NEW YORK REVIEW OF BOOKS April 12, 2001 Time of Indifference HELEN EPSTEIN Betrayal of Trust: The Collapse of Global Public Health by Laurie Garrett 754 pages, $30.00 (hardcover) published by Hyperion Dying for Growth: Global Inequality and the Health of the Poor edited by Jim Yong Kim, Joyce V. Millen, Alec Irwin, and John Gershman 584 pages, $29.95 (paperback) published by Common Courage Press Poverty, Inequality, and Health edited by David A. Leon and Gill Walt 358 pages, $55.00 (paperback) published by Oxford University Press Challenging Inequities in Health: From Ethics to Action edited by Timothy Evans, Margaret Whitehead, Finn Diderichsen, Abbas Bhuiya, and Meg Wirth 288 pages, $60.00 (hardcover), $37.95 (paperback) published by Oxford University Press During the cholera epidemic of 1849, Henry Mayhew, the great observer of London life, visited the district of Bermondsey south of the Thames. He wrote that the river water the residents drank and bathed in "appeared the colour of strong green tea, and positively looked as solid as black marble in the shadow-indeed it was more like watery mud than muddy water…. As we gazed in horror at it, we saw drains and sewers emptying their filthy contents into it; we saw a whole tier of doorless privies in the open road, common to men and women, built over it; we heard bucket after bucket of filth splash into it, and the limbs of the vagrant boys bathing in it seemed by pure force of contrast, white as Parian marble." Mayhew visits a house where an infant has died of cholera and is told that its inhabitants really do drink the water. He asks whether they have tried to get their landlord to do something about it, and is told, "'Yes, sir, and he says he will do it, and do it, but we know him better than to believe him.'" Bermondsey is now a middle-income London neighborhood, but its death rate is still nearly the highest in the city. Like all British people, its residents have access to reasonably good health care through the National Health Service, so why are they so unhealthy? Today people in Bermondsey die not from cholera and scarlet fever, but mainly from diseases of adulthood that are not considered contagious, such as heart disease, stroke, diabetes, and cancer of the stomach and lung. Lung cancer is known to be caused by smoking, but a number of researchers have proposed that the seeds of certain other diseases of middle and old age are actually planted in childhood, or even before. As George Davey Smith, David Gunnell, and Yoav Ben-Shlomo explain in Poverty, Inequality, and Health, poverty in childhood, and even among parents and grandparents, may predispose people today to many chronic adult diseases. So even though no one who lived in Bermondsey during the nineteenth-century cholera epidemics survives today, the poverty and infirmity of those times haunt their descendants like a kind of genius loci. Many common illnesses in high-income countries today may be legacies of the Industrial Revolution, a particularly unhealthy historical period. By the middle of the nineteenth century, people in the Western world were becoming, on average, slightly shorter in height. By 1900, Europeans and Americans were growing again, and since then each generation has been taller than the one before it. But between around 1820 and 1870, physical growth in the West stalled, and at the same time, rates of death and illness increased. The Industrial Revolution, which brought prosperity to many people, also brought crowding, poverty, malnutrition, and disease to many more. Today, new technology and expanded markets for commodities and labor are creating new economic and social changes, and just as in the nineteenth century, there are reasons to worry about the effects of the new economy on human welfare. Everywhere the health of the middle class is improving, but in many parts of the world, the health of the poor is not keeping pace. Especially in countries where AIDS, tuberculosis, and malaria are common, the gap between the health of people in rich and poor nations, and the gap between the health of the rich and poor within nations, are widening. The average Japanese person lives about twice as long as the average person in Malawi, Sierra Leone, or Uganda. Infant mortality in Africa may be five or ten times as high as it is in the West. In the United States, the life expectancy of Native Americans living on certain reservations lags by decades behind that of well-to-do suburban whites. As the editors of Challenging Inequities in Health write, there is a growing feeling that such enormous inequalities, while hardly new, are unacceptable, because they so often result from such social injustices as poor access to health care, inadequate food, impure water and air, unsafe working conditions, and extreme poverty. The physical suffering of the poor is not only abhorrent in its own right, but also serves as a barometer of the fairness of the underlying social order. Several new books provide a general view of health and poverty in the world today, and speculate that something is ailing the planet at large. Full review: http://www.nybooks.com/nyrev/WWWfeatdisplay.cgi?20010412033R@p2 Louis Proyect Marxism mailing list: http://www.marxmail.org
