The Fifth Freedom

Everyone has a right to health.

ERIC GREENBERG

On January 6th, 1941, in his celebrated Four Freedoms address, President Franklin D. Roosevelt asked Congress to help the allies of the United States fight the Axis powers. Roosevelt recognized that Americans would support such assistance for only two reasons: to protect the core democratic freedoms upon which the United States had been founded and to spread them abroad. Those embattled freedoms, he said, were fourfold—they were the freedoms from want and fear and the freedoms of worship and speech.

Today we live in an era of pandemics, malnutrition, and the pilfering of humanitarian aid by corrupt governments. Physical suffering is the norm. Three out of five people in the world have no health care. In the United States, the wealthiest nation in history, more than 40 million Americans do not have primary health insurance. Nor are all the dollars we spend on health care used very wisely. Some 17% of our health care dollars are spent tracing payments in a complex network of economic entities. We invest little in preventive medicine, and 90% of our health care dollars are spent on the last year of a person�s life, when the patient has four or five chronic conditions.

These facts lead me to advocate a Fifth Freedom: the freedom from sickness.

Unless we band together to reduce illness, it will be difficult to enjoy any of the other freedoms that Roosevelt championed. Consider Africa. Once, only the weak, old, or very young died from epidemics. But the AIDS pandemic there is carrying away the strong and young, the caregivers and economically productive members of a community. By 2010, life expectancy in the most desperate regions of Africa will fall to 30 years. Dying, the sick leave behind helpless children and the elderly. As John Pollock notes in his story on page 46, diseases thought to be subdued, like malaria, have made startling comebacks in the Third World, killing millions every year, most of them children. Indiscriminate intrusions into sensitive ecosystems compromise natural barriers, and new viruses leap from animal to man.

When the strong and young are gone, political chaos follows. The only governments that can rule in such circumstances are dictatorships supported by the paltry charity of others. This is a global crisis, and like fascism, it is a crisis that attacks the American values of freedom and liberty for all.

Roosevelt and his political heirs could not imagine the economic consequences of societies without healthy citizens. Our current stance toward world health—indeed, toward health on our own soil—reflects a continuing failure of imagination. For instance, while pharmaceutical companies consider the rosy markets for prostate cancer in the United States, inland China faces the elemental threat of schistosomiasis, a disease of poor sanitation that infects 200 million people worldwide every year, 20 million of whom suffer severe disease. New therapies aren�t needed to remedy the situation; a clean water supply could reduce the infection rate by 77%.

If the United States wants to promote freedom within its borders and in the developing world, then it must be serious about promoting freedom from sickness. Only nations whose citizens are healthy can benefit from the ideals of Roosevelt.

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