Effect Measure

I noticed that Governor Mitt Romney, Republican presidential hopeful and much despised Governor of Massachusetts, just vetoed $8.15 million in funding for addiction treatment and prevention in his state. I’m not an expert on substance abuse issues, but I know it is an area of public health where we are in real trouble because of budget cuts. I have written quite a lot about bird flu here and the need to address it by strenghtening the public health infrastructure. Substance abuse is part of that infrastructure. But what, if anything, does cutting these programs have to do with bird flu? I feel strongly they are connected but I think I should be forced to say how. Let me take a first crack at it (the breeze you’ll feel is caused by my frantically waving hands). Here goes.

Our friend Dick Clapp said to one of us we should adapt Barney Frank’s definition of government (“the things we choose to do together”) for public health: “the activities we choose to do as a community to enhance our health and quality of life.” It is an interesting suggestion with some important features. First, it emphasizes that public health activities are a choice — they are not forced on us — and the choice is made by the community. The object — to enhance our health and quality of life — goes beyond what many would conceive of as public health, too. What does it have to do with bird flu?

It has been our thesis that responding to a bird flu pandemic successfully is essentially a problem of community mobilization. The consequences of a serious epidemic disease causing 30% to 40% absenteeism also goes far beyond strictly medical and public health issues. It involves supply chains, sick-leave policies, how to cope with overcrowded and understaffed facilities, rationing of scarce resources and so much more. Responding to bird flu will intimately involve the choices we make as a community and even more importantly, perhaps, how we react as a community rather than as individuals. Will we help each other or will we flee from each other? Will we work together to help our neighbors if they need it with the reciprocal expectation they will help us when we need it? Or will it be every person for him or herself, every family on its own? The kinds of choices we make as a community also affect and color our attitudes towards each other as members of the same community. For soldiers, carrying out a mission is more than the military objective. To work it requires the kind of group solidarity that becomes the solid core for veterans for the rest of their lives. In Iraq we hear soldiers say it isn’t about fighting the enemy as much as it is about loyalty to his brothers. That kind of social cohesion requires attitudes and policies which have nothing to do with shooting or being shot at. They are choices soldiers make. They could as easily choose to see themselves only interested in their own survival. But they don’t. Nor should we and for the same reasons. We will survive better that way.

So our choices about substance abuse programs are part of a package and you don’t throw parts of the package overboard just because you aren’t using it at the moment. The stronger we are as communities, writ large, the better we will weather a pandemic. There are other reasons, too, however. The public health system serves the community while the medical care system serves clients. The public health system should have as a priority those least connected with the medical system, even more so in a pandemic. Drug addicted, pregnant women, those with abusive partners all fall into this category and will be especially hard pressed in a pandemic because of lack of connection to the medical system. Public health programs that serve these groups are ways to reach them, sometimes the only connection to the community’s social system they have. For those who insist on hard nosed reasons there are some, although I don’t think they are the best ones. We already devote a distressingly high overhead to dealing with the consequences of drug addiction in crime and anti-crime measures, including police. Those measures that some feel protect them will also be under stress and less effective. Any way we can reduce the demand by reducing addition is a net plus should a pandemic come to our communities.

For us it boils down to this. If we want to weather the storm we need strong communities. We don’t get them by cutting needed programs for substance abuse. In fact we don’t get them by cutting public health programs. The argument this isn’t the best use of scarce money is highly suspect when it comes from a right wing Republican Governor looking to run for President on social issues. It sidesteps the question of whether we need more, not less, resources for public health so we aren’t just shifting resources around. It doesn’t specify what any money saved would be used for (tax cuts in this case). It doesn’t compare the targeted program to scores of other programs that could be cut (like promoting Massachusetts tourism or tax subsidies or paying for the Big Dig screw-up).

That’s my first take on why cutting substance abuse programs make us less prepared to respond to a pandemic. Yeah, I’m waving my hands a little. Sue me.

Comments

  1. #1 Brooks
    July 31, 2006

    “Governor Mitt Romney, Republican presidential hopeful and much despised Governor of Massachusetts”

    That’s a cheap shot, and not at all accurate. But perhaps you think everyone from Massachusetts is scum?

    On the whole, Romney is a decided improvement over any of our recent administrations, including the general area of disaster preparations. Not to say there aren’t areas where he missed the mark.

  2. #2 revere
    July 31, 2006

    Brooks: It’s a shot but not that cheap. He has ruined the Dept. of Public Health, among other things. It isn’t cheap also because he is photogenic, smooth and dangerous, more so than his incompetent thoroughly hack predecessors. Regarding the good people of Massachusetts, they have no great love for him either, at least as I recall from the polls. He is no improvement regarding administration of the state, which continues to suffer under him as it did under the previous governors (the state doesn’t seem to have had a decent governor since Frank Sargent as far as I can tell). I’m also guessing he will get caught up in the tunnel scandal. Talk to people inthe Dept. of Public Health if you want to know about mismanagement, malfeasance and neglect. They are once again remodeling the place at great expense and for no reason. Meanwhile he cuts their budget for essential services.

