The United States was not prepared for a pandemic: Free market capitalism, deregulation could be to blame

By Elanah Uretsky, Brandeis University

It is not known when the pandemic will end. What may be an even bigger question is whether the United States will be ready for the next one. The past year and a half suggests the answer might be no.

As a medical anthropologist who has spent the past 20 years studying how the Chinese government responds to infectious diseases, my research may provide insight into how countries, including the United States, can better prepare for epidemics. .

Researchers agree that a good answer starts with a strong public health system. But this is something that has been put aside by the neoliberal system in the United States, which places more value on free markets and deregulation than public welfare.

Neoliberalism promotes a free market accessible to the wealthy few, making essential services less free for everyone else.

As American neoliberalism evolved, public health devolved

Neoliberal economic policies became popular in the 1980s during the Reagan and Thatcher era. This new approach aimed to make government leaner and more efficient through measures such as market deregulation, privatization, and reducing government provision of public services such as health and education – resources that do not necessarily lend themselves to commercial production.

While neoliberal governments always strive to promote the health, well-being and safety of their citizens, they place the responsibility for providing these services in the hands of private entities such as health insurance companies and healthcare providers. non-governmental organizations. This gives the government the opportunity to focus on economic performance.

But giving responsibility for a public good to a private company turns that good into a commodity that people must buy, rather than a service available to all.

Health spending in the United States, including hospitals, drugs, and private insurance, has more than tripled in the past 60 years. But the public health system that helps the nation prepare for the unexpected has been neglected.

US spending on local health services that help prevent epidemics and protect the health of populations fell 18% between 2010 and 2021. Two and a half cents of every medical dollar goes to public health, a figure that has fell from 1930 levels by 3.3 cents of every dollar. This has enabled the United States to manage health risks such as chronic diseases that threaten the health of individuals. But this leaves the nation insufficiently prepared for major health threats at the population level which have a much greater effect on the economy and society.

Cuts to public health have left the United States with a skeletal workforce to handle the pandemic. Therefore, the responsibility fell on the individuals. For example, without mandatory COVID-19 workplace safety guidelines, essential workers have been exposed to the coronavirus on a daily basis with insufficient or no protective equipment and disinfectants. They had to protect both their own health and that of their families when they returned home, a difficult task without the right resources and support.

And it was not unique to the United States. There were similar results of COVID-19 in other neoliberal countries like the UK and India that had shifted public health priorities.

How Asian Nations Learned Their Lessons

The story was different in many Asian countries where people enjoy the same types of individual freedoms as those who live in neoliberal societies. Difference is a type of collectivist mindset that guides these societies and encourages people and government to take responsibility for each other. In his book Flexible citizenship, anthropologist Aihwa Ong argues that this leads to a model of society where citizens can be independent and autonomous while also being able to rely on a state that supports the collective. Countries like Taiwan and South Korea may have been better prepared to respond to the pandemic, as most people are used to protecting themselves and their communities.

Like China, these countries have also learned from their recent experience with a pandemic. In 2003, China and much of Asia were caught off guard with the emergence of SARS. Like the United States, China’s public health system has taken a back seat in investing in market reforms for more than 20 years. As a result, he could not accurately track individual cases of infections.

After the SARS epidemic ended, however, the Chinese government improved the training of public health professionals and developed one of the most sophisticated disease surveillance systems in the world. This allowed China to respond more quickly to the 2009 H1N1 pandemic and late 2019 COVID-19 outbreaks, once it was able to overcome the first bureaucratic and political hurdles that held back local doctors and government officials to sound the alarm bells.

Some have attributed this swift action to China’s authoritarian form of government which allows greater control over people’s lives. But prioritizing public health is nothing new in China. This became official practice as early as 1910 when he adopted the methods of quarantine, surveillance and masking to respond to an outbreak of pneumonic plague.

Could this work in the United States?

Much like SARS did with China, COVID-19 has exposed huge gaps in America’s public health infrastructure.

Take, for example, contact tracing. SARS has taught China and other affected countries the importance of a robust system to identify and track people who may have been exposed to the COVID-19 virus. The Chinese government has sent more than 1,800 teams of scientific investigators to Wuhan to trace the virus, which has helped their efforts to quickly bring the virus under control.

In the United States, by contrast, poorly funded and understaffed public health departments have struggled to test and educate people who have been in direct contact with infected people. This crippled the ability of the United States to prevent the spread of COVID-19.

In my home state of Massachusetts, the local government partnered with the world health organization Partners in Health to launch a contact tracing operation. But even then, people were on their own. This became all the more evident as people rushed to get vaccines after their initial approval, through Facebook groups and informal volunteer networks who worked to help people get appointments. Those who had the resources learned to take advantage of the system while others were neglected.

This is typical of a consumer-driven, market-based American healthcare system. Americans are often convinced that the solution to a health problem must be technical and expensive. The focus has been on developing vaccines and therapies, which are critical to ending the pandemic, while ignoring lower-cost solutions.

But masking and social distancing – non-pharmaceutical interventions long known to save lives in epidemics – have been abandoned. Adoption of these simple interventions depends on strong and coordinated public health messages.

As seen in several Asian countries like Taiwan and South Korea, a well-thought-out public health communication plan is the key to a unified response. Without clear and coordinated guidelines from a public health system, it becomes difficult to prevent the spread of an epidemic.

What it takes to be prepared

Anthropologist Andrew Lakoff describes preparation as more than just having the tools. It is also about knowing how and when to use them, and to inform the public well.

Such preparation can only occur in a coordinated manner organized by national leaders. But the United States has seen little of this over the past year and a half, leaving the response to the pandemic to individuals. At a time when emerging viruses pose a growing threat to health and well-being, the individualism of neoliberal policies is not enough. If neoliberalism can be good for an economy, it is not so good for health.

Elanah Uretsky, Associate Professor of International and Global Studies, Brandeis University

This article is republished from The Conversation under a Creative Commons license. Read the original article.


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