A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 14: THIRDWORLDIZATION
No Peace Dividend appeared
With the fall of the Berlin Wall politicians all over the world spoke of a Peace Dividend. The world had surplus cash and long-neglected social programs could be subsidized. But no Peace Dividend appeared. Overnight the former Cold War multitrillion-dollar spending became a latter-day Marshall Plan for reconstruction of the ex-communist world. Ten billion dollars shifted from coffers in Bonn to national bank vaults in Moscow in a single day. And that was just one of many West-to-East transfers. By 1991 the Soviet Union no longer existed. AIDS was overshadowed by history and the microbe spread, unfettered by any serious efforts on the part of human beings to limit its modes of transmission. In March 1993 special counsel to President Boris Yeltsin, Dr. A. V. Yablokov, addressed the grave state of the Russian people’s health in a speech before the nation’s Security Council. The primary cause of Russia’s massive excess death burden was suicide, which rose by 20% between 1991 and 1992. In 1976 the numbers of diphtheria cases in the U.S.S.R. approached zero. But in 1990 it reemerged. When the Iron Curtain was lifted, it revealed the Third World status of the old communist regimes, and conditions only worsened amid infrastructural chaos, with countless opportunities for the further emergence of not only HIV but all manner of microbes.
The wealthy nations of North America and Western Europe
The process was occurring during the 1980s and the early 1990s inside the wealthy nations of North America and Western Europe as well. Health economists tallied up the costs of diseases that were preventable through diet, exercise, cessation of tobacco or illicit drug use, elimination of alcoholism, and the like, concluding that personal health decisions were no longer the exclusive purview of individual choice. Smokers cost the rest of society billions of dollars. So did alcoholics. And fat people. Dr. John Knowles, president of the Rockfeller Foundation said: “… one man’s freedom in health is another man’s shackle in taxes and insurance premiums. I believe that a right to health should be replaced by the idea of an individual moral obligation to preserve one’s own health – a public duty if you will.”
New York City – 30,000 AIDS orphans by the end of 1994
New York City alone would have more than 30,000 AIDS orphans by the end of 1994, Newark over 10,000. Just as AIDS was exhausting the extended-family networks in much of Africa, so it was taxing the social support systems in America’s poorest communities. As the virus found its way into communities of poverty, the burden on urban public hospitals was critical as the United States had no system of national health care. By 1990 an estimated 37 million Americans were without any form of either public or private health insurance. Another 43 million Americans were either chronically uninsured or underinsured. By the end of 1993 more than 25 million Americans were hungry, consuming inadequate amounts of food. Complacent after decades of perceived victories over microbes, positioned as the runt sibling to curative medicine and fiscally pared to the bone by successive rounds of budget cuts in all layers of government, public health in 1990 was a mere shadow of its former self.