Zika appropriations: second verse, same as the first

We can’t have public health without public money. Full stop. For those of us in public health in whatever capacity, the commedia dell’arte surrounding the Zika Response Appropriations Act is more of the same depressing dogshit: inadequate token funding for a sensational health threat, Tom Frieden sounding the alarm that failure is basically inevitable with this inadequate level of funding, and act three will be the failure itself and everyone will be pissed off at the CDC. Your stupid relative will post something outraged on Facebook along the lines of: “Why doesn’t the CDC have personnel stationed at every airport in the world to ensure that I personally am protected from this?” (This paraphrases an actual argument I saw during the Ebola crisis). Said relative will of course never consider that maybe his borderline-erotic fixation on “small government” (or whatever narrative we’re currently using to sell ruthless austerity politics to khaki-wearing boomer dweebs) is exactly why the CDC can’t do that. And the carousel goes around and around.

One terrible argument that I’ve engaged with in this looking-glass election cycle is that free college is actually a bad idea because “government funding” of education will lead to restrictions on academic freedom. As far as I can tell, this will happen because there are conservatives in Congress or something. This argument is obviously fatuous when it comes to higher education — I personally do not enjoy racking up life-ruining debt to learn titration techniques in the Pfizer-Chevron-Gates Chemistry Lab Experience Complex. I think the counterargument to the “free college is bad” assertion has some broader applicability here to public health funding: you know what’s really restrictive to academic freedom, and to the proper function of public health research and services? Not having any fucking money. Endless layoffs. Having to choke out a hundred other applicants for even a shot at an ever-shrinking tranche of that sweet Gates money.

To my mind, there is a philosophical superiority to public funds and public programs when it comes to public health. Public funds are administered by the government, meaning that there is at least nominally some type of democratic oversight of how the money is appropriated and how the programs function. It also means that the programs have some bureaucratic inertia, which I actually think is a good thing — that type of inertia can be protective against the wilder winds of political trends. We can argue about whether meaningful democratic oversight is a reality in our Neoliberal Hell World and with our Congress. Critically, though, having public programs funded and administered according to the whims of idiosyncratic billionaires is not better. It is, in fact, very bad. It’s a weird leap from not liking conservatives in Congress to giving up on the whole endeavor of public services and programs. Asserting that public programs are useless or inessential sort of makes you a conservative, in my opinion.

All of this is why there needs to be a concerted effort from the public health community to combat the neoliberal turn in the USA and elsewhere and the iron-fisted mandates of austerity politics. Public health will continue to fail without sufficient funding, and with each failure people’s belief in the utility of public programs erodes even further. We can’t keep hoping to capitalize on every new and transient threat that piques public fear for a few weeks. That has not been enough, and will never be enough, to get us what we need to do our damn jobs.

The problem is not necessarily that we don’t take Zika seriously, the problem is that we’re starving ourselves of the resources necessary to minimize the harm that Zika could wreak and then wondering why public health doesn’t work. I think it is the responsibility of every public health professional to get involved in anti-austerity activism and to articulate a coherent and appealing justification for public goods. “Public” is in the name of the discipline, after all.