Elemental: You report that the United States, which is responsible for 4% of the global population, has seen 22% of the Covid-19 deaths—and of course that only accounts for numbers through September 2020. Apart from being incredibly sobering, what do these numbers tell us?
Nancy Krieger: I think a very important thing to point out is that with a lot of the Covid-19 data, people have resorted to counting cases and then looking at what percentage of the population they are. So, when you come up with statistics like 4% of the population and 22% of the deaths, it tells you something — but it doesn’t tell you enough. The better data, to really compare countries accurately, that isn’t compromised by variables like how many people have access to testing, how accurate the testing is, how Covid-19 deaths are being defined, etc., is the data around excess deaths.
We calculated something on the order of 260,000 excess deaths for the United States for the period of January 1 through September 12, 2020. Soon after we published our findings, the Morbidity and Mortality Weekly Report (the main journal of the CDC) came out with its analysis showing upwards of 300,000 excess deaths in the United States.
So, the disproportion—4% of the population responsible for 22% of the deaths—is one part of understanding what we’re seeing in the United States during this pandemic. Another part is just how many excess deaths we’re seeing.
How do we swallow what we’re seeing in America when it comes to Covid-19 alongside the idea that the United States is a supposed world leader in medicine?
The United States has phenomenal resources available to some people with regard to biomedical advances, but the U.S. also leads, among industrialized nations, in the number of people who are uninsured. We can say the U.S. leads in terms of biomedical technology and expertise, but in terms of actual access of the population to health care itself, the U.S. does not lead—it falls way, way behind.
Public health and clinical care should be complementary partners . In the United States, clinical care has gotten a lot more attention in terms of health dollars. Privatization has a lot to do with this. In the U.S., public health has long been underfunded.
After the 2008 economic debacle, lots of public health was cut and then never recovered. And, of course, the functions of public health departments are very different from the functions of medical entities providing care to patients. The fact that there are some public health agencies across this country that still rely on pen and paper and fax machines is an indicator.