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10/10/2013

An Unhealthy Shutdown

by Craig Klugman, PhD.

It’s week 2 of the government shutdown with no end in sight. In fact, some people are saying this is a good thing because it achieves their aim of shrinking government. Some Congressmen want the country to go off the deep end of the fiscal cliff, not believing that it would have negative repercussions for the population. The problem is that it turns out the government actually helps protect our health.

Thinking about having some meat for dinner? You may want to test that meat for e. coli yourself because the government shutdown means FDA inspections of food facilities have all but ceased. Want to avoid getting the flu? Unfortunately, the Centers for Disease Control & Prevention program that tracks flu outbreaks and directs vaccine distribution is shuttered.   Maybe you are pregnant or a new mom who is dependent on the Woman, Infants & Child (WIC) food program. That program is close to running out of money, unless the state’s want to chip in. Newly struck with a disability and needing benefits? The Social Security Administration and Veteran’s Administration furloughs mean there are not enough workers to process new claims. If you need a new or replacement social security or Medicare card, again, you are out of luck.  And if you’re thinking about drinking water or breathing air, you are on your own because the Environmental Protection Agency (EPA) does not have enough staff to monitor and has also suspended Superfund clean up work. And if you have an incurable disease that you were hoping to enroll in a clinical trial to help scientists learn more about, consider that the National Institutes for Health (NIH) have slowed down enrolling subjects in clinical trials. Perhaps the most publicized victim has been military families whose loved one died in service. Because of the shut down, military death benefits are on hold [though Wednesday night the House voted to reinstate this particular benefit].

Maybe you think you are fine testing your own food, water, and air every morning. To accomplish that, you might need help from some websites. As a result of the shutdown, however, the people who used to maintain government information websites are at home, forbidden from working. As of October 7, a visit to many federal government websites showed blank pages with words stating that the shutdown has shuttered the site. Other sites such as PubMed are open for business but are not being updated. Hopefully you will not need information from the U.S. Department of Agriculture, PubMed, National Oceanic and Atmospheric Administration, Library of Congress, U.S. Archives, U.S. Census Bureau, Federal Emergency Management Agency, and the Department of Human Services among others.

Public health exists because there are many activities that each of us as individuals cannot do on our own. We need to come together as communities and societies to find people with the expertise, organizations with the authority, and leaders who can put it all into action. Recognizing this reality, the CDC had to recall some experts to help deal with a salmonella outbreak in California. I am proud to admit that I do depend on the federal government for many things. I am proud that as a citizen of this country, I can depend on them to do it. Until now.

There are those who believe that the role of the federal government is to provide defense and not much more. They believe we should be on our own for everything else, or at least those should be dealt with at the state and local levels. The problem with that approach is that we cannot all be experts at all things, which is what an every-person-for-themselves approach requires.  And in a bizarre flip of Rawl’s maximin principle, those that are hurt the most in this situation are the least well off.

This is simply the middle of the second week of the shutdown. With no resolution in sight, the affect on health and welfare will only multiply as those people who are dependent on government programs find there is no money for November checks, and charities and states that have taken up the slack find their resources running thin. Those whose jobs are furloughed may struggle as their savings dwindle reducing their ability to purchase health food and even receive needed health care.

The United States already has some of the worst health indicators in the developed world (we rank 51 in life expectancy) and now we have cut assistance to those who need it the most. In a shut down, the losers are not the opposition party in Congress, but rather the tens of millions of citizens who depend on these programs to have a roof over their head and food on the table. Perhaps most enraging in all of this is that the members of Congress continue to receive their full paychecks and benefits (including the Capitol Hill gym). To me the behavior of these elected officials is unethical, violating notions of social justice by stripping the means for people to achieve health and survive. However, it is possible that no one in Congress understands this because one of the shuttered government agencies is the Office of Government Ethics.

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