The year that reminded us about public health

2014, from the perspective of public health, was the year of Ebola. 

The Red Cross website states that, “The current Ebola outbreak is the worst in history. More than 7000 people have died from Ebola and over 17,200 cases have been reported [since the epidemic began in May 2014 in Sierra Leone]. Sierra Leone, Liberia and Guinea are the hardest-hit countries”.
There are over 10,000 volunteers, many from the affected countries, working with the Red Cross on Ebola. Christmas and New Year celebrations have been cancelled in the ironically-named capital, Freetown, in Sierra Leone.  Palo Conteh, head of the Ebola response unit, said, "We will ensure that everybody remains at home to reflect on Ebola”.

But Ebola is there and not here and, barring serious mutation, it is unlikely to come. The reasons for this are clear and have to do with the poverty and lack of health services in the affected countries. Sierra Leone is tropical and small with a population of about six million people, 70 per cent of whom are in poverty despite the country’s deep harbour, its diamonds and gold, rutile and bauxite exports.
Civil war between 1991 and 2002 left the country in a shambles, its infrastructure smashed, with 50,000 dead and millions displaced. Only half the population has reliable access to clean drinking water and so diarrhoeal diseases are common and kill children.

In 2012, according to the WHO, the Government spent $15 per person on health.  Each year in Sierra Leone 220,000 children are born. The infant mortality rate of 73 deaths per 1000 births puts the country near the top of that league. There is one doctor per 50,000 of the population, and 70,000 children younger than five years die each year, the highest rate in the world.

Maternal mortality is also high, at eight per 1000 births. As humanitarian organisation Amnesty International puts it, one in eight women risk dying during pregnancy or childbirth. “Thousands of women bleed to death after giving birth. Most die in their homes. Some die on the way to hospital; in taxis, on motorbikes or on foot. In Sierra Leone, less than half of deliveries are attended by a skilled birth attendant, and less than one in five are carried out in health facilities.” Female circumcision is rife.

So, while 6000 deaths from Ebola are tragic, the underlying social conditions in Sierra Leone enable this to occur, and many times that number of children and women die of conditions also attributable to the environment. That is the central message of public health.

To achieve good levels of public health and avoid death from childbirth, diarrhea, malaria and Ebola, we must go back to basics. You can’t contain or prevent Ebola without clean water and cups to drink the rehydrating fluids, and without basic medical amenities. If you can’t stop a hemorrhaging mother bleeding to death you can’t treat Ebola.  

You cannot do these things without improving the environment.

Clinical teams can be rushed in to help Ebola victims – a thoroughly worthy response. But the longer term requires action that addresses poverty, provides aid, and costs money. Serious money. That’s what Ebola reminded us about this past year.

The second environmental lesson 2014 has taught us is that our fantasy, created as though we were turtles lolling in the warm waters of the Galapagos Islands remote from the mainland of reality that global warming either doesn’t happen or doesn’t matter, is that there is no protection against the serious health problems arising from it in future. This is something we need to learn and act upon despite the bipartisan chaos that surrounds the Australian politics of climate change.

Time to get serious, time to stop pretending that the carnival that is life in Australia is free and instead see that the environment – physical, human and global – will set the agenda for our future health. 

Published in Australian Medicine, Opinion, 23 Dec 2014.  http://bit.ly/1xORSzt