Can a Disease Outbreak Help a Country?

When public health expert Harris Pastides was in Kenya in the 1980s, he couldn't believe how brazenly the government was lying about its health crisis.

At any health-care facility, he said, "you could physically point to the ones who were HIV-positive and stumbled into the hospital to die."

The hospitals were "overflowing" with AIDS patients, he said — yet the Kenyan government continued to insist that it did not have a problem.

Two decades later, the country still hasn't drawn much attention to the problem, and at least 10 percent of its population is HIV-positive, threatening an even graver crisis.

Pastides' experiences in Kenya seem familiar today, as information emerges that China had been covering up its troubles with the infectious disease SARS, or severe acute respiratory syndrome.

Since the revelations, however, Beijing has dealt with the crisis far more publicly, revising its estimate of SARS patients sharply upward, and getting rid of the capital's mayor and the national health minister in perhaps the most public sackings of public officials since the Communist Party took over in 1949.

Beijing's actions have impressed a number of observers because the Chinese government is known to be one of the most secretive and insular in the world.

But public health officials like Pastides, the dean of the school of public health at the University of South Carolina, say transparency is simply in a country's best interests — as Kenya's case shows.

General transparency is something desired by the world community, and as one of the largest countries in the world — in both size and population — China's attempts at transparency are especially heralded.

There has been some speculation SARS may be the tear through which sunlight penetrates China. If so, disease might not only be a negative thing, but a positive thing, too.

Self-Interest at Heart

Throughout history, human beings have continually faced epidemics of new pathogens: the bubonic plague centuries ago, cholera one century ago, HIV this century. "SARS is only the most current example," Pastides said.

Each time a community has been faced with an epidemic, it has been human nature to play down the situation. There's the natural inclination toward optimism, and there's the inclination to look at an epidemic in relative terms.

But the primary reason for concealment is self-interest, according to Robert Blendon, professor of health policy and political analysis at Harvard University's Kennedy School of Government.

"Cover-ups are all related to the same thing: People are afraid of the economic impact," he said.

Much has been made of SARS' economic impact in the age of easy global transportation, but epidemics have been part of free trade as long as the concept has existed.

Port cities were typically the first places to be struck by epidemics, and at the time, public health authorities weighed the same decision they do today: alarm the populace and save lives, or anger and jeopardize the merchants' businesses with word of an outbreak.

This relationship between public health and commerce was so close that public health authorities wielded considerable power, Blendon said. They had the authority to shut down ports, confiscate shipments and burn them as they thought necessary.

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