The Invisible Shield, part 2: "Follow the Data" (RadicalMedia, Digital Outpost, PBS, 2024)

by Mark Gabrish Conlan • Copyright © 2024 by Mark Gabrish Conlan • All rights reserved

After the second episode of Julius Caesar: The Making of a Dictator, PBS followed it with the second episode of their quite interesting series on public health policy in the U.S., The Invisible Shield. The show title was based on the observation that the success of public health campaigns lies in what doesn’t happen: the epidemics that are prevented, the people who live a long lifespan because diseases that could have killed them don’t occur. As a result, American public health agencies tend to be underfunded; they mobilize effectively in the face of an actual emergency but they’re allowed to shrivel up and shrink once the emergency is past. As I pointed out in my comments on the first episode, “The Old Playbook” (https://zengersmag.blogspot.com/2024/03/racism-sexism-libertarianism-and-public.html), the U.S. used to do that to its military as well: expand arms spending in the case of an actual war and then let it atrophy once the war was over and the immediate threat had passed. That changed with regard to the military after the end of World War II, the emergence of the Soviet Union as America’s existential enemy and the start of the Cold War, when the U.S. decided to build what author Seymour Melman, in the title of his 1976 book, called The Permanent War Economy. Alas, public health in this country has never got that similar level of attention, or even close to it.

The second episode was called “Follow the Data” because accurately charting the course of public health and the potential threats to it are crucial in combating them – but some data are more equal than others. The show reports that in general, people of color in this country have a shorter life expectancy than white Americans. Why is that? If you’re a racist, you’re likely to argue that people of color simply are racially inferior and their earlier mortality is hard-wired into their inferior genes. If you’re not driven by such ridiculous prejudices, you’re likely to look for the explanation in the lower economic position most U.S. people of color are in, the life-threatening jobs they have to work, the crummier neighborhoods in which they live, and all manner of factors that make people of color less likely to live long lives than whites. One problem with American public health in general – which was addressed in the first episode as well as this one – is that beginning in 1798, under a bill signed into law by John Adams, the U.S. gave ultimate responsibility for public health not to the national government, but to the various states. What this means in practice is there are 50 state public health authorities, each with their own ways of encoding data, so impending epidemics can literally slip through the cracks because one state’s data are unreadable by other states with different encoding and collecting systems. The problem gets compounded when certain states decide for political reasons not to collect data on the race or ethnicity of certain people facing certain conditions.

The most fascinating interviewee on this program is Abigail Echo-Hawk, an enrolled member of the Pawnee Nation of Native Americans and chief research officer of the Seattle Indian Health Board. She wrote a report on the COVID-19 pandemic as it affected Native Americans in the continental U.S. and Alaska and coined the phrase “data genocide” to describe what she said in the show was both deliberate and inadvertent failure to record the race and ethnicity of COVID-19 patients. “The erasure of Native people through data is what I consider a cultural genocide by the United States government, where they no longer have to fulfill treaty rights because we can't even prove we exist anymore,” Echo-Hawk said on the program. “As an urban Indian health program, as an Indian health care provider, we have a treaty right to quality health care. And yet the Indian Health Service has always been chronically underfunded, funded in between 30% to 40% of known need. When you think about public funding, you fund what you know. And if there are no data, then there's no information. If there's no information, there's no problem. And if there's no problem, why would you fund it? So if we can't get the data we need to understand the challenges we have, we’ll never be able to muster the political will actually to confront those issues.” (I also give Echo-Hawk and another interviewee on the show, Dr. Brian Castrucci, a lot of credit for pointing out that “data” are plural. Few things in common discourse annoy me more than people who say “data is” and “data shows” instead of the correct “data are” and “data show.”)

Echo-Hawk also told a story on the program that sums up how little the federal government cares about Native American health care. She recalled that in February 2020, when the COVID-19 pandemic was just hitting the U.S. and the initial epicenter was in Washington state, the Seattle Indian Health Center and other groups treating Native Americans were running short on personal protective equipment (PPE). “We sent out requests to our state, our federal, and our county partners,” Echo-Hawk said. “Soon, we received a box at our clinic and the CEO and myself opened up that box expecting to see gowns, masks, and the PPE that our providers need. Instead, what we found was a box of body bags. We had been sent a box of body bags instead of the PPE that we had requested. While this was a very literal example of Indian health care funding and the way that we have been treated in this United States that has created the health disparities that currently exist for my people, it is also a metaphor for the way that many tribal nations experienced getting resources for the COVID-19 response early in the pandemic.” She responded by taking one of the body bags and turning it into a ceremonial dress, which she wore to showcase the glaring inadequacies of the U.S.’s response to COVID-19, especially in indigenous communities.

Though few responses to COVID-19 in the U.S. were as tone-deaf as sending body bags instead of the PPE Native health practitioners needed to keep people alive, we’ve seen all too many examples of the politicization of public health and the bizarre counter-reaction to sensible public health measures in the face of the pandemic, including Florida Governor Ron DeSantis’s insane appointment of Dr. Joseph Ladapo, an outspoken critic of COVID-19 vaccination, to run his state’s health department in 2022. “Florida will completely reject fear as a way of making policies in public health,” Dr. Ladapo said in the press conference announcing his appointment. “So we're done with fear. That's something that unfortunately has been a centerpiece of health policy in the United States ever since the beginning of the pandemic. … This idea that people don't get to make their own decisions on issues of health related to their own personal health is wrong. Vaccines are up to the person; there's nothing special about them compared to any other preventive measure.” “Follow the Data” gives a quick history of public health measures that actually prevented epidemics, including the campaign two 19th century London doctors, William Farr and John Snow, led to stop cholera at a time when it was killing literally millions of Londoners. Unfortunately, the show ends with a chilling dramatization of the ways public health measures became politicized and the demonstrations targeting Democratic governors like Jay Inslee of Washington and Gretchen Whitmer of Michigan for delaying reopenings of their states because COVID-19 was still epidemic there. Whitmer was publicly denounced by then-President Donald Trump, who put out messages on Twitter demanding “LIBERATE MICHIGAN!” in opposition to the carefully thought-out policy she was pursuing on the advice of her public health experts, and she was the target of an alleged assassination plot by members of a far-Right militia organization called the “Wolverine Watchmen” in 2020 over her COVID-19 policies.