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.