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Public health is in a worldwide state of crisis and it needs to be addressed on a global scale, Pulitzer Prize-winning author Laurie Garrett said Thursday evening in the Buffalo Niagara Marriott in Amherst.

Garrett, whose latest book, "Betrayal of Trust: The Collapse of Global Public Health," was published last month, was the keynote speaker in the Rose and Al Pastor Distinguished Lecture Series sponsored by the Women's and Children's Public Research Foundation at the Children's Hospital of Buffalo.

"There are more cases of malaria than ever before -- 3 million died last year," she said in an interview before a reception for her in the Marriott. "There are record levels of dengue fever, record levels of tuberculosis -- there are 8 million active cases and 2 million died last year.

"And we have the greatest plague in human history. By 2004, we will have more than 34 million cases of HIV. Fifteen million will die in Africa alone. In 14 nations, (that's) more than 10 percent of the population that's infected at this time. And there's no sign that his thing has come close to peaking. You look at those numbers and you say that public health has failed."

Garrett said that with the current emphasis on globalization, America cannot ignore health catastrophes in other countries.

"Twelve percent of the American labor force is foreign-born," she said, "so we can't think any more of public health in nationalistic terms or local terms. We have to see it as a globalized enterprise."

Garrett applauded President Clinton's recent declaration of HIV as a threat to national security. She noted that one of her most receptive audiences was for a speech she gave for CIA agents.

She also saw hope in the five public health initiatives that were passed in the recent Millennium Summit meeting of world leaders at the United Nations.

"Whether they execute them or not is another matter," she said.

She said that public health in this country has been allowed to deteriorate because people have looked at it as an entitlement program, like welfare.

"Since the Reagan administration," she said, "the burden has been shifted to the local public health systems. But it isn't about medical care. It's about population care. They're very different things.

"Our major problem is there's kind of a political enlightenment that we need. Protecting the health of a 12-year-old should be like Mom and apple pie."

Garrett, a reporter for Newsday on Long Island, said she began her research into public health worldwide after the publication of her first book, "The Coming Plague: Newly Emerging Diseases in a World Out of Balance," which won her the Pulitzer Prize in 1996.

At that time, she said, she reflected the general belief of scientists that the solution to widespread diseases was to rely on the public health system.

"I'd go speak," she said, "and public health people were coming up to me -- not the administrators, but the people down in the trenches -- and they were saying that's not a good thing to say. We're really in sorry shape."

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