Why do we feel so vulnerable to epidemics now? Americans live longer than ever; you'd think we would feel a little more secure. Yet we seem to be awash in epidemics: There are infectious ones, like AIDS, MRSA (methicillin-resistant Staphylococcus aureus
), and hepatitis C. Each winter, there's an epidemic of flu. But we also have epidemics of asthma, autism, allergies, attention-deficit/hyperactivity disorder, addiction to crystal meth, and absent and permissive parenting. And that's just the A's. Childhood bipolar disorder, Internet predation, obesity, and teen suicide give us shivers of fright for our children and ourselves. Granted an epidemic doesn't have to involve a germ, but shouldn't it involve some kind of disease?
It seems that all sorts of things can be understood as epidemics now. Twenty years as an epidemiologist, including research collaborations with some really smart epidemiologists, statisticians, and physicians, only scratched the surface of what "epidemic" means to people today. When I started out in the field in the late '70s, the average person was hard pressed to identify what epidemiology was. ("Something to do with skin, right?" they'd say.) Then came AIDS, and suddenly epidemiologists were in demand.
AIDS let the proverbial cat out of the bag. Instead of putting an end to one epidemic, it seems to have made room for dozens more.
In part, the extraordinary attention AIDS received, and the funding that went into researching it, helped elevate the status of any epidemic. Whether you're a researcher in need of grant money, a nonprofit organization looking for donations, or a government agency hoping Congress will increase the appropriation for your projects this year, your disease has to look more important than the other guys'. The word "epidemic" simply packs more punch than an "interesting problem" or a "heartbreaking illness."
Competition for funding isn't the whole story, though. Epidemics reflect a deep sense of unease in our society.
One deep-rooted misgiving stems from an inchoate dread — a fear of the randomness of the universe, of the damned unpredictability of who will live and who will die. To insure against random loss of life is the reason we have public health and safety institutions. I recognize that it's really improbable that the bacterium in the water supply or the crazy guy walking the streets with a knife will find me, as opposed to someone else — but I'm happy there are municipal water purification systems and a police force, to make sure. I sleep better that way.
More than randomness though, epidemic fears are inspired by anxiety about modernity. Nowadays it might be Internet hookups that spark our doubts, or air travel, or fast food. In earlier times, it was worshiping differently (or less), letting young women go to work instead of marrying, having children with someone from a different religion, eating food that wasn't grown in the home garden, and so forth. People have always had this worry. If we keep doing what we're doing, the gods are going to be angry and we'll be in danger.
Because of this anxiety, when we're feeling worried about modern parenting, the state of marriage today, or the amount of time we spend in our cars or online, we imagine that we see the fruits of exactly the "deficiency" of interest in the form of some health problem. For instance, the American Public Health Association says that childhood obesity shows the danger of high divorce rates, the "latchkey phenomenon," and a "barrage of images and ideas" from the media. Now, the APHA is about as far as you can get from the social conservatives who fear for the sanctity of marriage because of gay weddings — yet even this relatively lefty group has very moralistic worries about American life, and claims that obesity is evidence that their concerns are on target.
Many of today's epidemics, and even the not-yet-realized epidemics that we imagine, come from this same anxiety driven process. We worry about a decline in social contact in America — there's too much "bowling alone," as the sociologist Robert Putnam described it. And we see autism, teen suicide, and drug addiction as evidence. We worry that nefarious foreigners are messing up our neat society or polluting our gene pool, and we imagine an epidemic sparked by "bioterrorism." In recent times that particular mirage took the form of multinational exercises like "Atlantic Storm" — a simulation in which a radical Islamist cell grows smallpox virus in a lab in Klagenfurt, Austria (disguised as a brewery!), then releases the virus in Penn Station in New York, LAX, the Grand Bazaar in Istanbul (a cinematic touch), and train stations in a bunch of European cities. Havoc ensues.
In a way, an epidemic is a way of naming a social problem that lets us express what worries us.
I had noticed this in the context of AIDS a while back. AIDS seemed to give people permission to talk about all sorts of intimately important subjects that were making us fearful, or uneasy — sexual license, homosexuality, the irrepressible yen for consciousness-altering drugs, etc. But it seems to be true of many of our "epidemics" now.
Until the time of Hippocrates, about 400 BC, the word "epidemic" had nothing to do with disease at all. It was an adjective, not a noun, and it had a series of meanings, all having to do with being "native," in the sense of "characteristic of a particular populace," or something to do with "home." It's only in the last 500 or so years that an "epidemic" has been a defined disease event. Maybe, when we say that there's an epidemic of violence against immigrants, an epidemic of grade inflation in colleges, or an epidemic of middle-school sex, we don't mean the same thing as when we notice an increase in MRSA or an outbreak of salmonellosis associated with peanut butter. Maybe we call something "epidemic" when it seems to have to do with what is essentially us.