Well, in a perfect world the Ebola virus would have never reared its ugly head. But ideally, the virus would have been contained at the outset and not spread to cause a global health threat. The virus, first discovered in 1976 in the Democratic Republic of Congo (back then Zaire…oh ineffectual governments, but more on that later), has been a mainstay in the headlines since the outbreak in West Africa earlier this year. As more African countries are imposing quarantines, travel bans and health testing upon entrance into certain countries, the question comes to mind, what would have happened had, say, an American tourist traveled to a remote rainforest and was bit by a fruit bat, contracted the virus and then returned home to Ohio?
Unfortunately, the virus is outpacing its containment and available treatments; increasing the probability it transitions from an epidemic to pandemic. I’m in Amartya Sen’s corner in wishing that the disease of poverty were communicable. Then, perhaps, maybe the response to the Ebola outbreak would have decreased the death toll. The spread of the virus is just another reminder of the inequity between the societal determinants of health throughout Africa and the U.S.
Let’s look at a snapshot of the countries most severely affected by the virus: Guinea, Sierra Leone and Liberia compared to the United States. The societal determinants of these countries play a large part in the high incidence of poverty and effectually their limited capability to handle the epidemic.
Let’s break this down a bit more…
- Poverty: The percentage of the population living on less than $1/day in Guinea is 43.4% and 83.7% in Liberia. In the U.S. (poverty measured >$2 a day) was 1.2% in 2011
- Health Access: In Sierra Leone, there are 0.2 physicians per 10,000 population and 24.2 physicians in the U.S.
- Cultural behavior: Populations using improved sanitation as of 2011: Guinea 18%, Liberia 18%, Sierra Leone 13%, U.S. 100% (transmission of Ebola linked to families and friends washing bodies of the dead, a common Muslim tradition and practiced widely throughout Africa though uncommon in the U.S.)
The World Health Organization prevention and control measures to contain the outbreak include prompt and safe burial of the dead, identifying people who may have been in contact with someone infected with Ebola, monitoring the health of contacts for 21 days, quarantine the sick to prevent further spread, promote importance of good hygiene and maintain a clean environment. Arguably one of the most important societal determinants of health is the accountability and capacity of governments to address population health, in this case a burden of the responsibility to control the virus falls on these country’s governments. However, because they lack the human and infrastructural resources to do so, multilateral aid has kicked in to fill the gap to prevent a pandemic (though some argue too little too late).
As we can see from a brief glimpse into the disparities in resources between the Ebola-stricken countries in Africa and the U.S., the societal determinants in health of these populations could be correlated to the spread of Ebola and the ability of the governments to efficiently and effectively respond to those living in high-risk areas. Back to the first question: if Ebola first appeared in the U.S. back in March, would it continue to be front-page news as an out-of-control virus that has already taken thousands of lives? Or would it be a public health success story of rapid response and confinement followed by research and development of Ebola treatments? If the disease of poverty were communicable, would the Ebola response in the U.S. be drastically different than the current situation?