Imagine for a minute that you are a resident of Puerto Rico. If you were born there, then you are a citizen of the United States. However, your vote for President doesn’t count since Puerto Rico doesn’t have any votes in the Electoral College. Congress makes laws that affect you but you don’t have any representation there. A lot of mainland-born Americans live and spend their money on the island, but, for census purposes, they’re not counted as residents. So you have an island with a lot more people than what is counted and not as much tax remuneration to provide services.
That would cause some sort of resentment against the Federal Government of the United States, right? Maybe just a little bit?
Now, imagine that you are hit with a pretty serious disease outbreak like influenza in 2009, chikungunya in 2015, or Zika in 2016 (and into this year). Imagine that you need help from one of the most elite public health organizations in the world, but that organization happens to be an agency within the federal government that also treats your people like second-class citizens.
Yeah, it’s a political minefield.
That’s pretty much the situation under which people from CDC are working with their colleagues in Puerto Rico. I’m not going to get into the details of what is going, of course. I will tell you that colleagues are working together, and that the collegiality between them is strong. It has to be because so many of them (99%) are there to help people, save lives.
They would probably do a much better job if they didn’t have to navigate the political seas on top of everything else. However, that’s the nature of the job, right? If you work in a government agency, and the government is run by elected officials, then you’re going to be at the whims of whoever those elected officials are. I mean, just look at the mess of things that are going on when we went from a center-left Obama Administration to a far-right Trump Administration.
Who suffers, though? Not the people working. (Maybe a little bit.) The people who are the recipients of the services are the ones who suffer. As we move into an era of trying to kill any clinic that dares offer abortion services, women who use those clinics for healthcare will suffer. Their children will suffer as well since good healthcare starts before birth. Their families will suffer when those women are too sick to help provide for them, or die from preventable diseases like cervical cancer.
There are also the effects on morale that these situations have. People don’t work as efficiently because they find themselves walking on eggshells. Unless they’re like me and just stomp on those eggshells, of course. Or, they stop communicating with those who need to know things because they are afraid of the repercussions of saying something that the bosses won’t like. And so on and so forth.
Gosh, I wish public health was completely divorced from politics. Unfortunately, public health — at least in the United States — is a function of the government. That, and people would never allow public health to be run by a for-profit business (i.e. privatized). But maybe they should?
Whether they should or not is best for another post at a later time. For now, I continue to wait for that one 24-hour period where Mr. Trump doesn’t embarrass us as a nation. Maybe by day 100 he’ll get the hang of being
Putin’s puppet president.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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