Posted: 17 Oct 2016 09:06 AM PDT
Politics in America and Europe may be increasingly isolationist, but deadly pathogens aren’t. Votes for Brexit and Donald Trump may, in fact, be votes for worsening pandemics and fewer doctors and researchers to fight them.
This summer Brits chose to leave the E.U. and Americans nominated Trump as the Republican Party candidate. On both sides of the Atlantic, Brexiters and Trump supporters voted to go it alone. Their leaders preach keeping out immigrants and shunning multilateral organizations like the E.U. and NATO. But economic downturn and international criticism may not be the worst fallout.
As a global health researcher, I think the potential impact on our health could be even scarier. Here’s why.
The isolationism championed by Brexit architects and Trump alike endanger the coordinated efforts required to keep pandemics under control. The xenophobia that has been their rallying cry threatens health-care delivery and critical health research at home.
Less cooperation, more disease
These critiques are not without basis: Multilateral organizations can be slow and at any given time, the costs and benefits may not be evenly shared. Some were even criticized for delays in responding to the exceedingly urgent Ebola crisis. But there are also intrinsic advantages to large-scale, multicountry cooperation, particularly when it comes to global health.
Pooling funds from more than 50 donor nations, The Global Fund for AIDS, TB and Malaria has supported low- and middle-income countries in saving an estimated 17 million lives since 2002.
Why is this approach better than each country providing its own unilateral assistance?
First, the Global Fund has streamlined the funding process; instead of applying to four dozen different funding sources, the government of Rwanda can expect to receive US$148 million to fight AIDS from a Global Fund grant over 18 months starting July 2015, according to the organization’s website.
Second, the Global Fund, in turn, pools country requests for lifesaving HIV and malaria treatments and buys drugs in bulk at cheaper prices. Their pooled procurement process is essentially the Costco of the global pharmaceutical market. Purchasing in huge quantities allows economies of scale and wholesale pricing that have helped bring the cost of first-line HIV treatment down from as much as $10,000 per person per year in 2000 to as little as $100 in 2016, according to a recent MSF report.
Yet, whatever the potential benefits for recipient countries, some may say treating HIV and malaria in Africa and Asia is simply not a priority in hard economic times at home. “Let’s fund our NHS instead,” the Brexit campaign plastered on its infamous bus wrap. “America First” pledges Trump.
On both sides of the Atlantic, the current political trend is not just unilateral; it is also inward-facing and isolationist. This is a losing strategy in the face of global epidemics like Ebola and Zika.
The notion that the epidemics of poor countries do not concern Europe and the U.S. is not just morally dubious, it’s dangerously incorrect. The Ebola outbreak showed just how quickly a deadly virus can make its way from a rural village in Guinea to a subway car in New York.
In fact, Ebola was brought under control only by a coordinated cross-border response, international collaboration throughout the regions most affected and worldwide contact tracing. Fragmented, uncoordinated responses allowed the epidemic to get out of control in the first place.
With more than half a million people now returned home from Zika-affected Brazil after this summer’s Olympics, we need to share information across borders and collaborate financially, strategically and operationally on control measures.
Turning away doctors and scientists
Ultimately, the political trend of isolationism isn’t just bad for controlling emerging epidemics. It threatens the day-to-day health of Brexit and Trump supporters alike. Migration has allowed medical systems in Europe and the U.S. to attract top global talent.
As Dr. Sarah Wollaston, a member of the British Parliament, said, “If you see a migrant in the NHS, they’re more likely to be treating you than standing in line in front of you.” A former GP and onetime Euro-skeptic, she campaigned to stay in the EU out of concern for the national health system.
Beyond direct medical care, isolationism risks crippling scientific research leading to new vaccines and medicines by restricting the flow of scientists and students to universities and research centers. Brexit could threaten funding for cancer and mental health research as well as the U.K.‘s ability to attract and retain scientific talent. Likewise in the U.S., xenophobic policies and sentiments could have a dire effect on advances in science; all six of the U.S.-based scientists who won Nobel Prizes this week are immigrants. Even with visa exceptions for certain professions, a nativist ethos makes any country a far less appealing destination for migrants with in-demand scientific and technical skills.
The Brexit referendum has already steered Britain down a dangerous path. But with global epidemics and domestic health care at stake, the U.S. still has time for cooler heads to prevail this fall before Trump is in the White House and his policies literally make us sick.This summer, both Britain and America saw elites in populist clothing whipping up a frenzy by chanting “Vote Leave, Take Control” and “Make America Great Again.” The public health threat posed by these xenophobic, isolationist movements is just another indication of how ill they serve the public interest.
Elizabeth Radin, Mailman School of Public Health, Columbia University Medical Center
Posted: 17 Oct 2016 06:00 AM PDT
Breast Cancer Awareness month comes every October, and the display of pink ribbons is hard to miss. The contemporary fight against breast cancer has succeeded in promoting visibility of the disease, in honoring those who have died from it and in giving patients resources for navigating their diagnosis, as well as a sense of hope for the future. But this did not happen overnight, nor did it originate with the pink ribbon campaign conceived in the early 1990s.
