Book Report: The Betrayal of Trust

The Betrayal of Trust, by Laurie Garrett, is another must-read for those of you who have a deep interest in global public health and a deeper interest in wanting to see improvements in the practice of public health.

First, praise for Laurie Garrett as an author. Her writing is compelling. She weaves beautiful stories out of tragedy and paints a picture with her carefully chosen words. I have read other books by Garrett and will keep coming back for more. I did not mind the length of the book, coming in at a hefty 768 pages, but then again, I am an avid reader and this is my field of interest.

Garrett outlines how public health interventions, such as the public supply of clean water, have brought us this far. We are living longer than our ancestors and, arguably, we are living “better”. However, she posits that the world’s public health organizations are in a woeful state with disastrous preparation for “the BIG one”. Collectively and globally, she warns of a lack of preparedness of public health agencies. However, the public health agencies, as underfunded and resourced as they are, are our best defense against microbial threats (through efforts to vaccinate large swaths of the pubic, maintenance of sanitation systems, and responses to actual or perceived threats).

In each chapter, she dissects a different public health threat….

  • The first chapter investigates the pneumonic plague panic of 1994 in India.
  • The second chapter scrutinizes the Congolese Ebola epidemic of 1995.
  • The third chapter documents the collapse of Soviet/Russian public health, with particular attention to drug-resistant tuberculosis.
  • The fourth describes the decline of public health efforts in the US under its `managed care’ and `medicine for profit’ health system.
  • The fifth chapter is titled “Biowar”.
  • And the last chapter is Garrett’s epilogue.

She builds the case that we need public health not only to stay safe and healthy now, but to ensure that we are ready for a superbug, a biological threat, and even to ensure that our water supply stays clean. Public health so often functions in the shadows….we are the ones who count disease, who test the water, who make sure your food is safe, and who occasionally remind you to get vaccinated. It is the work that helps to build optimism around the elimination of polio or smallpox. And, importantly to me, that work, builds equality and cuts through some of the injustices we see in our world. So, the next time you hear about funding to the CDC being cut or funding to your local health department being diverted, pick up the phone and call your representative to protest. We need public health!

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