Have we for­got­ten the point of pub­lic health?
By Jonathan Smith (See Biog­ra­phy)

Num­bers form the foun­da­tion of pub­lic health.  But in a sense, pub­lic health is over­run by the very num­bers that strengthen the field.  We take indi­vid­u­als and we group them, we strat­ify them, divide them, com­pare them.  But we never iden­tify them.  There are actu­ally strin­gent rules in place to ensure that the iden­tities of our research sub­jects are com­pletely erased: we reduce them to a number.

This can be appro­pri­ate in some con­texts, and the impor­tance of num­bers in pub­lic health can­not be over­stated. Num­bers pos­sess the power to cre­ate pol­icy and shape rhetoric, all of which are activ­i­ties that are hope­ful attempts to cre­ate change for the bet­ter.  What hap­pens, though, when this polit­i­cal rhetoric falls on deaf ears? What hap­pens when the num­bers that we so adamantly defend in pub­lic health fall short in pro­duc­ing any true value to the peo­ple who are affected by the dis­eases that we study?

I came to real­ize the lim­i­ta­tions of tra­di­tional research when I received an email from the National Union of Minework­ers in regards to a research pro­posal: “I should also cau­tion you that there has been an out­cry about never end­ing researches that are done within the min­ing sec­tor and the peo­ple end up feel­ing like guinea pigs of some sort with­out see­ing or ben­e­fit­ing from the out­comes thereof.” What is the point of research if there is no real ben­e­fit? For well over a cen­tury, gold min­ers have been sent home with dis­eases and left to die. That is the bot­tom line. Today, lit­tle has changed except the rhetoric and num­bers that high­light the sit­u­a­tion.  I became acutely aware that the end result of any research con­ducted on this issue is that min­ers con­tinue to die.

Does an individual’s story have a role in pub­lic health? In almost all cases, the pub­lic health com­mu­nity says no.  Maybe because sto­ry­telling is very polit­i­cal, it all depends on who is telling it and how it is told; how the author wants to con­vey his point.  If I told you the story of Godzilla back­wards, it would be about a moon­walk­ing dinosaur that rebuilds Japan.  So in this sense, sto­ry­telling has failed to catch on in aca­d­e­mic dis­course.  Does that mean it fails to have aca­d­e­mic rigor? Of course not. It is sim­ply dis­carded as such because num­bers are much more com­fort­able.  In the con­text of gold min­ing in South Africa, the same story of TB in the min­ing indus­try has been heard for over a cen­tury. In this case, num­bers have failed us; there is no com­fort.  They get us no where.  In turn, sto­ries are all that remain.

Peo­ple, in fact, are not num­bers.  They are, as I last checked, peo­ple.  They have human char­ac­ter­is­tics. Liv­ing with the fam­i­lies of min­ers in South Africa, I learned that poor, black, for­mer gold mine work­ers are no dif­fer­ent from any­one else. But all too often, we look upon them as “them,” as in “Not Us” or “Other.” This is done for rea­sons I can­not yet under­stand.  They have lives.  They have senses of humor. They have argu­ments with their sons about play­ing music too loud. They have wives who they love, and who they fib to about lik­ing their cook­ing. To the rest of the world these men dis­ap­pear, but to their fam­ily and com­mu­nity these men are ever present.  Unfor­tu­nately, as the num­bers on this sub­ject all too eagerly tell us, the end result is always death.  A point­less, need­less death; TB is cur­able and eas­ily pre­ventable.  HIV is pre­ventable and treat­able.  The solu­tion to damming this river of dis­ease that flows back into these men’s home­lands as a result of this sit­u­a­tion is not rocket sci­ence: treat the patient with TB until he is cured.

I hope They Go to Die pro­vides a unique and never-before-seen per­spec­tive on this issue from the view of the per­son most affected by it, the per­son at the cen­ter of it: the for­mer miner. By exam­in­ing this issue from this per­spec­tive, I hope my film offers an in-depth, unbi­ased under­stand­ing of the com­plex legal, health, and human rights ques­tions sur­round­ing this pre­ventable tragedy.