    Cheap shot? No. Quite expensive in terms of the health and well being of the people of Massachusetts.

  3. #3 C. Corax
    July 31, 2006

    Count me among those Massachusetts residents who despises him. He keeps vetoing our pay raises (I’m in higher ed) because he wasn’t the one who negotiated our contracts.

    Funding substance abuse programs is a no-brainer. They help prevent crime, they help prevent the spread of HIV, and they help prevent human suffering. Romney has been slashing SA funds every chance he’s gotten. Shame on him.

  4. #4 Mya
    July 31, 2006

    Good post!!

  5. #5 crfullmoon
    July 31, 2006

    I’d love to send revere’s letter to him and say, I agree. (Though, you put it more concisely, C.Corax.)

    We’d be better off if he was trying to move back to Utah rather than the District of Columbia.

    Addicts looking for fixes and going through withdrawal during a pandemic? Major issue, no matter what the substance.

    “An ounce of prevention is worth a pound of cure.”

    (As for the Big Dig, can you imagine if we’d had an earthquake? We can get them here. And, no one leaving for doing a bad job deserves 6 months severance pay, especially when they were getting paid so much more than the median income of their state.
    Many people got paid to put the Big Dig together the way it ended up; they should pay to fix it, not taxpayers.)

  6. #6 Brooks
    July 31, 2006

    Well, if you are determined to look at a very narrow range of issues, it’s easy to hate any politician. The longterm view requires that Massachusetts get out of the entrenched socialist agenda of the Massachusetts democrats. The socialist agenda that says you WILL be heavily penalized for taking responsibility for yourself.

    No, Romney isn’t “much depised”.

  7. #7 tympanachus
    July 31, 2006

    Is Brooks your token Red Stater or the nucleus of some kinda widely spreading substance abuse problem?

    Sane drug policies are not options in the USA. Finest book yet written on the issue, On Drugs, is by a prof of comp lit at UMass Amherst named David Lenson (who is proudest of having played saxophone with John Lee Hooker, Buddy Guy and Junior Wells).

  8. #8 Luke
    July 31, 2006

    Revere, great post, addicts are just poor people anyway, right? It’s not like ” G-Dubs and Daughters Don’t/haven’t Dabble(d)”, eh?

    Brooks, I would not call the current nation encompassing onslaught of republican issues ‘narrow’ by any means.

    It seems the current administration (and let’s face it, the entire current Republican controlled US Government as a whole) has hosed up the Medicare prescription plan pretty badly and continues to drive at what amounts to be a low-level ‘holy war’ on the Roe V. Wade and stem cell research matters. I have to say that I am not impressed with right’s ability to get our health care system moving in the CORRECT direction…. Quick hint, the answer is not going to come in preventing minors from crossing state lines to end unwanted pregnancies without parental consent.

    Wake up repukicans, we are facing the potential start of a global conflict along with a smoldering pandemic; and where is the challenger I ask all of you on the left? Who is going to get the CHECK together to balance all of this heavily right sided world-angering crap?

    As an independent, I would say we need to find a happy place between socialism and trading minimum wage pay increases for the continued strengthening of the Republican ‘cast’ system (ie. killing he inheritance tax); where by spoiled little fraternity party boys like G-dubs become president on family money…. and the rich get richer…blah blah…

    I have to wonder who will invade first, H5N1 or Chinussia-QaedaBollahorea?

  9. #9 Doc
    July 31, 2006

    Quite the character ole’ Mittens….

    Romney at his best…

    Snip – “The best thing politically would be to stay as far away from that tar baby as I can,” he told a crowd of about 100 supporters in Ames, Iowa.”

    “Black leaders were outraged at his use of the term, which dates to the 19th century Uncle Remus stories, referring to a doll made of tar that traps Br’er Rabbit. It has come to be known as a way of describing a sticky mess, and has been used as a derogatory term for a black person.” -Snip

    http://www.cnn.com/2006/POLITICS/07/31/romney.racialremark.ap/index.html?section=cnn_topstories

    “….real cosmoplolitan…”

    Doc Holiday

  10. #10 Name
    July 31, 2006

    Here in Vancouver (Canada), it was actually a right-wing mayor who surprised everyone by emerging as the strongest champion for harm reduction, bringing together 3 levels of government plus our healthcare and police bureaucracies to step out way ahead of the curve with safe injection sites etc.

