We Need a Structural One Health

No one ever says to you, “Lie to me.” The enemy says, You will do and believe certain things. It is your decision to falsify, in the face of his coercion. I am not sure this is what the enemy wants, or anyway the usual enemy. Only a Greater Enemy, so to speak, would want that, one with greater objectives, and a clearer idea of what the ultimate purpose of all motion is. –Philip K. Dick (1974)

Perhaps unbeknownst even to themselves, many an epidemiologist, veterinarian and wildlife biologist confounds episodic and structural crises.

The good doctors gun from outbreak to outbreak, isolating samples, sequencing genetic markers, administering prophylaxes, and, for epizooses, culling the sickest and burying the dead. To be sure, that kind of firefighting is critical. We can’t have deadly pathogens running amok now, can we?

But the oft-difficult mechanics of an intervention do not lend credence they address the cause of the outbreak. Disease isn’t synonymous with its etiological agent or the map of its victims, whether or not either is placed within a One Health context that acknowledges the functional ecologies humans, livestock and wildlife share.

Such epistemological myopia, however well funded, misses the structural factors underlying pathogen emergence and by virtue of that omission the pathogens’ likely reemergence.

Every one of the new potentially human-specific influenzas, for instance, have evolved out of industrial poultry and livestock. Along with H5N1 and 2009’s H1N1, human near-specificity has been documented in agribusiness H1N2, H7N1, H7N3, H7N7, H9N2, in all likelihood H5N2, and perhaps some of the H6 series.

Within the past year alone two new swine influenzas were discovered in the U.S. undertaking limited human-to-human transmission: a new H3N2 and a bizarre if attenuated H1N2 found here in Minnesota. Likely only two of a diverse and spatially expansive cryptic reservoir entwined with the hog industry’s commodity chains.

As we have discussed here (and here, here, and here), the socioecological phase change underlying the new influenzas is historical in origin. In what became known as the Livestock Revolution, starting before but accelerating after WWII, agribusiness globally reorganized husbandry into cities of monoculture pig and poultry.

The resulting livestock landscapes select for virulence, spillover and human specificity in influenza and other pathogens. Under such circumstances one new hydra influenza is replaced by another, no matter how efficacious the emergency responses brought to bear.

*

The distinction between types of crisis, then, is definitional, framing the very nature of disease. In addressing another crisis—the Great Recession and capitalism more broadly—philosopher István Mészáros elaborates,

The crucial difference between the two sharply contrasting types of crises is that the periodic or conjunctural crises unfold and are more or less successfully resolved within the established framework, whereas the fundamental crisis affects the framework itself in its entirety…

[In] view of the inescapably complex and prolonged nature of the structural crisis, unfolding in historical time in an epochal and not episodic/instantaneous sense, it is the cumulative interrelationship of the whole that decides the issue, even under the false appearance of “normality.” This is because in the structural crisis everything is at stake, involving the all-embracing ultimate limits of the given order of which there cannot possibly be a “symbolic/paradigmatic” particular instance.

In a structural crisis–slow and rolling, confined, in the case of capital’s, to no industry or region–the systemic contradictions start to run up against each other. No spatial fix, sector switching, financialization, privatization, primitive accumulation, or “productivity gains” extracted from workers offers surplus capital escape from its own decades-developing trap.

Indeed, as the bank crisis continues to show, palliative efforts can deepen the very crisis they were ostensibly undertaken to alleviate. Even setting aside the fates of the vast majority of the planet whose labor powers the machine of modern civilization, and who are treated as little more than passive markets, from capital’s viewpoint alone the proverbial tourniquet tightens so much it severs the artery it was meant to staunch.

However ingenious and diligent its applicants, epidemiological firefighting, focusing on the level of the outbreak, similarly fails to address collapsing health ecologies, which are confined to no single host population or locale. Such efforts can even be twisted to aims in direct contradiction to their personnel’s best intentions.

To connect the two catastrophes, within the current economic crisis epidemiological interventions increasingly represent declensionist rationales for the neoliberal land grabs, wholesale deforestation and agricultural intensification that underpin many of the epizootic outbreaks in the first place. The outbreaks that result are presented as due cause for clearing the field of all agricultures and alternate economies save the most highly capitalized and “biosecure.”

In other words, without a Structural One Health connecting ownership to outcome, well-meaning epidemiologists can find themselves helping precipitate epizootic outbreaks.

*

As Mészáros puts it,

Without understanding the overall systemic connections and implications of the particular events and developments we lose sight of the really significant changes and of the corresponding levers of potential strategic intervention to positively affect them, in the interest of the necessary systematic transformation. Our social responsibility therefore calls for an uncompromising critical awareness of the emerging cumulative interrelationship, instead of looking for comforting reassurances in the world of illusory normality until the house collapses over our head.

Can the current epidemiological infrastructure address such a scope? How, for one, does the World Bank or the World Health Organization approach outbreaks that originate in the machinations of the very powers on which they depend for funding and legitimization?

