Public Health in a Time of CholeraInfluenza: In Defense of Frieden's 'Moralizing'

I came across this post decrying the choice of Ralph Frieden as CDC director due to his "bluenose moralizing." Here's part of the argument:

What can't be denied is that Dr. Frieden and Mayor Bloomberg together promoted the myth that bad health is purely a matter of bad behavior.

The myth was an alarming break with the reality of the real causes of poor health, but it played well. There was the ban on smoking in bars, the ban on serving trans fats, the constant hectoring about what we eat and how much of it, and the finger wagging about AIDS "complacency" and our failure to use condoms. There were the restaurant closings on account of violating the health code (that was after the City's health department had been embarrassed by media reports of rats in a number of food establishments). Those were aspects of the stagecraft that has characterized the Bloomberg reign in NYC, but none of them had much impact on the city's health.

What there wasn't, under Bloomberg-Frieden, was any discussion of how to improve health through providing better housing - and Dr. Frieden seems to have raised no objection to the mayor's new plan to charge homeless people rent for staying in city shelters.

There's more in a similar vein, blaming Frieden for not solving the problems of economic inequality, housing, and so on. I couldn't quite figure out why this post bugged me, until I remembered something I wrote about clean water and oral cholera vaccine (OCV) in developing countries ("The Politics of Cholera and of the Great White Bwana):

One of the constant refrains I always hear is that diarrheal diseases, such as shigellosis, cholera, and other bacterial dysenteries, could be easily solved if there were adequate potable water and sanitation. That's completely correct. It's also completely unrealistic, as a recent editorial by Lorenz von Seidlein in Tropical Medicine & International Health argues.

The problem is that this 'ultimate' solution of massive infrastructure investment often means that foreign governments and NGOs are discouraged from effective, short-term solutions. One such solution is the oral cholera vaccine ('OCV'). While it is a highly effective vaccine, public health officials in developing nations have had very little success in generating the finances needed for an OCV program.

Cholera outbreaks are blamed on the healthcare system--and thus, the healthcare officials. Sanitation improvements (pipes, sewage treatment, water filtration), when even possible, often fall under a different ministry over which the health officials have no say.

Would sewage treatment be better than OCV? Absolutely. But OCV does save lives, and, given that the alternative is to do nothing, something is better than nothing. Campaigns to promote condom use can lower the transmission of STDs. Would I like to see more economic opportunity for women, particularly those of color? Sure, but, until that happens, lowering the rate of STD infection is still worthwhile. And then I'm confused by the anger against NY's smoking ban, since smoking is implicated in many of the ~160,000 annual lung cancer deaths. To the extent that we create a less smoker-friendly environment which discourages people to smoke (and encourages smokers who have given up their addiction to not start smoking again), that can only be a good thing.

Likewise, regarding the trans-fat ban, given that lower income people have fewer healthy food options, reducing the unhealthiness of the foods that are available seems to me as a good thing.

Again, the CDC isn't in the ending poverty business--it's in the disease control business. We don't need the CDC to tell us that poverty is bad for our nation's health. We need our political, not public health, leadership to do something about massive societal inequity. Until then, fighting some of the health-related consequences of that inequality is still worth doing.