George A. Sprecace M.D., J.D., F.A.C.P. and Allergy Associates of New London, P.C.

by George A. Sprecace, M.D., J.D.

On April 4th,  Dr. Jordan Kassalow, an ophthalmologist practicing in New York City, gave a presentation to the Southeast Connecticut Committee on Foreign Relations entitled: “Confronting Contagious Diseases and Global Health Pandemics”.  Specific comments  related to his treatment of  “River Blindness” in Africa in conjunction with the Helen Keller Foundation.  Dr. Kassalow is currently Director of the  Council on Foreign Relations’ Global Health Project, dealing with international health issues and  foreign policy.

Dr. Kassalow,  who personally witnessed the great need  for health care in the world during part of his training in Mexico, initially decided on a personal one-on- one, hands-on approach, by repeatedly  volunteering his time in Africa to deal with a particular form of infectious disease that causes blindness.  Thousands were helped, but there were always thousands more out of reach of the most committed and energetic individual approaches.   This led to a landmark example of private-public sector collaboration in the form of the Onchocerciasis Control Programme In West Africa,  reflecting the critical importance of private sector and non-governmental agency involvement  in such projects.

His experiences and comments raised the question of dealing with the underlying  “disease”  for which rampant illnesses, starvation,  and poor health care are the symptoms: global, intractable, abject poverty.  In a world where 5% of the population utilize  50 percent of the world’s resources, and where in some individual countries 2% of the population control  95% of the wealth and the means of wealth formation,  it would appear axiomatic that what is needed to deal with the problems of  global disease and its parent - world poverty - is effective human motivation. Otherwise, the 5% and 2% noted above couldn’t care less - and don’t.  In a world as diverse as ours is in history, mores, customs and challenges of geography, the one common denominator is the human condition, in which the prime mover is at all times  economics.  Before anything else comes survival, and the means of survival.  If our best world leaders care  to deal with World Health on a macro- scale, in addition to the micro-, “ad hoc” level currently been used,  the approach needs to be through  raising the fortunes of all world populations.

But why bother?  What could be the motivation for the “ haves”  to intervene on behalf of the “ have-nots”?   Nothing so far has worked on a macro- level.  It is the thrust of these comments,  which I shared  with some of the members of the Committee on Foreign Relations at the meeting of April 4,  that only economic motivation in the form of personal profit, while pursuing a win-win philosophy, can mobilize the “haves”  on a global scale.  In this sense, “greed” may not be “good”, but it certainly is a primal force of human behavior in the form of self-interest regardless of local mores, customs or history.  Another motivation promoting interest in  World Health is the fact that we are rapidly becoming one world,  interconnected to the extent that “their” health problems  are rapidly becoming  “our” health problems, whether we are dealing with tuberculosis,  HIV, hepatitis, drugs  or many other examples including exotic tropical diseases borne throughout the world by  increasing  travel and emigration throughout the world.

And what could be the bases for the personal profit motivation?  These would be the natural resources and the worker population of the under-developed countries, a  “quid pro quo”  in return for massive investment of expertise, education, technology and infrastructure development.  Although a pejorative term, this arrangement, pursued with enlightened as well as self-interested  leadership, good will and hard-headed realism, could be called “ economic colonialism”.   Properly motivated and  channeled, the approach could indeed be the rising tide that raises all ships, a win-win situation.  Currently, the present “ global economy”  in practice is a study in uncontrolled exploitation, disregard for human rights and for the environment, and total lack of coordination and oversight; this,  despite the fact that transnational corporate activities in effect determine public and  foreign policy.  It is a study in true “greed”,  hypocrisy and cynicism, a classic win-lose situation.  And even the winners are barely skimming the surface of the potential for global economic development in untapped  and wasted natural resources, and  in mobilizing our greatest resource: our world population,  properly motivated through economic self-interest.  In such a setting, the rampant illness and death of hundreds of millions of people through starvation and disease, and the clamor for population control by any means including slaughter and civil war, would not only be immoral; it would be stupid.

If we wish  to address successfully the great world problems of poverty, disease and exploitation, we need more self-less individuals like Dr. Kassalow and the many others giving of themselves.  And what we also need is an enlightened self-interest on the part of the leading nations of the world to implement the above approach.  The United Nations could assist in this effort, as an adjunct to personal, corporate and national self-interest.

Sometimes, discussions of this type produce unease, irritation, even anger on the part of the comfortable and  the uncritical.  I am reminded that if you lie to a person,  you may irritate him;  if you tell him the truth,  you may absolutely infuriate him.    But critical discussion among intelligent peers of good will is a necessary first step.

G. S.

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