Not for lack of trying; don’t get me wrong. But public health depends on the public. If we fail it, it fails us. The virus SARS-CoV-2 is real, and it's bad. It’s a novel agent that infects the human respiratory system. Introduce that virus into a society that rigorously enforces and believes in the kind of difficult-but-basic measures that arrest its spread, you get deaths in the hundreds; drop it into a society that doesn’t do those things and you get deaths in the thousands. Drop it into a society that also suffers massive socioeconomic and racial inequities, with a political class trying to turn those inequities into unjustly held power, and you get deaths in the hundreds of thousands.
A pandemic is a social hack as much as a wetware dive. A virus is just a fleck of genetic polymer encased in a bubble of fat and protein. A disease is what happens when it gets into a body. A pandemic is what happens when it gets into the body politic.
It’s a classic challenge—a fight between the public health of a society and the medical choices of, well, you. Of a country of yous. The lifesaving public health advances of the 19th century—sanitation, sewage, nutrition—gave way to more technocratic and individualized medical interventions in the 20th. As the physician and public health expert John Knowles wrote in 1977, that meant everyone had an incentive to reach for expensive three-point shots to save their own lives, rather than work toward collectivist health overall, even though preventative measures like exercise, fluoride, nutrition, cleaner air, and access to primary care have more bang for the buck, society-wide. Knowles thought that there had to be a third way, that “the idea of 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.” But it’d only work, Knowles wrote, if people had enough education and information, and if you gave food to poor people. Think of it as Universal Basic Health.
That’s not where we’re at. The fight is now more brightly lit than ever thanks to a pandemic and politics. Anyone can get Covid-19, but like the future, the disease and its consequences are unevenly distributed. Poor people and nonwhite people have borne the brunt of the disease, and because of disparities in the demographics most affected—thanks to a statistical property called overdispersion—it was still, somehow, possible for individual people to not see their connection to the greater whole. For months, the dynamics of the disease allowed some people to still think that Covid-19 is a problem over there, something that only kills brown people in blue cities. Somebody else’s problem. Any measures taken to fight it seemed, to them, to be worse than the disease.
