Guest post by Annemarie Goldstein Jutel
Diseases are much more than the viruses which cause them. Even in the presence of well-defined physical illness, social and cultural beliefs and behaviors have a strong impact on how we can understand the disease and mitigate its impact. The Ebola virus provides us with an excellent example. A source both of fascination and fear, this virus highlights just how the words we use to discuss it influence its impact on the ground.
Classifying disease has roles which go beyond simply helping someone to get better. The whole process of classifying diseases formally and maintaining public health records emerged at the same time as the modern state, with disease tracking part of how nations sought to identify and protect their citizenry. Nineteenth-century epidemics such as influenza and cholera were constrained in their spread by the length of time it took for sick people to travel; the slowness of transport meant that the sick normally died before they could travel far enough to spread the disease. Today, however, because of the increasing efficiency of travel, germs can travel from country to country, spreading disease across national borders: disease victims have a chance of surviving long enough to pollute a second nation. Classifications therefore had to be able to cross national boundaries with the germs.
The ICD and the WHO were both created in response to this boundary infringement. The classification and tracking of disease was used by the modern state as a way to manage its identity, its knowledge, and the health of its people. Diagnosis, in some ways, makes the state, as diagnosis statistics, like population statistics, define a country’s health, its priorities and its threats.
Ebola is perceived today as an important threat to the integrity of the nation. Daily reports indicate which countries have cases and which countries are clear. Descriptions of the Ebola virus use the metaphorical language of boundary infringement focusing on “outbreak,” “spread,” and “invasion.” Not surprisingly, public health actions in response to these infringements are couched in in military terms. We have a war to win against Ebola and an Ebola Czar to help us do so. We try to bring the outbreak under full control to neutralize the virus.
While we discuss Ebola in this tone, we generate a way of thinking about the disease that defeats the public goal of erradicating the virus. What if we were to think of the problem of Ebola in a deficit model, rather than as an invasion? Instead of rushing to close our borders to the African incursion (and some American politicians have even found ways of associating Ebola with Mexican immigration, advocating even fiercer border control between the US and its southern neighbor), we would swarm around our African brothers and sisters in their homelands, surrounding them with care, supplies and succor. We would stop targeting them as vectors.
Getting the discourse about Ebola right is as important as understanding the virus itself!
Annemarie Goldstein Jutel is an associate professor at the Graduate School of Nursing, Midwifery, and Health at the Victoria University of Wellington, New Zealand. She is the author of two books published by Johns Hopkins, Social Issues in Diagnoses: An Introduction for Students and Clinicians and Putting a Name to It: Diagnosis in Contemporary Society.