Why Not Diarrhea?

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Why Not Diarrhea?Why Not Diarrhea?

by Raywat Deonandan
Jan 8, 2005

This original Podium article was published on the Rabble.ca website on Jan 19, 2005, under the title, “Why Not (Cough, Cough) Diarrhea?”.

One of my favourite political talk shows is TVOntario’s Diplomatic Immunity. It’s a nice polite Canadian antidote to the dogmatic shoutfests on American cable news channels. This week, the panelists were discussing an uncomfortable point: the Asian tsunami has thus far killed 155,000 people, but every month diarrhea kills more than 140,000 people worldwide while malaria and AIDS each kill 250,000. So why is the world so keen to send $3-4 billion in aid to help tsunami victims while the staggering annual sum of preventable disease deaths goes largely unaddressed? Also, according to the show, long suffering Darfur, home of the world’s other biggest preventable ongoing human disaster, has been pledged a mere $1 billion since 2003.

There are several reasons for this discrepancy, though only a few were identified by the show’s panelists. First, there’s the “CNN effect” wherein the tsunami devastation was seen on TV; no one wants to watch diarrhea on the news.

Second, the peoples of the Indian ocean are well represented in the immigrant populations of Western countries, hence their concerns are amplified here, relative to those of Africa, where the lion’s share of the world’s infectious disease deaths occur.

Third, a natural disaster is a discrete phenomenon that we perceive we can fix. People are wet and injured on a beach, we can send money to get them dry and fed. AIDS, malaria and diarrhea are seen as continuous chronic problems, a black hole of money with no end in sight; whether we send money today or tomorrow makes no real difference. There’s a greater “feel-good factor” in sending immediate aid to a family shivering in the cold who need warmth, water and food right away.

Though many (myself included) derided the news agencies for initially focusing on the inconvenienced Western tourists in Phuket while thousands of Sri Lankans and Indonesians were being washed out to sea, it now seems likely that that focus helped to propel Western concern for the entire region, and hence encouraged the opening of Western wallets. Most of us, even those who’ve never vacationed, can imagine ourselves on those beaches, so the tragedy takes on a personal dimension. We can also imagine the horror of being sucked into an ocean. Death by diarrhea is less of a vivid nightmare for us, though we know it happens regularly in almost any community in the Developing World.

The comparisons to Darfur underline a distinction between tragedies caused by nature and those caused by people. Compared to those affected by the whims of the very Earth itself, victims of a genocide (or of any war, for that matter) are somehow less deserving of sympathy and support because, in some convoluted nonsensical way, they brought their distress upon themselves. More accurately, their society is perceived as both the cause and instrument of disaster. Similarly HIV/AIDS has long been painted by the brush of righteousness, with its victims branded as having suffered the judgement of God.

Moreover, there’s a subtle element of racism involved. Let’s face it: the West as a whole seems to prefer the poor of Asia to the poor of Africa, where most of the diarrheal, malarial and AIDS problems exist. We perceive Africa as a benighted land that will forever be suffering from one malady or another. When nations of comparative civil stability and functioning industry are beset, though, it is perceived as an undeserving tragedy beyond the norm and therefore worthy of our attentions.

The primary nations struck by the tsunami are uniquely positioned within a nexus of expanding Southern economies. By some projections, India’s economy will grow by 8% and Thailand’s by 6% in 2005, while the Indonesian economy has been growing by over 4% in each of the last three years. Meanwhile average incomes in these countries remain significantly lower than that of Europe or North America. Thus these nations represent both a growing market for Western products and a source of inexpensive industrial labour. The tsunami tragedy is not just one of lost human lives, it is also one of lost wealth for the West. The rush of aid flowing from wealthy nations is not driven solely by altruistic motivations, though that is surely what compels the private citizen who sends a cheque to the Red Cross. Rather, nations must rebuild Southeast Asia to protect their own long term wealth and to prevent disruptive ripples through the inernational banking system. There is no such advantage or compulsion in fighting AIDS or diarrhea in Africa.

Since foreign aid is a zero sum affair, wherein monies spent in one arena necessarily means less money spent elsewhere, it is dangerous yet unavoidable to rank tragedies in terms of greatest need. The stats above do not indicate that we should spend less money on tsunami relief. Rather, they illustrate the great need for wealthy countries to invest in greater amounts in alleviating the burdens of less dramatic health tragedies. As many have already pointed out, the tsunami disaster is an opportunity for the wealthy nations of the world to finally focus on eliminating preventable human suffering. Let us hope it’s not a wasted opportunity.


Raywat Deonandan, PhD, is an Epidemiologist and International Health Consultant. Visit www.deonandan.com.