That breast cancer garners an impressive amount of social awareness is no accident; it is the result of decades of committed activism beginning in the 1970s, and was driven in large part by the spirit of the women’s liberation movement. Until this point in time, breast cancer was an “unspeakable” condition that women experienced privately and silently, with shame rather than social support. It took the acts of individual women speaking out about cancer, as well as feminist organizing that targeted the relationship between female patients and the male-dominated medical establishment, for the issue to go public and become less stigmatized.
During the 1970s, second wave feminism helped spawn the women’s health movement, which was meant to empower women to demand greater knowledge about their own bodies, and freedom to take charge of their reproductive and sexual health. Feminists challenged what they saw as a common power dynamic in medicine in which patronizing male doctors claimed authority over passive female patients by dictating their care and denying them participation in medical decision making. This led to the publication of Our Bodies, Ourselves by the Boston Women’s Health Collective in 1973, as well as the creation of educational projects to teach women how to examine themselves and advocate for their own healthcare needs.
The lack of choices and autonomy for women was particularly evident with issues like childbirth, sterilization and abortion, but it also applied to breast cancer. Since about 1900, a woman suspected of having breast cancer would undergo a “one step” operation. A surgeon would perform a biopsy along with a radical mastectomy, and the patient would typically wake up with her breasts, chest muscles and lymph nodes entirely removed, regardless of the size or characteristics of her tumor, or her personal wishes.
One of the first women to protest this standard of care was journalist Rose Kushner, who discovered she had a breast lump in 1974, at the age of 45. Kushner insisted on a diagnostic biopsy followed by a modified mastectomy. “No man is going to make another impotent while he’s asleep without his permission, but there’s no hesitation if it’s a woman’s breast,” Kushner pointed out, echoing the reigning feminist position on sexist double standards in medicine. In 1975, she published Why Me? What Every Woman Should Know About Breast Cancer to Save Her Life.
Kushner’s ideas were initially rejected by cancer experts – one called her book a “piece of garbage” – but over time they became common practice, as research proved that women with early-stage disease could safely conserve more of their breast tissue. Kushner was eventually appointed as the first member of the National Cancer Advisory Board by President Jimmy Carter.
Several prominent women followed Kushner’s lead in speaking out about breast cancer during the decade. When she was 56 years old and about to become the First Lady, Betty Ford had a mastectomy after being diagnosed with the disease. She held a press conference in September of 1974, sharing the details of her story with the public.s As a result, millions of women examined themselves and scheduled screenings with their doctors, which led to a spike in reported incidents of breast cancer known as the “Betty Ford blip.” One such woman was Happy Rockefeller, wife of Vice President designate Nelson Rockefeller, who discovered her own malignant lump just two weeks later.
As TIME explained, Ford and Rockefeller’s candidness helped many others confront “a little understood disease that was once discussed only in whispers.” Other notable women who came forward about their experiences with breast cancer in the 1970s included writer Babette Rosmond, actor Shirley Temple Black, chef Julia Child and NBC news correspondent Betty Rollin.
During the 1980s, AIDS eclipsed cancer as the major health crisis commanding national attention. AIDS activists became known for their confrontational style of politics, as groups like ACT-UP staged theatrical guerilla street protests in order to lobby for government research money. Their use of symbolism, in the form of a red ribbon, and their demands for increased federal funding influenced the next wave of breast cancer activism.
The pink ribbon became a symbol of breast cancer awareness as the result of efforts by Self Magazine, the cosmetics industry and the Susan G. Komen foundation in the early 1990s. The concept was first inspired by breast cancer patient Charlotte Hayley, who individually distributed thousands of peach colored ribbons in her community, along with cards that encouraged funding for cancer prevention. When representatives from Estee Lauder and Self expressed interest in her idea, Hayley turned them away because she was worried about the cause becoming commercialized—so they changed the color of the ribbon from peach to pink. The first pink ribbons were handed out at the 1991 Susan G. Komen Race for the Cure in New York City, the same year that saw the founding of the National Breast Cancer Coalition.
Today, activists are pivoting their focus from awareness and early detection towards saving the lives of patients who have progressed to advanced stage IV disease, or metastatic breast cancer. And breast cancer activism has evolved from individual patients voicing their own experiences, to the formation of community support groups for cancer survivors, to political organizing for a cure. It has grown from a small grassroots movement to a widespread network of professional advocacy. Critics point out that, along the way, the struggle against breast cancer has been exploited by companies co-opting the pink ribbon to advertise their own products or bolster their image. But before all of that, it was a movement about giving women the courage to speak openly about their bodies, and the agency to decide their preferred course of treatment when faced with a serious illness.
Sascha Cohen is a PhD candidate in the history department at Brandeis University, specializing in the social and cultural history of 1970s America.
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