This recent World Bank report, written and reviewed by some excellent people, offered the economic case for One Health,

The case for control of zoonotic diseases (zoonoses) is compelling. The economic losses from six major outbreaks of highly fatal zoonoses between 1997 and 2009 amounted to at least US$80 billion: [Nipah Virus, West Nile Fever, SARS, HPAI, BSE and Rift Valley Fever]. If these outbreaks had been prevented, the benefits of the avoided losses would have averaged $6.7 billion per year…

Potential losses resulting from a severe influenza pandemic, for instance, that leads to 71 million human fatalities would be US$3 trillion, or 4.8 percent of the global GDP. Preventing and controlling zoonotic disease outbreaks thus benefits economies and public health because epidemics and pandemics do not develop. In addition, tackling endemic zoonoses would reduce a major source of human suffering and economic losses that disproportionately affects many of the poorest households in developing countries.

The authors attempt to convince the world’s richest countries to do the right thing—to reinvest in ecohealth and conservation—by appealing to their pockets. Pay a little now—US$1.9 billion to US$3.4 billion annually across 139 countries—peanuts really—and save a lot now, even in the face of a low year-to-year probability a deadly pandemic will strike. The gains would even compound, advancing campaigns in poverty reduction, food security and food safety.

One Health is also presented here as a means of controlling operational costs and precipitating the kinds of service consolidations so beloved by austerity,

Not only is a One Health approach to zoonotic disease more effective, it is likely to be also more efficient as it entails sharing of some costs among the services responsible for animal, human, and environmental health. For instance, during a joint vaccination campaign (such as that noted earlier for Chad), some human capacities and equipment, as well as operating costs, can be shared, resulting in lower costs for the joint campaign than for two separate campaigns. Laboratories, which have a key role in early detection of disease and accurate diagnosis, can also reduce costs through attention to how animal and human health work is carried out… These savings would range from 10 to 15 percent of the total costs of a global surveillance and disease control system…

The UN literature is filled with such Promethean appeals. A lost cause here in part because it can’t address capital’s structural compulsions, which in passing select for and spread deadly pathogens.

Even cagey efforts strategized around courting our rulers’ sense of self-preservation can publicly acknowledge the problem’s source only by failing to mention it. Quite a trick (and perhaps the only one available under those circumstances).

There are, of course, other self-administered sleights of hand, even behind closed doors. The world’s governments have run remarkable interference for agribusiness, shielding the latter from its health and safety blowback. All part-and-parcel of externalizing costs off company margins, efforts without which these enterprises, suffering congenital diseconomies of scale, wouldn’t exist.

The maneuvers involve much more than renaming ‘swine flu’ ‘H1N1 (2009)’.  A few recent American examples across my desk:

• Under the 2013 Agricultural Appropriations bill wending its way through Congress, the Secretary of Agriculture would be required to grant a temporary permit for genetically modified crops even in the face of a court ruling staying planting until an Environmental Impact Statement is filed. As Alexis Baden-Mayer writes, the ‘Monsanto rider’ effectively indemnifies agribusiness from federal law.

• The USAID-funded Program for Biosafety Systems organized political support among Kenyan policymakers and regulatory agencies around ratifying a bill establishing the legal framework for American GMOs in Kenya. The program also provided technical support for field trials of GM cotton and corn.

• Rajiv Chandrasekaran’s characterization of USAID in Afghanistan is nothing short of scathing. USAID blocked efforts to promote growing state-ginned cotton, the most viable alternative to poppy and an economic safety value for farmers maneuvered into joining the Taliban,
  

  …Protecting King Cotton was more important than defeating the Taliban. Several U.S. officials familiar with the matter told me that USAID could have asked the White House to issue an exemption [to the Bumpers Amendment], given the national security importance of stabilizing Afghanistan, but senior officials at the agency refused to promote a crop in which Afghanistan did not have a comparative advantage in world markets. “Their thinking is all about free trade–that Afghanistan is better suited to produce pomegranates and raisins than bales of cotton,” said one USAID official who disagreed with the agency’s stance. “But what about the goal of keeping people from shooting at our troops?”

  In effect, USAID undermined its government’s own war effort.

• The U.S. diplomatic cables WikiLeaks released shows the heaven and earth governments moved to protect Big Food from the bad PR of what many feared at the time might turn into a pandemic killing millions. This cable, straight from the desk of the Secretary of State herself, speaks to the extent to which the U.S. aggressively combated trade bans against U.S. meat. While the campaign is epidemiologically supported—you can’t get H1N1 (2009) from cooked pork—I could find not a word anywhere in the 3000+ WikiLeaks cables (keyword ‘influenza’) on the new influenzas’ very real origins in industrial pig and poultry.

• In defense of its ammonia-steamed ‘pink slime’ ‘finely textured beef,’ which this spring suffered the shock of a consumer backlash, Beef Products, Inc. lined up three U.S. governors, one a Presidential candidate, to publicly eat what was until recently sold only as dog food. Now that’s power.

*

Another alchemy is to disappear responsibility inside broad concepts. Disease emergence in this New York Times review is framed within environmental damage,

Experts are trying to figure out, based on how people alter the landscape — with a new farm or road, for example — where the next diseases are likely to spill over into humans and how to spot them when they do emerge, before they can spread.

