Avoiding a headline of "where were you?"!
As interesting as was the idea that our priorities get defined by the volume of media coverage they receive, it was even more interesting to me that no one challenged it. Moreover, as I took in the way people were processing this presentation, it was apparent that the listening audience was pretty much automatically accepting the notion that the "hotter" the issue, the more we should be paying attention to it.
Perhaps we don't question the assumption that lots of media coverage of an issue means that it is (by definition) highly important, because there is both an intuitive and a logical sense to this approach. Moreover, as a CNN spokesperson once explained to me, "The media doesn't devote much space to issues that the public isn't interested in. If we did, we would be out of business. Therefore, we have to know what the public will find interesting and newsworthy, and then we run with it."
So the media covers what sells--which in a market society presumably reflects those issues that people tend to be most interested in. Policy makers and private-sector leaders pick up on this because if they don't, they become obsolete and either unelectable or expendable. Once the policy makers and private-sector leaders glom onto an agenda, the bureaucracy and the private sector adjust and in turn devote their attention to these priorities. In short, media coverage volume defines the public and consumer interest. That interest then drives policy makers and private-sector leaders, who in turn drive the bureaucracy and the private sector, and so forth. Pretty clean and crisp, eh?
Recently, I had a reminder that as clean and crisp as this sequence is, it doesn't always lead to the correct answers.
My reminder came in the form of yet another presentation--which I listened to as a member of the Colorado Interagency Influenza Coordinating Committee. (Judging by the media coverage that this issue is getting these days, one can't help but conclude that the threat of a pandemic has all but disappeared.)
The presentation was made by a professor from Colorado State University. It so happens that this professor has made several trips to Indonesia. She is involved in efforts to help that country develop better ways to raise, live with, slaughter, eat, and dispose of its poultry. After listening to her presentation, all I could think was that if I were 20 and blond, I would be saying "Oh my God"! Nothing in my Western world and food safety background prepared me for her slides and lecture.
In Indonesia, children routinely play in areas where chickens are slaughtered. Blood, feces, feathers, and body fluids build up on floors and in facilities with little or no cleansing. Chickens live with people the way cats and dogs live with people here. Dead chickens and eggs are stored with no refrigeration. (One slide showed unclean eggs sitting for three weeks in an unrefrig-erated display case waiting to be sold.) The few commercial hen houses that exist are seldom cleaned. Mice and cats run free and feast on the remains of slaughtered poultry. Most people, especially in the countryside, own, live with, and eat (their own) chickens. And, not surprisingly, Indonesia leads the world both in the number of avian flu (A/[H5N1]) cases, and especially, in the number of deaths.
Despite the dearth of media coverage on pandemic flu these days, public health officials continue to be concerned that such an event might occur. The longer the avian flu virus hangs around, the more opportunities it has to mutate into a form that can be easily transmitted between humans. The situation in Indonesia would seem to present ideal conditions for a virus to obtain this capability.
In fact, as I listened to the professor's presentation, I found myself thinking the following:
1. The H5N1 virus is endemic in Indonesia--as it can now be found in almost all of that nation's provinces.
2. People live in very close proximity to poultry in Indonesia and are frequently exposed to poultry body fluids, thereby giving the virus plenty of opportunities to infect a human.
3. The more times this virus can get into a human, the more opportunities it will have to reassort, mutate, or both into a form that could trigger the pandemic that many fear.
4. This is real. The situation in Indonesia is playing out every day, and it isn't going to change.
As I was connecting the dots, I quickly wrote down what I thought was the "takeaway" point from the presentation that I was listening to. In my journal, I wrote:
It's hard to imagine that the avian flu virus could possibly have a better environment in which to evolve into a pandemic virus than the one that it currently enjoys in Indonesia. While no one can obviously predict if the virus will evolve in such a way as to become easily transmissible between people, the opportunities that the virus has in Indonesia to reassort and/or mutate on its own are if nothing else, plentiful. It is endemic in the country's poultry flock. People live in close proximity to their poultry and are further involved in unprotected ways with poultry slaughter, where exposure to chicken blood, fluids and feces is significant. In these circumstances and as the virus gets transmitted between birds and sometimes even to people, the virus has multiple opportunities to change. This overall situation enhances the probability that a pandemic virus could emerge from this country.
After the meeting, I e-mailed the professor (who is an avian-disease diagnostic veterinarian) and asked her what she thought of my little summary. Her response was very interesting:
"I think what you wrote is great! I wouldn't make any changes."
Our profession has more than enough to do. Driven both by media coverage and by our own professional ethic, many environmental health professionals are already marching off to do battle on the sustainability and global-climate-change fronts. We are also maintaining and in some instances, reinforcing our important positions on other fronts as well--ranging from food safety to West Nile virus to meth houses to indoor air quality--and then to the myriad other concerns with which we deal daily.
It was but a year ago, however, that many health departments and environmental health programs were deeply into the process of readying preparations for all-hazard response in general and pandemic response in particular.
Although the media would have one believe that these issues have ebbed, we know better. As I have written many times, we may never face either a pandemic or even a calamitous terrorism event. On the other hand, if either (or both) were to occur, it would be unforgivable to be caught unprepared--given the potential consequences in human lives and socioeconomic disruption that either of the events could cause.
The media offers us a useful glimpse of where the public's concerns and interests lie. As professionals in environmental health, however, we must augment that definition of priorities with the specialized knowledge we have. Even though the final list might look a little different than the one that gets defined by media coverage, we have to know that it is the real list. The ability and the mandate to develop such a list is a measure of how seriously we take our own professionalism.
There is a "can't-win" irony to all of this. If a tragic event were to occur and it caught us by surprise--thereby resulting in widespread death, destruction, and socioeconomic impacts--you and I both know that the media headline would be: "Where Were the People Who Were Supposed to Protect Us?" And we all know that the public would likely agree. Therefore, no matter what the headline of today's media presentations might be, we need to remain mindful of the agendas we know to be real. A "Where Were You?" headline would be tantamount to an indictment on our profession and its ability to fulfill what is expected of us. We must prevent such a headline from ever appearing.
Nelson Fabian, M.S.