Ebola reminds us of the need for the scaffolding we often do not see until it fails.
As of now, over 1,400 suspected or confirmed cases of Ebola, and at least 200 deaths from the disease, have been reported in the area of Congo and Uganda. Outbreaks like this are challenging in the best of times, as communities and health workers do all they can to contain the spread. Such efforts helped to limit and ultimately end the 2013-2016 West African Ebola outbreak, which could have been far worse without the presence of global health infrastructure—the network of NGOs, government agencies, public and private investment, and international bodies dedicated to supporting health and preventing disease around the world. When such programs are well-funded and working, the world is a safer, healthier place. When they are not—when they are subject to firings and funding cuts and a collapse of political support, as they have been over the last year or so—this creates a difficult context for global health. That the present Ebola outbreak has emerged in such a context is cause for concern indeed. That we have entered a time of disinvestment in global health infrastructure reflects what could be fairly called a blind spot in how we in the US think about health and the infrastructure that supports it at home and abroad.
We tend to treat health like something to be fixed when it breaks. Under this paradigm, we are healthy until we are not, and it is then that we should apply the best possible healthcare solutions to return us to the world of the well. Our investment in health largely follows this lead, with vast sums going to the development of the drugs and treatments that do this work of fixing. To be clear: there is nothing wrong with having the best possible healthcare at our disposal when we are sick—there is nothing wrong with fixing. Indeed, my early training is as a doctor, and I spent the first part of my career engaging in the work of repairing health when it “breaks.”
Yet, as an overarching framework for how we think about, and invest in, health, this model can fall short. It is not enough to have the best possible fixes if this comes at the expense of addressing the root causes of health and disease in society. Just as, in individuals, we would not be content just to treat the symptoms of disease and leave the underlying problem unaddressed, in societies, we should not put all our eggs in the curative basket without investing in the prevention that makes cure less necessary, populations healthier.
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