    Several factors were influential in changing hearts and minds about the approach to Vancouver’s long thriving drug culture. One was deeply personal: the realization among the city’s privileged classes that their own youth were increasingly among those being sucked down the drain of addiction. Another was more pragmatic: a growing understanding of the enormous costs of addiction to our taxpayer-funded healthcare and justice systems, after an explosion of HIV & hep infections among the city’s IV drug users in the late 1990s.

    When community members–especially influential community members–connect on a personal level with the high costs of failing to act, and also understand the benefits of doing so on a very pragmatic level, the impetus for change is powerful.

    (We still have a long way to go and backward forces to contend with, like a new PM who’s ideologically opposed, but the benefits are probably too obvious now to go back.)

  11. #11 BAW in MI
    July 31, 2006

    I don’t live in Massachusetts, but my paranoid schizophrenic, homeless daughter does. I hope SOMEONE in the state, excuse me, commonwealth will fund social service programs for those less fortunate than themselves. It truly annoys me when someone who has “lots” cuts funding for those who have “not much at all,” through no fault of their own. Could use a little compassion here. Of course I’m one who believes all humans have a right to health care, shelter, food, clothing……. I would willingly pay more taxes to help those who need it.

  12. #12 tympanachus
    July 31, 2006

    Luke: “~ continued strengthening of the Republican ‘cast’ system (ie. killing he inheritance tax)~”

    Or whack nearly half of the estate tax lawyer-auditors in the IRS. Generally a good thing, whacking lawyers, especially auditors, but I smell a large repubecan rat shittin’ the place up while he continues to plunder the treasury and pillage the Land O’ The Usta Be Free. As that sometimes substance abusing Steve Earle sings, “The Revolution Starts Now

  13. #13 Lrod
    July 31, 2006

    To everyone who reads this—What is it going to take before we all get mad enough to band together and make some positive changes before it’s too late? I am referring to organizing impeachment rallies for all present elected officials?

  14. #14 Ann
    July 31, 2006

    I have yet to figure out why the majority of people who are our working class can vote for the idiots that they do. Until those people wake up and realize that their reps (from President on down) are not working for their benefit, but only for the wealthy, nothing will change and we are forced to suffer the decline of many positive programs etc. I am truly scared for the future of the US and the world.

  15. #15 Floridagirl
    July 31, 2006

    Sometimes we get lucky in politics. Not lately, I admit. It is not supposed to be the “party” in office. It is supposed to be the “Man” or “Woman”. It seems these days, the party and the lobbists are those who are making the laws, leading the budget cuts, and killing the spirit of the American people. What truly amazes me is that more people have not caught on.

    As far as Medicare, The new payment system “Pay for Performance” will eventually drive physicians, clinics,and hospitals to the breaking point. It is new, so there is not much said… it is complicated, and the information is not easily found on their website. By forcing participates to “prove” they are complying with evidence based practice they remove the individual care that is given to patients. I approve of evidence based practice, I just do not think it applies to every single patient, without consideration of other factors. To base Medicare payments to these participates based on how well they perform is unjust. If a hospital’s clientel is mosly elderly, there is expectation that some patients will be readmitted. There may not be much that can be done about that. But to penalize……… Well I am off my soapbox.

    Politicians should be elected based on their record of integrity, and foresight. Not on who has the most money, or which party they belong to.

    Experience with politicians has taught me that there are precious few who meet the above criteria. I am lucky to know those few well.

    Each individual should look at the whole package a canidate brings with him to the polls… NOT just Right to Choose or Prolife. There are too many other important issues that also need to be addressed. Like our Public Health System…… From the inside out…… we are trying very hard to bring more services to the community. I guess we will keep trying……

  16. #16 M. Randolph Kruger
    July 31, 2006

    Delicate sensitivities folks. UH, arent drugs illegal in every state in the US? So we have paid, and paid and paid ad nauseum for drug abuser to get clean, get treatment, get free living space, get everything you and I have to go to work each day for. Ah lets just GIVE it to them. That’ll solve EVERYTHING!

    Someone has to pay for this stuff and it is not the abusers of the system that get the bills. Very few of them ever get clean and they die rotting like human garbage in some institution as the drugs take them apart piece by piece. These people impinge on my life, liberty and pursuit of happiness without due process of law. To some it makes sense to tax someone else for this. THE MONEY IN YOUR POCKET IN THS COUNTRY BELONGS TO SOMEONE ELSE. We make a law…and TAKE IT! So lets pony up MORE money for yet another failed program across the US and supply drugs, homes etc to those that are jerks, poor and above all worthless to society.

    As for Romney, it seems that a majority of people in MASS voted for him Revere, so disliked by some might be more accurate. He didnt do the Big Dig, but he is shutting it down. His predecessors and the Kennedy’s build that joke so the blame lies somewhere else. Might be time to cut the funds for that shit too so we can pay for drug addicts lifestyles. Lets give them enough drugs to kill themselves though if we are are going to provide it to them. I mean give them the hottest stuff on the planet. One last ride.

