Correspondence
Correspondence DEFENDING DEFENSE I ENJOYED READING the July 23 editorial, "No Defense," by Robert Kagan and William Kristol. The article contained the most accurate reporting I have seen on the...
...The only goal airpower could achieve is to turn Mullah omar into a martyr among extremists, just as President Clinton's 1998 cruise missile strikes turned bin Laden into a hero...
...She suggested that a solution was to "counteract the free market with social programs...
...At least they'll have some pretty clubhouses...
...For example, even if income inequality correlates with poorer health, the causal mechanisms underlying the relationship would still require explication...
...If these proven strategies—which presumably mean the dos and don'ts that as a doctor I have preached for almost 30 years (don't smoke, drink moderately, wear your seat belt, use condoms, see your physician)—work, then why has our health in comparison to other countries—all much poorer than us— declined over the last few decades even as fewer people engage in these bad behaviors...
...The article contained the most accurate reporting I have seen on the state of the defense budget and the disastrous repercussions the recent tax decreases will have on future defense spending...
...Our relative decline among nations in health outcomes suggests that good health is not a priority in this country...
...First, Braveman asserts that we misquoted her...
...Finally, both Bezruchka and Brave-man seem to think we are challenging their right as citizens to promote their idea of social justice and to advocate certain political viewpoints...
...In a radio debate on July 30 with one of us (Marmor), Bezruchka readily acknowledged that income inequality is a "proxy for something we don't fully understand...
...But that clearly does not buy us health...
...our country's leaders and citizens need to be made aware of the importance of our nation's military and the challenges to adequately fund it...
...There is no clean line of demarcation, as Satel and Marmor imply there is, between "prescribing" policy and merely reflecting on it...
...Health professionals are misguided when they presume that public health expertise endows the profession with special authority to prescribe policies concerning wealth redistribution, labor laws, education, and nuclear war...
...Instead, the special province of public health is the scientific analysis and practical development of mechanisms to prevent and track injury and disease...
...on the basis of these notes we stand by our story...
...This should not be confused with compromising the scientific standards that guide how we study those questions...
...GENE TAYLOR (D-Mississippi) Washington, DC CATCH HIM BY THE WITS IN AN OTHERWISE well-argued piece ("A Cowering Superpower," July 30), Reuel Marc Gerecht comes to the patently absurd conclusion that a hail of cruise missiles and cluster bombs would stop terrorists such as Usama bin Laden...
...While bombing the Taliban's leadership and troops in response to a terrorist attack may make us feel better, it will not stop the threat posed by Al Qaeda...
...Systematic bombings did not bring Saddam Hussein to heel in the Gulf War, nor did they convince Slobodan Milosevic to vacate Kosovo (until NATo began publicly planning a ground offensive...
...As I recall from an address a few years ago to an Episcopal Laymen's conference by a now-retired bishop, as the clergy and laity worry more about platitudes and secular issues than the faith, the Church is in constant danger of being reduced to a mere "ecclesiastical club" for its remaining members...
...BILL SHINGLETON Senior Fellow National Defense Council Foundation Alexandria, VA HEALTHY JUSTICE THE JULY 16 article "Does Inequality Make You Sick...
...By applying the same methods to the larger problem of Al Qaeda, the United States can neutralize the threat without resorting to fruitless bombings...
...parishioners are free to ignore her at their pleasure, although they might eventually meet for services in another location...
...Especially when the healthiest country in the world, Japan, has twice as many male smokers as we do...
...Throughout history, effective public health strategies have been waged in the political arena by pursuing major social transformations, be they lobbying for the end of child labor, promoting universal schooling, or, more recently, mobilizing to curb nuclear weapons, an effort that received a Nobel Prize a few years ago...
...The undisputed fact that the Japanese enjoy longer life spans despite higher rates of smoking indicates as much...
...Provision of health care, wherein we spend almost half of the world's budget for such services, appears to be important...
...DONALD F. WISEMAN Memphis, TN...
...by Sally Satel and Theodore Marmor does not seriously question the said hypothesis but suggests that public health workers should stick to "proven strategies to better the health of the population...
...personal behavior (e.g., smoking, diet) surely plays a considerable role, but it is not the entire story...
...According to Satel's notes, Braveman said that "illness is caused by the power imbalance in a capitalist society...
...Bezruchka's cross-national comments...
...While it is the case that Bishop Jane Dixon legally controls Christ Church in Accokeek, Maryland, under both secular and canon law ("Intolerant Episcopalians," June 16), she only controls a very pretty, historic building...
