Public Health Is About All Of Us - Honolulu Civil Beat


About the Author

Carol Titcomb

Carol Titcomb of Waimanalo is a pediatrician in a community health center.


“I’m worried about our civil liberties,” I overheard.

When our nation’s founders endowed us with the right to life, liberty, etc., they certainly could not have foreseen protesters carrying automatic weapons into their state capitol, drunken revelers on the beaches or fisticuffs over mask mandates in the midst of a pandemic.

John Stuart Mills wrote that “over himself, his own body and mind, the individual is sovereign.”

But individual liberties are curtailed by those of others as the cost of living in society. This is not the nation of you, it is the United States of America.

When you buy a motorcycle with your hard-earned cash, you must first get a license before you can operate it on the open road. You haven’t the liberty to exceed the speed limit, to barrel through a traffic light, cross walk or curb.

Customers line up socially distanced outside Kahala Whole Foods during COVID-19 pandemic. August 5, 2020

Customers lined up socially distanced outside Kahala Whole Foods on Wednesday. More of us need to accept that the pandemic requires shared sacrifice.

Cory Lum/Civil Beat

Some feel the law goes too far in mandating helmet and seat belt use, but cost of trauma care is largely borne by society and the state has a compelling interest in reducing health care expenditures. Public health is not just about you. It is about all of us.

In this pandemic, you may have lost your job or shuttered your business; you may not have had food in the pantry or enough savings to pay rent. Here is where being a member of society is supposed to work in your favor; the state has a responsibility to support you in this state of emergency.

‘This Is Not The Flu’

With COVID-19, a majority of infected individuals, about 80%, will have mild or even no symptoms, but a significant proportion will become seriously ill: 15% to 20% will need hospital care, up to and including ventilators, even those between 18 and 45 years of age. The average length of hospital stay has been 11 days.

Have you coverage for critical care? Can you afford the copay, the time off from work? Is there someone who will step in to take care of your family while you are incapacitated?

And then there is that societal cost. You are not paying for your COVID-19 test and case tracking, your hospital care or ambulance ride, your insurance risk pool is.

Perhaps in your particular case the average risk of mortality is low, but what makes this disease so devastating is that some young and otherwise healthy individuals could not be saved, despite intensive care. This is not the flu, as health care workers have said over and over.

If you are fortunate to have mild disease, you may yet spread the infection to one or two others. There have been “super-spreaders” responsible for tens, if not hundreds of other cases.

Those others might not be so fortunate. They might include vulnerable members in your household, at your workplace or among your friends.

What about the emergency techs and medical staff, none of whom have the liberty to refuse to risk their lives in order to save yours?

When protesters complain about hardships, I think of my parents’ “greatest” generation, some of whom spent months in freezing and fetid bomb shelters during the Blitz, lost family and fortunes in the Holocaust, or sent their sons off to war despite being themselves interned. Rosie riveted, grew victory gardens and bought war bonds.

The American ethos of “individual rights” has eclipsed our efforts to respond to this pandemic. There are examples of bold, empathic leadership, for example, in Prime Minister Jacinta Ardern, who called upon all New Zealanders to pull together and make bitter sacrifices in order to protect one another. They have now eliminated coronavirus from their shores and are opening up their schools and businesses with protections in place.

This is more in keeping with our Hawaii culture. Aohe hana nui i ke alu ia (No task is too big when done together by all).

Malama kekahi i kekahi — care one for the other.

The period of social distancing is a kind of kapu (prohibition). As Hawaii people, we define ourselves in relation to aina — the land; ohana — our extended families; kaiaulu – our community; and akua – our spiritual power. These are reciprocal relationships: the land produces ai — food which nourishes us, and we in turn act as kiai — stewards of this land.

These relationships were codified in the kapu system. It dictated, for example, which species of fish at which stages of the life cycle could be gathered by which people in which season.

Our kupuna lived with “rules, not rights,” and by observing kapu, they kept our lands and seas fruitful, our streams and shores pristine, our people healthy. They found meaning and purpose in their kuleana — responsibility to serve lahui — the generations to come. As Loea Dennis Kauahi said: “You don’t survive alone. No, you survive as ohana.”

This pandemic binds us in a shared destiny, and we need to turn to our cultural roots of interconnectedness: Malama kekahi i kekahi — care one for the other.

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About the Author

Carol Titcomb

Carol Titcomb of Waimanalo is a pediatrician in a community health center.


Latest Comments (0)

As for the pandemic. We live in America, a Constitutional Republic.  In a Constitutional Republic, the will of the majority does NOT negate the rights of the individual. Masks should be optional and mask shaming should be against the law...

depdvr · 1 month ago

"The pandemic binds us in a shared destiny, and we need to turn to our cultural roots of interconnectedness"As we can see from the comments that the "about all of us" is open to interpretation and ideological mindset that has been formed by reaction to a country that has been splintered apart.In a country where cultural identity is more important than integration, where race and sex predominate politics instead of rallying around shared values and how to achieve those national goals, and when citizenship for anyone who crosses the US border, a national line that many want to tear down - consensus is a serious challenge even in a pandemic.In fact, the pandemic brings to the surface what has been festering, and that is the results of a predatory health care system, a corporate controlled political system that focuses on profits, allows profits to be hidden from taxation, and abandons the working-class to a lower standard of living while advertising itself as "exceptional". 

Joseppi · 1 month ago

Dr. Titcomb, please provide evidence of "protesters carrying automatic weapons into their state capitol" or revise your statement to say "semi-automatic" weapons.  There is a big difference.  One is illegal; the other is legal.

AP · 1 month ago

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