But which people? By what mechanisms? Even as the article makes the effort to describe the emergence of Nipah virus it fails to mention the economic geography of hog intensification so intimately tied to Nipah by some of the very researchers interviewed.

Even when causes are alluded to here, they aren’t really described except in the broadest of generalities,

[Experts] say it’s critical to understand underlying causes. “Any emerging disease in the last 30 or 40 years has come about as a result of encroachment into wild lands and changes in demography,” says Peter Daszak, a disease ecologist and the president of EcoHealth.

Public health researcher Vincente Navarro, addressing another ideation, objects to such Platonic equivocation,

It is not inequalities that kill people. It is the people who produce and reproduce inequalities through their public and private interventions that kill people. In most cases, we have the specific names of those responsible for those inequalities and, therefore, for those deaths.

Hiding those responsible inside an idea has its geographical equivalent. From the Times review,

[Emerging] diseases have quadrupled in the last half-century, experts say, largely because of increasing human encroachment into habitat, especially in disease “hot spots” around the globe, mostly in tropical regions…

In the Amazon, for example, one study showed an increase in deforestation by some 4 percent increased the incidence of malaria by nearly 50 percent, because mosquitoes, which transmit the disease, thrive in the right mix of sunlight and water in recently deforested areas. Developing the forest in the wrong way can be like opening Pandora’s box…

“By mapping encroachment into the forest you can predict where the next disease could emerge,” Dr. Daszak, EcoHealth’s president, says. “So we’re going to the edge of villages, we’re going to places where mines have just opened up, areas where new roads are being built. We are going to talk to people who live within these zones and saying, ‘what you are doing is potentially a risk.’ ”

While I greatly respect the ecological detective work described here—Richard Ostfeld’s work on Lyme disease is foundational—and mapping encroachment as a disease proxy is a fabulous idea—I gave it to Daszak at a One Health confab in Verona in 2010—its application here is framed by something of a pious deception however unintended.

Metropole scientists are lecturing the global South about deforestation and disease risk, which are widely driven by structural adjustment programs and export economics originating at capital’s core.

It would be a much more honest appreciation if we were to label New York and London the world’s worst disease ‘hot spots’ instead, as they are two of the largest commodity termini from which surplus capital surveys and acts on its global domain.

Although not explicitly discussed in the article, proposed solutions are often as spurious, presenting a cause of the problem as its solution.

Monetizing ecosystem services, for instance, an approach so close to the heart of the new green capitalism, only contributes to Lauderdale’s paradox. It only helps add exchange value to increasingly scarce primary forest and waterways, offering agribusiness greater incentive to corner a dwindling, and financially appreciating, landscape.

Alternately, increasingly apparent, the cult of Paul Krugman notwithstanding, Keynesian bailouts can’t save neoliberalism from itself because state finances are being stripped saving companies that caused—and continue to cause—our economic and ecological collapses.

As JPMorgan’s latest bust shows–$9 billion and counting after parlaying the initial credit default swap crisis into a competitive advantage—bank bailouts only set up the next catastrophic round. Running analogous interference for agribusiness on H1N1 and other pathogens only allows the sector an opportunity to breed the next deadly strain.

That’s why political economist Gar Alperovitz argued last week Wall Street’s banks are too big to regulate, a conclusion applicable to multinational agribusiness. At this point corporations regulate governments. Milton Friedman’s zombies have eaten through Hobbes’s Leviathan.

For Alperovitz the sole means of controlling these firms is reversing field and nationalizing them. They have become at one and the same time too big to fail and by virtue of the compounding risks they must take at our expense too big to succeed.

Tinkering offers too small a scale of solutions the resulting problems demand, except, perhaps, in providing companies and governments ideological cover until the next depression or pandemic. In the ecohealth domain the best international technocrats can offer at this point are modest plans for getting companies to buy third-party insurance for producing deadly outbreaks.

Agribusiness, however, has shown no compunction about spending the political capital needed to indemnify themselves tabula rasa should they kill a billion people by way of the next plague. Until now someone else has always paid the large portion of the bill for outbreaks and other environmental disasters, a moral hazard of apocalyptic proportions the World Bank report fails to assimilate.

If the last decade has taught us anything, a truly holistic ecohealth must finally extend its purview out along the circuits of capital. Together they comprise both cause and mode by which most diseases now emerge.

*

If One Health practitioners are unable to assimilate structural crises, including the blame their sponsors share—naming names however politely—the political will may be supplied from elsewhere instead. Popular movements outside the present infrastructure may step in.

For many professionals, the present revolts across North Africa and the Middle East, correlated with food crises, serve as fair warning. For much of the world, on the other hand, the more populist of the revolts—neither passive nor markets—symbolize the very hope of the future.

As such conflicts intensify, spreading out through the social fabric, polarizing the world between neoliberalism and its discontents, One Health practitioners unwilling to disengage from their professional prosopagnosia leave themselves beholden to a cabal demanding geometrically untenable scientific rationales.

Lie to me, researchers will be charged. Lie to me about the color of an epidemiological sky everyone else can see with their own eyes. In accepting such duties, however, ecohealth scientists risk being upended from the other direction by a gathering tsunami black with anger.