...What we argue is that the public health community has no special expertise in defining and achieving social justice...
...The United States's relatively slower rate of improvement, however, does not constitute a decline, something to regret, or anything of the sort...
...Bezruchka and Braveman make several claims...
...in both cases there must be high standards for evidence and analysis...
...As for the relative differences in health between countries, this very ambiguity about the determinants of a population's health status undermines Dr...
...Social values can and should influence the kinds of questions that researchers study...
...Even if those living on the lowest rung of the social ladder had sufficient material resources, their health would still suffer because they are deprived relative to others...
...U.S...
...By treating every stray remark in an intercepted phone call as an imminent threat, the military has failed to meld its signal intelligence with information about Al Qaeda's intentions and abilities...
...Does anyone seriously think that this is possible through education about the usual dos and don'ts...
...America's armed forces and intelligence agencies must better integrate their analysis to avoid more embarrassing debacles...
...The study of social determinants of illness is, as we have said, a proper field of scholarly inquiry, but great care must be taken to distinguish correlation from causation...
...IN THE BISHOP'S HOUSE FORTUNATELY FOR BOTH God and man, the Church resides in the hearts, minds, and souls of Christ's adherents, not in the buildings that house their services...
...The first statement that you falsely attributed to me in the recent article—suggesting that capitalism is the sole or direct cause of illness— is as indefensible as the authors' notion that a public health researcher should not examine—or publicly discuss—how political, economic, and social factors may influence health and the determinants of health...
...As a member of the House Armed Services Committee, I appreciate the honesty and insight of this article...
...There is no substitute for good intelligence and well-executed covert action...
...Second, our understanding of the factors that contribute to disease is far more subtle than Bezruchka implies...
...With a $2 million bounty on his head and a combined FBI-CIA effort pursuing him, Kansi was captured without a shot...
...STEPHEN BEZRUCHKA School of Public Health and Community Medicine University ofWashington Seattle, WA SALLY SATEL AND THEODORE MARMOR advance the strange notion that public health researchers and research agencies should not be involved in the translation of research into policy...
...A series of covert and open actions could systematically dismember Al Qaeda...
...one of us (Satel) attended her talk at the 1996 annual meeting of the American public Health Association in New York City...
...I believe it is a responsibility of public health researchers to go as far as possible in applying their work to inform policy, not only to improve health in the aggregate but to make its distribution more just...
...Everyone, not just politicians, will need to get involved when our health becomes important to us...
...They criticize the NIH, CDC, and a large mainstream foundation for supporting this type of radical transgression...
...PAULA BRAVEMAN Professor of Family & Community Medicine, University of California, San Francisco San Francisco, CA SALLY SATEL AND THEODORE MARMOR RESPOND: Drs...
...Bezruchka regards the health status of America's poor as sorely lacking, reasoning that, relatively speaking, the poor of other industrial nations have improved their health status more in the past quarter century...
...To embrace a global social action agenda distracts from the profession's vital mission and may well trivialize less ambitious but worthy public health initiatives...
...Airpower alone has a woeful history of changing state behavior...
...The 1997 capture of Mir Amal Kansi, who killed two people at CIA headquarters in 1993, is the best road map...
...The gap between the United States and the leader in the "Health Olympics" is so big that one way we could close it is to avoid counting all the deaths from heart disease, our number one killer...
...it does present a puzzle, the answer to which has to do with a number of factors, including the availability of health insurance...
...Furthermore, in this article and in earlier statements by Satel, I am misquoted, in a manner that portrays my views, and by extension those of other public health researcher-activists, as simplistic and polemical...
...It is noteworthy that the authors seem to attack exclusively those researchers who study questions having explicit implications for social justice policies...
...The authors need to be more careful in the future...
...If health is to become important in America, then the ways to achieve it will require political remedies to change the structure of this country so that everyone shares more fairly in the pie...
...This necessarily involves looking beyond, as well as at, the most proximate factors—such as disease organisms or chemical exposures—to the policies that can influence people's exposures and resiliencies...
...Nothing could be further from the truth...
...Similarly, America's 1986 strikes against Libya did not deter Tripoli from bombing Pan Am 103 two years later...
...Ironically for the Anglican Communion, principled opposition to the kind of doctrinal nonsense advocated by some American and English bishops is being effectively mounted by conservative bishops from countries, such as those in Africa, where the faith was originally introduced by colonial missionaries...
Vol. 6 • August 2001 • No. 45
