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World Saving, Cheaply Done

On the Attack

I read with great delight your article "Unlikely Prophets" (Fall 2005). It depicts the giant strides in public health and further re-echoes that we are moving from the defense line to the attack in the field of medicine.

Olaniran Abimbola, MBBS
Ibadan, Nigeria

Putting "Cheap" in Perspective

The claim that breastfeeding is "free" ("Ten Cheap Ways to Save the World," Fall 2005) obscures the way that we have balanced our global epidemiological books on the backs of the world's women.

On the biological level, a woman requires an additional 500 calories per day during the first six months of lactation—[as well as ideally adding] 400-mg calcium daily and vitamins such as B-6 and D. On the social level, the time investment involved in exclusive breastfeeding is enormous.

Finally, aside from the costs of breastfeeding, we must remember that its effectiveness in decreasing risk from diarrheal infections reflects our colossal failure to provide billions of people around the world with safe drinking water. This emphasis on breastfeeding rather than clean water is typical of the current tendency in public health to value individual-level interventions over structural ones.

Jennifer S. Hirsch, PhD '98
Associate Professor
Mailman School of Public Health Columbia University

Bravo on a compelling piece! ["Ten Cheap Ways..."] was clearly written, to the point, and I am especially pleased to see the economic tie-in. We are a research advocacy organization whose mission is to make medical and health research—including prevention and public health research—a much higher national priority. This article is an important advocacy tool for us.

Karen A. Goraleski
Director, Prevention Research Initiative
Alexandria, Virginia

When it comes to adequate water supply and sanitation, three of your "Ten Cheap Ways to Save the World" need to be put into perspective.

Oral rehydration therapy (#3) is no substitute for potable water and its power to prevent disease. Procter & Gamble's "PUR" product (#7) can produce small amounts of drinkable water, but it must be imported and cannot replace a water supply system. Finally, the pit latrine (#4), a long-used way to dispose of human waste (particularly in rural areas), may not be so useful or adaptable for the millions of persons living in peri-urban and urban areas.

Our public health efforts now need to ensure that all of humankind is able to benefit from full-scale water and sanitation systems.

Arthur Cohen, JD, MPH '80
Baltimore, Maryland

I was somewhat taken aback to read that one "cheap way to save the world" is to purchase PUR packets to purify water. In most cases, a low-tech method using direct solar radiation to reduce pathogens will render water safe to drink. The cost is negligible as this approach entails setting water-filled plastic bottles in the sun for several hours. Safe drinking water is certainly a public good. Why does a public health magazine promote a private-sector response to a public-sector responsibility?

Carol Underwood, PhD
Senior Faculty Associate, Population and Family Health Sciences

Editor's Note: To learn more about solar disinfection of water, go to

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