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Keeping cool in the global warming climate
Published in Australian Medicine 19 November 2018 https://bit.ly/2QZAsSO
Tuesday, November 13, 2018
It's counter-intuitive but getting healthier should make us worry
Unlike in the past, modern public health programs have led to more poverty, unemployment and a rapid rise in chronic illnesses, says a leading GP
Confronted with challenges in our daily work, reinforced by depressing news about global politics, it is understandable that we feel like hunkering down and concentrating on local distractions, such as family and valuable friendships — not that these ‘distractions’ are uniformly free of challenges, of course.
But what is occurring globally establishes a context within which we all work and there can be value in looking above the parapet, keeping an eye open for a sniper in the distance.
Adjunct Professor Thomas Bollyky, a senior fellow and director of the Global Health Program at the Council on Foreign Relations in Washington DC, has written a challenging essay in the latest issue of council publication Foreign Affairs. The article is both informative and deeply disturbing. Entitled ‘Health without wealth’, Bollyky addresses “the worrying paradox of modern medical miracles”.
“For the first time in recorded history,” he states “bacteria, viruses and other infectious agents do not cause the majority of deaths or disabilities in any region of the world.” This infamy belongs to chronic illness.
Bollyky takes an historical view of how the vast improvements of the past century in health occurred in the US and Europe as a result of controlling communicable diseases.
These measures included “government-mandated measures — such as milk pasteurisation, laws against overcrowded tenements, and investments in clean water and sewage treatment systems — and better social norms around hygiene, childcare and girls’ education”. Half of the improvement in life expectancy in developing countries between World War II and 1970 was due to these means — and not to antibiotics and immunisation, Bollyky claims.
These public health measures had a strong relationship with prosperity. They occurred because governments invested in water and sewers and public housing. And, in return, a healthier workforce contributed to prosperity.
Big cities, the engines of innovation and achievement, became increasingly affluent because of rising productivity and were able to complete the circle of public health investment leading to societal economic benefit.
Related reading:
- Point-of-care testing: A revolution in waiting
- Patients pay attention when prescribed physical exercise
However, modern-day public health programs to address the likes of malaria, HIV and child immunisation have undoubtedly saved lives and increased life expectancy, but have failed to increase prosperity. “The recent hard-won gains threaten to bring a host of new and destabilising problems,” Bollyky writes.
This is because such programs, which are often paid for by outside agencies rather than local governments, have not automatically led to greater productivity, more employment or the expansion of local health services. In fact, the situation has led to more poverty, unemployment and a rapid rise in chronic illnesses as a result of changes to food supply, greater availability of tobacco and housing shortages.
In this setting, chronic disorders have flourished and a new generation of peri-urban slums have developed.
In Australia, we enjoy the ability to treat these conditions and we have succeeded in pushing many of them into the senior years. But think back to the 1950s and ’60s when our therapeutic abilities were much less and where death from an MI or stroke was common among middle-aged men. That is how it is in many less economically developed nations now — a huge loss of productive workforce in middle age.
Bollyky states that deaths from hypertensive heart disease among people under 60 have increased by nearly 50% in sub-Saharan Africa in the past 25 years.
“In 1990, heart disease, cancer and other non-communicable diseases caused about a quarter of deaths and disabilities in poor countries,” he adds. “By 2040, that number is expected to jump as high as 80% in countries that are still quite poor.”
The remedy, Bollyky suggests, is a more comprehensive approach to international aid — ensuring that investments help countries to improve their healthcare systems, make their cities more liveable and “enable their companies to employ more people more productively”.
While our preventive approaches to chronic illness in Australia could do with more money, we can be thankful that we have healthcare that enables us to manage chronic ailments, especially through general practice.
However, in this global era of chronic illness, it would be wise for governments to remember that spending on healthcare and enjoying prosperity are two sides of the same coin.Professor Stephen Leeder is an emeritus professor of public health and community medicine at the Menzies Centre for Health Policy and School of Public Health, University of Sydney.
Published in the Medical Observer 18 October 2018 https://bit.ly/2PwaJVK
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