    I for one am tired of paying for Big Digs, drug addicts, wars too that are always unfinished. Pork for politics in general and I do also mean Iraq because it will finish nothing. Yeah, cut all that shit out and maybe we can pay our friggin’ teachers something they can live on. Wouldnt matter though. The Clintons thought that a single teacher making 50,000 a year with 3 kids was rich. They will just come up with yet another victim that they feel is being treated unfairly by our system. Time for more money.

  17. #17 tympanachus
    August 1, 2006

    Kruger: Git yosef to see A Scanner Darkly – ‘spect the enforcement perspective might agree with you.

  18. #18 M. Randolph Kruger
    August 1, 2006

    Did Tymp. Pretty crappy movie. I can go to S. Memphis and see the same thing though and thats real. Box on this one is only 4.7 million so far.

    Howz the wife and kids? Didja sign up in vounteer status yet with an NGO?

  19. #19 tympanachus
    August 1, 2006

    Watsa matter – don’t like Dick? Very faithful to the text. How ’bout Blade Runner?

    Didja see Waking Life? Maybe ya don’t like Linklater.

  20. #20 Ana
    August 3, 2006

    Foreign policy and public health.

    The US first tried to treat with the Taliban, in Afghanistan, about pipelines, poppy fields and so on. That didn’t work out and the US lost patience. (9/11 had nothing to do with this btw. the invasion of Afgh. was planned before it and agreed to by the international community, who paid for it.)

    Previously, the US had armed and funded the Northern Alliance and other rebel jihadists, in an effort to take over the territory and get the Russkies out.

    After the semi-victory of the US and Coalition Forces, the poppy trade exploded once again, as the puppet Gvmt. (Karzai) does not control the country, deliberately I suppose. Afgh. lives off poppies, provides 80 to 95 % of the world’s street heroin.

    Everyone – warlords, Gvmt, remnants of Taliban, small farmers, desperate housewives, small traders down the line, truck drivers, the CIA, the Gvmt, etc. – counts on this trade to survive.

    Small or even big farmers in Afgh. have no banks to apply to for loans to grow saffron, peaches, or cabbages: they have no choice. There is only one cash crop, everyone will grow it.

    The US supports that.

    The consumers – the market – is outside the country, mainly in the US, the EU, other First World spots.

    Just one last remark: there is myth about, that the Taliban, in the interest of moral purity, slashed the poppy crop. They did it to raise prices after a production glut.

  21. #21 sameer
    May 8, 2009

    Revere, great post, addicts are just poor people anyway, right? It’s not like ” G-Dubs and Daughters Don’t/haven’t Dabble(d)”, eh?

    Brooks, I would not call the current nation encompassing onslaught of republican issues ‘narrow’ by any means. Several factors were influential in changing hearts and minds about the approach to Vancouver’s long thriving drug culture. One was deeply personal: the realization among the city’s privileged classes that their own youth were increasingly among those being sucked down the drain of addiction. Another was more pragmatic: a growing understanding of the enormous costs of addiction to our taxpayer-funded healthcare and justice systems, after an explosion of HIV & hep infections among the city’s IV drug users in the late 1990s.I for one am tired of paying for Big Digs, drug addicts, wars too that are always unfinished. Pork for politics in general and I do also mean Iraq because it will finish nothing. Yeah, cut all that shit out and maybe we can pay our friggin’ teachers something they can live on. Wouldnt matter though. The Clintons thought that a single teacher making 50,000 a year with 3 kids was rich. They will just come up with yet another victim that they feel is being treated unfairly by our system. Time for more money.
    ====================================
    mike
    ============================
    Drug Rehab Facilities-Drug Rehab Facilities

  22. #22 sameer
    May 8, 2009

    It’s a shot but not that cheap. He has ruined the Dept. of Public Health, among other things. It isn’t cheap also because he is photogenic, smooth and dangerous, more so than his incompetent thoroughly hack predecessors. Regarding the good people of Massachusetts, they have no great love for him either, at least as I recall from the polls.Wake up repukicans, we are facing the potential start of a global conflict along with a smoldering pandemic; and where is the challenger I ask all of you on the left? Who is going to get the CHECK together to balance all of this heavily right sided world-angering crap?As for Romney, it seems that a majority of people in MASS voted for him Revere, so disliked by some might be more accurate. He didnt do the Big Dig, but he is shutting it down. His predecessors and the Kennedy’s build that joke so the blame lies somewhere else. Might be time to cut the funds for that shit too so we can pay for drug addicts lifestyles. Lets give them enough drugs to kill themselves though if we are are going to provide it to them. I mean give them the hottest stuff on the planet. One last ride.
    =============================
    mike
    ==========================
    Drug Rehab Facilities-Drug Rehab Facilities

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