists   

n.（政治活动的）积极分子，活动家( activist的名词复数 )

参考例句：

• His research work was attacked by animal rights activists . 他的研究受到了动物权益维护者的抨击。
• Party activists with lower middle class pedigrees are numerous. 党的激进分子中有很多出身于中产阶级下层。 来自《简明英汉词典》

7 epidemics   

n．流行病

参考例句：

• Reliance upon natural epidemics may be both time-consuming and misleading. 依靠天然的流行既浪费时间，又会引入歧途。
• The antibiotic epidemics usually start stop when the summer rainy season begins. 传染病通常会在夏天的雨季停止传播。

8 sanitation   

n.公共卫生，环境卫生，卫生设备

参考例句：

• The location is exceptionally poor,viewed from the sanitation point.从卫生角度来看，这个地段非常糟糕。
• Many illnesses are the result,f inadequate sanitation.许多疾病都来源于不健全的卫生设施。

9 hazardous   

adj.(有)危险的，冒险的；碰运气的

参考例句：

• These conditions are very hazardous for shipping.这些情况对航海非常不利。
• Everybody said that it was a hazardous investment.大家都说那是一次危险的投资。

10 possessed   

adj.疯狂的；拥有的，占有的

参考例句：

• He flew out of the room like a man possessed.他像着了魔似地猛然冲出房门。
• He behaved like someone possessed.他行为举止像是魔怔了。

11 tenements   

n.房屋，住户，租房子( tenement的名词复数 )

参考例句：

• Here were crumbling tenements, squalid courtyards and stinking alleys. 随处可见破烂的住房、肮脏的庭院和臭气熏天的小胡同。 来自辞典例句
• The tenements are in a poor section of the city. 共同住宅是在城中较贫苦的区域里。 来自辞典例句

12 alleys   

胡同，小巷( alley的名词复数 )； 小径

参考例句：

• I followed him through a maze of narrow alleys. 我紧随他穿过一条条迂迴曲折的窄巷。
• The children lead me through the maze of alleys to the edge of the city. 孩子们领我穿过迷宫一般的街巷，来到城边。

13 forth   

adv.向前；向外，往外

参考例句：

• The wind moved the trees gently back and forth.风吹得树轻轻地来回摇晃。
• He gave forth a series of works in rapid succession.他很快连续发表了一系列的作品。

14 microscopic   

adj.微小的，细微的，极小的，显微的

参考例句：

• It's impossible to read his microscopic handwriting.不可能看清他那极小的书写字迹。
• A plant's lungs are the microscopic pores in its leaves.植物的肺就是其叶片上微细的气孔。

15 villain   

n.反派演员，反面人物；恶棍；问题的起因

参考例句：

• He was cast as the villain in the play.他在戏里扮演反面角色。
• The man who played the villain acted very well.扮演恶棍的那个男演员演得很好。

16 knotty   

adj.有结的，多节的，多瘤的，棘手的

参考例句：

• Under his leadership,many knotty problems were smoothly solved.在他的领导下，许多伤脑筋的问题都迎刃而解。
• She met with a lot of knotty problems.她碰上了许多棘手的问题。

17 vaccines   

疫苗，痘苗( vaccine的名词复数 )

参考例句：

• His team are at the forefront of scientific research into vaccines. 他的小组处于疫苗科研的最前沿。
• The vaccines were kept cool in refrigerators. 疫苗放在冰箱中冷藏。

18 collapse   

vi.累倒；昏倒；倒塌；塌陷

参考例句：

• The country's economy is on the verge of collapse.国家的经济已到了崩溃的边缘。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做了一次彻底的调查分析。

19 complexities   

复杂性(complexity的名词复数)； 复杂的事物

参考例句：

• The complexities of life bothered him. 生活的复杂使他困惑。
• The complexities of life bothered me. 生活的杂乱事儿使我心烦。

20 entirely   

ad.全部地，完整地；完全地，彻底地

参考例句：

• The fire was entirely caused by their neglect of duty. 那场火灾完全是由于他们失职而引起的。
• His life was entirely given up to the educational work. 他的一生统统献给了教育工作。

21 ideological   

a.意识形态的

参考例句：

• He always tries to link his study with his ideological problems. 他总是把学习和自己的思想问题联系起来。
• He helped me enormously with advice on how to do ideological work. 他告诉我怎样做思想工作，对我有很大帮助。

22 tolerance   

n.宽容；容忍，忍受；耐药力；公差

参考例句：

• Tolerance is one of his strengths.宽容是他的一个优点。
• Human beings have limited tolerance of noise.人类对噪音的忍耐力有限。

23 eroded   

adj. 被侵蚀的，有蚀痕的 动词erode的过去式和过去分词形式

参考例句：

• The cliff face has been steadily eroded by the sea. 峭壁表面逐渐被海水侵蚀。
• The stream eroded a channel in the solid rock. 小溪在硬石中侵蚀成一条水道。

24 toxic   

adj.有毒的，因中毒引起的

参考例句：

• The factory had accidentally released a quantity of toxic waste into the sea.这家工厂意外泄漏大量有毒废物到海中。
• There is a risk that toxic chemicals might be blasted into the atmosphere.爆炸后有毒化学物质可能会进入大气层。

25 solely   

adv.仅仅，唯一地

参考例句：

• Success should not be measured solely by educational achievement.成功与否不应只用学业成绩来衡量。
• The town depends almost solely on the tourist trade.这座城市几乎完全靠旅游业维持。

26 constrain   

vt.限制，约束；克制，抑制

参考例句：

• She tried to constrain herself from a cough in class.上课时她竭力忍住不咳嗽。
• The study will examine the factors which constrain local economic growth.这项研究将考查抑制当地经济发展的因素。

27 affected   

adj.不自然的，假装的

参考例句：

• She showed an affected interest in our subject.她假装对我们的课题感到兴趣。
• His manners are affected.他的态度不自然。

28 underpin   

v.加固，支撑

参考例句：

• China needs regional stability to underpin its continued economic growth.中国需要地区稳定来巩固其持续的经济增长。
• These developments are underpinned by solid progress in heavy industry.重工业的稳固发展为这些进展打下了基础。

29 interventions   

n.介入，干涉，干预( intervention的名词复数 )

参考例句：

• Economic analysis of government interventions deserves detailed discussion. 政府对经济的干预应该给予充分的论述。 来自辞典例句
• The judge's frequent interventions made a mockery of justice. 法官的屡屡干预是对正义的践踏。 来自互联网

30 downwards   

adj./adv.向下的（地），下行的（地）

参考例句：

• He lay face downwards on his bed.他脸向下伏在床上。
• As the river flows downwards,it widens.这条河愈到下游愈宽。

31 gaping   

adj.口的；张口的；敞口的；多洞穴的v.目瞪口呆地凝视( gape的现在分词 )；张开，张大

参考例句：

• Ahead of them was a gaping abyss. 他们前面是一个巨大的深渊。
• The antelope could not escape the crocodile's gaping jaws. 那只羚羊无法从鱷鱼张开的大口中逃脱。 来自《简明英汉词典》