In 1971, Dr. John Rawls, an American philosopher and moral theorist, put forth an idea known as the “Veil of Ignorance” in his book, “A Theory of Justice.” The crux of the thought experiment was that if we could build a society from behind a “Veil of Ignorance,” in which no one would know what their eventual place would be, whether as a wealthy CEO able to travel the world at leisure or a day laborer desperately trying to make ends meet, then — potentially — the result would be a just and fair global society without inequality.
The consequences of a world that wasn’t designed behind a “Veil of Ignorance,” in which a vast inequality exists between the wealthy and poor, becomes a sobering reality throughout the pages of Dr. Peter Hotez’s compelling examination, “Blue Marble Health: An Innovative Plan to Fight Diseases of the Poor amid Wealth.” Hotez is a physician, research scientist, and social justice advocate, and current dean of the National School of Tropical Medicine at Baylor College of Medicine, as well as the endowed chair in Tropical Pediatrics at Texas Children’s Hospital and president of the Sabin Vaccine Institute. He is also part of the Texas Task Force on Infectious Disease Preparedness and Response, and a U.S. Science Envoy to the Middle East for the State Department and White House. It is a resume that makes him acutely adept at putting forth a composition that argues for the “control and elimination of the world’s worst poverty-related illnesses.”
Neglected tropical diseases (NTDs) is a term that Hotez and his colleagues coined to describe a group of diseases that are the most common afflictions among the world’s poor, including diseases such as parasitic infections (like tapeworms) as well as viral infections like dengue. As we learn from Hotez, these diseases, although largely unknown and rarely thought about by the medical establishment, are not rare diseases. They are just, in part, invisible to the wealthiest populations.
In “Blue Marble Health,” Hotez thoroughly examines the global burden of NTDs and their insidious ability to trap people in poverty, even in the world’s wealthiest nations. Using easy-to-follow methodical logic, Hotez argues that NTDS are the “hidden reason that the bottom billion cannot escape poverty,” and that something needs to be done about it straight-away by those with the capacity to do so, such as policy-makers, CEOs of drug development companies, and leading religious institutions.
The book opens with an overview of historically significant contributions to the field of global health, and the many successful efforts to reduce the burden of infectious diseases on the world’s poorest populations. It includes a robust account of not only the health impacts, but economic impacts as well, that resulted from cooperative international efforts to eradicate infectious disease. While openly discussing the many successes by global health organizations since WWII, Hotez does not hesitate to shed light on some of their recent dismal failures. “In 2015, WHO published its findings that global efforts to reach those populations in need of mass drug administrations (for NTDs) has resulted in only 40% of people in need gaining access.”
His critiques of the dominant health organizations and economies of the world do not stop there — in subsequent chapters, Hotez takes on each of the G20 countries, as well as Nigeria. He succinctly discusses their successes, if any, but turns a greater proportion of his attention to each country’s misplaced priorities, allowing the dire circumstances resulting from NTDs to perpetuate. One example he gives is India, with its surplus stockpile of nuclear weapons, although nearly a quarter of its population are living in abysmal conditions and “NTDS are endemic throughout certain areas of the country; a country that is home to the largest population of children living with parasitic worms throughout their intestines in the world.”
As the Science Envoy to the Middle East, Hotez stresses that NTDs are primarily diseases of the poor, but they are also a product of environments destabilized by war and ceaseless conflict. He predicts that areas currently incubating what will be emerging NTDS are areas currently controlled and occupied by ISIS: “The NTD-conflict interface might likely be the diseases resulting from the atrocities and civil war in ISIS held territories,” where it is not surprising that the fanatical and brutal terrorist organization known to use civilians as human shields “has shown little if any interest in preserving any semblance of public health infrastructure.”
Toward the book’s end, Hotez turns his attention to home and introduces the “Continental Poverty Divide” in the U.S., where a majority of “America’s bottom billion”— those living in extreme poverty, with upwards of 5 million living on less than $2 a day— fall victim to NTDs. “NTDs are a reinforcing mechanism for poverty,” and, contrary to popular opinion, these NTDs are not primarily a result of immigration, but of consistent transmission among the poor. According to Hotez, a best-case estimate puts 12 million living with an undetected parasitic infection.
Making the case that NTDs may be a contributing factor for the academic achievement gap observed among children living inside the borders of the poverty divide, Hotez states: “Driving through poor areas of Houston, where the School of Tropical Medicine is based, and elsewhere in Texas and the American South, I am struck by the frequent sight of stray dogs often traveling in packs. There are so many eggs (parasitic) harboring in the waste of these animals scattered through parks and playgrounds where children come in contact with these eggs. They are ingested and hatch in the their intestinal tract where they can cause seizures, lung infections that mimic asthma as well as cause damage to their brains resulting in cognitive and developmental delays.” And as we learn from Hotez, pediatricians caring for these children are not taught to look for such diseases, so they are often misdiagnosed, resulting in even further disease-associated health and economic impacts.
In a concluding chapter, a tribute to John Rawls and his profound theory of justice, Hotez relates “Blue Marble Health” to Justice as Fairness, and lays out a strategy for the G20 countries to effectively address the NTDs afflicting their poorest constituents.
For some audiences, the beginning of “Blue Marble Health” may be highly discomforting, given the degree of public health paternalism Hotez puts forth, but by the book’s end, their uneasiness likely will subside as increased emphasis is placed on diplomacy and democratic cooperation in making health policy decisions.
Hotez states that his key goal for writing the book was to unravel some of the details surrounding the observation that “most of the world’s neglected diseases are found in the wealthiest countries, including the G20 nations,” and that this unforeseen global social injustice needed a paradigm shift from the traditional global health schools of thought. Therefore, a new effective global health framework was necessary to tackle this unfairness, a framework he proposed in the article “NTDs V.2.0: ‘Blue Marble Health — Neglected Tropical Disease Control and Elimination in a Shifting Health Policy Landscape,’” published in 2013.
The “Blue Marble Health” framework and its namesake book were titled after the image taken of Earth by the crew of Apollo 17 in 1972, a photo that, for a time, became an international symbol for peace. In a way, it seems that what Hotez truly wants is for readers of his book to see in it what the world saw in that photo: an inspiration to work for peace and social justice, and, perhaps, to be inspired enough by its content to, in their own way, “launch an assault on global poverty-related diseases.” We can only hope he gets what he desires, because this ‘blue marble’ and the people living here would most certainly be better for it.