What’s Killing
Us: A Practica Guide to
Understanding Our Biggest Global Health Problems by Alanna Shaikh. TED Books 2012, Kindle, iBookstore, Nook
Reviewed by Tom
Levenson
The last decade of the seventeenth century was a great age
for London’s media junkies. Paper had become cheap enough to permit the
emergence of the first real
newspapers in the English-speaking world.
The censors saw their reign end in 1696, the year after Parliament
declined to renew the
Licensing Act. With that, printers no longer had to fear harsh penalties
for operating an unapproved press.
Free lance journalism was emerging as a plausible way to make a sort of
a living – even if one of its most prominent practitioners, Daniel Dafoe, did
do his stint in debtor’s prison.
Given all that, it’s no surprise that a torrent of what we
may call new media poured forth. If you had something to say and even quite
modest means, you could say it – and plenty did. Readers could lay their hands
on learned disputes on the question of singing in church; coiners advising the
government on the best methods to prevent counterfeiting; at least one poem by
a law student on the subject of long vacations.
All of these appeared in the form that truly came into its
own in the 17th century. That would be the pamphlet: a modest tract,
easier to write, cheaper to print, swifter to plow through than any scholar’s
tome…
…All of which is to say that there is nothing new under the
sun.
Flash forward roughly
three hundred years, and lay your digital mitts on the subject of this review,
Alanna Shaikh’s What’s Killing Us. It is an e-bite of an argument, less
than forty pages to cover Shaikh’s top-ten list of global health problems. It is a pamphlet by any other name, and
hence an example of one of my favorite everything-old-is-new-again gifts of the
digital revolution.
One note before getting to the meat of Shaik’s work.
Sharp-eyed readers will see that I’ve left unmentioned one property of What’s Killing Us. It’s a TED book, and TEDity has come
in for its lumps here. This
one doesn’t, or shouldn’t, in part because it does not attempt to reduce the
difficult reality of global health to a trademarked Big Idea. Instead, it is an example of what TED
promises but does not always deliver – a guide to thinking about a the
complexity of an issue that enables – really demands that — the reader join in
figuring out what the hell to do.
To grab that reader,
Shaikh begins in the grand tradition of the pamphleteer, sounding the call to
action: “The
biggest global health problems, like tuberculosis, are getting worse.…This is
the moment to get on the right road.
If we don’t, the results will be ugly.” Her challenge is to convey that urgency with enough
detail to persuade her readers about the various huge problems she invokes –
all in the very short form she has chosen to make her case. To do so, she writes to a formula –
three or four pages on each major issue, passages further broken down into
sub-sections – “the basics;” “why we should worry;” and “what we can do.”
The result is a predictable read – but it works. Some of the issues tackled are
well enough known as not to need much background, and Shaikh skillfully uses
that familiarity to build themes that accumulate across her catalogue of
woe. She begins by looking at the
threat from pandemic influenza – and she uses that (for now) somewhat lower-key
danger to introduce a thread running through the full range of developing-world
public health crises, the need to strengthen weak health-care systems to handle
local eruptions of illness.
From the flu, Shaikh moves to some of what may be called
the classics of global health:
diseases often associated with poverty (think obesity, pollution-exacerbated
lung conditions, diabetes) and the infectious diseases of the tropics that
have been historically ignored by industrial medicine and biomedical
research. As she progresses,
Shaikh continues to add to her catalogue of reasons to care about suffering
distant strangers.
She begins with
the pragmatics: diseases of poverty are (much of) what makes being poor so
wretched – and wretchedness leads both to cycles of impoverishment and to
increased risk of conflict. At the same time, the pragmatic argument —
healthy first-worlders should care about sick people far away because bad
stuff, like war and/or infectious diseases can leap borders – leads to
the first hint of the moral one: the existence of preventable or treatable harm
imposes an obligation on those with the means to act.
That self-interest/altruism duet swells in her account of
neglected tropical diseases – thirteen to seventeen (depending on who’s
counting) parasitic and bacterial diseases mostly concentrated in Sub-Saharan
Africa and Asia. She cites an advocacy
group’s estimate that puts the cost of an integrated control approach at as
little as fifty cents per year per receipient — $700,000,000 to reach the 1.4
billion most at risk.
To digress just a bit: if that number is about right, and if Sheldon
Adelson and the
Koch brothers shifted their priorities just a bit, then for the same order
of their contributions to GOP causes this year, they could change the lives of
one fifth of all humans on earth, hundreds of millions of them kids. A man can dream…
Put another way:
an endowment of about $18 billion, just over half of that possessed by
Harvard University, would yield enough income to fund treatment on that scale
in perpetuity. As Shaikh
emphasizes in other ways, we face huge but not intractable problems.
That digression is actually an example of what Shaikh’s trying
to do with (or to) her audience:
she gives just enough of the story to lead readers to pick up the line
of argument themselves. Some of
her attempts to do so don’t work quite as well as others. Her section on HIV/AIDS offers little
more than the triumph of
hope over experience in a vague call for better health care systems in the
developing world to deal with the specific demands of HIV prevention and
care. Well, yes…but I know folks
working on the front lines of such systems who surely understand that, and
wouldn’t mind a little more concrete help, thank you very much.
In the latter half of her book, Shaikh expands her ambition,
if that were possible, asking us to focus on the health implications of
global social, cultural and environmental problems. Childhood,
motherhood, urbanization, climate change are all implicated in unnecessary
deaths. Women and children both prosper when women gain power over their lives,
controlling over their fertility, economic autonomy and so on. Climate change, which Shaikh describes
as “the single greatest threat to human health” requires addressing just about
everything that humans do on earth.
If we’ve bought into the dual moral/self-interest argument by this
point, we’re now asked to confront some huge – and increasingly vaguely defined
– possible issues. What’s Killing Us is
persuasive in making the case that these large social and environmental
concerns are powerfully understood as health issues, but it doesn’t fully take the
next step: what does thinking
about climate change in terms of disease and poverty compel us to do, beyond
vague impulses?
That is: by the
end of the text, Shaikh doesn’t quite deliver on the promise of her subtitle –
she’s certainly guided us through lots of stuff, but the practical bit isn’t all there. To be fair, Shaikh set out not to solve all the problems of the world,
but to suggest that many of them are solvable. Even so, her closing manifesto lands
with a thud: “We just need to act
on [the knowledge of the issue]. We need to donate money and push our
governments to donate too. We need to support scientific research, good governance,
better infrastructure and clean water.”
Well, yes.
Sure. We do. But that is a rather deflating list. If
Shaikh had allowed herself just one more essay – not that one page epilogue but something a bit more substantial – that addressed directly what she
thinks the individuals reading her work could do, she would have left folks – me – energized, charged up. Now, I’m just thinking, “Oh well. Guess
I’ll to write another check.” That’s not nothing – but it's not enough, and less
than Shaikh could have achieved. This work is well worth a look; I do recommend it. But – and here I’m sure Shaikh would
both agree and be pleased at the result – if it moves you at all, you’ll have
to read much more.
Tom Levenson writes books (most recently Newton and the Counterfeiter)
and makes films, about science, its history, and whatever else catches
his magpie's love of shiny bits. His work has been honored by a
Peabody, a National Academies Science Communication and an AAAS Science
Journalism Award, among others. On leave from professing science writing within MIT's Graduate Program in Science Writing, he's working on a book the birth of money in the age of the Scientific Revolution.