Understanding the Wider Health Crisis is Important for Adequate Response
>> “Any epidemic anywhere must now be seen as a threat to virtually all countries especially those that serve as major hubs of international travel.”
>> “Doctors worldwide are losing some of the most useful and affordable antibiotics.”
>> “At least 333 million new cases of sexually transmitted diseases, other than HIV infection, occurred in one year.”
These quotes from The World Health Report (WHR) 1996 indicate the extent of the threats to health at a world level despite all the advances in science and technology. The reason for quoting from this rather old report is that this is a very remarkable report in terms of the seriousness of the warnings it voiced.
It was about 27 years ago that this report warned, “We stand on the brink of a global crisis in infectious diseases. No country is safe from them… The optimism of a relatively few years ago that many of these diseases could easily be brought under control has led to a fatal complacency among the international community. This complacency in now costing millions of lives – lives that we have the knowledge and the means to save, yet we are allowing to trickle though our fingers.
Further this report said, “Antibiotic resistance in hospitals worldwide threatens to leave medical and public health workers virtually helpless in the prevention or treatment of many infections. Many of the most powerful antibiotics have been rendered impotent. Disastrously, this is happening at a time when too few new drugs have been developed to replace those that have lost their effectiveness. In this contest for supremacy, the microbes are sprinting ahead,” Various factors have combined, this report said, to create, “perhaps the richest opportunities ever for the spread of infections.”
In particular this report focused attention on the threat of new emerging diseases – “During the past 20 years, at least 30 new diseases have emerged to threaten the health of hundreds of millions of people. For many of these diseases there is no treatment, cure or vaccine and the possibility of preventing or controlling them is limited.”
The WHR report warned, “Without doubt diseases as yet unknown – but with the potential to be the AIDS of tomorrow, lurk in the shadows.”
Hospitals, are supposed to be a place for treatment, but this report pointed out that in the USA alone nearly 2 million cases of infectious complications acquired in hospitals occur every year, including about 70000 related deaths.
If one of the most widely read health documents with the credibility of the WHO attached to it voiced such serious warnings and comments, then surely these should have led to serious remedial actions. But there is no evidence of such successful remedial actions and instead what we see in the health crisis situations which followed is that the situation was repeatedly messed up badly in country after country due to lack of adequate preparations and policy response.
It is true that most countries have experienced overall rise in life expectancy in recent decades but this has been accompanied generally by an increase in chronic health problems, physical as well as mental. In Britain, for instance, General Household Surveys in 1972 and 1988 revealed a 50% increase in ‘long standing illness’ and a 75% increase in acute illness during the preceding two weeks. In the same country during 1960-90 hospital admission for children suffering from asthma went up by ten times.
Walter Yellowlees, a highly experienced doctor of this country said in a paper read to the Royal College of General Practitioners: “I believe it is true to say that in those countries which have achieved unparalleled advance in technological skill in medicine and in what is called standard of living, we are witnessing the decay of man – the decay of his teeth, his arteries, his bowels and his joints on a colossal and unprecedented scale.”
While the proportion of elderly people is increasing rapidly in many countries; disability, disease and above all loneliness are denying happiness in old age to many of them. Available data shows that 41 per cent of elderly women live alone in Australia and Denmark. It has been estimated that at age 60 a third of population has some kind of disability. Time Magazine reported in a widely discussed investigation that even in the USA, “in possibly thousands of cases, nursing home (elderly) residents are dying from a lack of food and water and the most basic level of hygiene.”
An important cause of increasing health problems even in some of the richest countries is the heavy exposure to hazardous chemicals and pollutants. According to Samuel Epstein, an authority on this subject “The volume of hazardous wastes disposed of every year in the U.S.A. has risen from under one million tons in 1940 to well over 300 million tons in the 1980s – more than one ton per U.S. citizen per year. The industries involved – fossil fuel, metal mining and processing, nuclear and petrochemical have littered the entire land mass of the U.S.A. with some 50,000 toxic waste landfills.”
Exposure to hazardous chemicals and radiation as well as other hazards has increased greatly. Occupational health hazards and accidents are proving extremely costly for an increasing number of workers, and in addition they face increasing problems of physical and mental stress as well.
Russell Train, former chief of the Environmental Protection Agency, USA has stated, “There are today more than 30000 chemicals in actual commercial production. Every year, this list grows by some 1000 new compounds. Of the more than two million known chemicals, only a few thousand have been tested for carcinogenicity and-aside from those used in food additives, drugs and pesticides-only a few hundred have been adequately tested. We know, in fact, very little about the health effects even of the 30000 chemicals already in commercial production. We have no way of systematically screening the chemicals that go into production, we have no way of knowing precisely which chemicals go into production every year. In other words, we not only don’t know whether what’s going on out there is dangerous-we don’t even know what’s going on out there. We have, however, learned one thing: it’s what we don’t know that can really hurt us, even kill us.”
The London Food Commission said 3009 pesticides were approved for use in Britain in and that of their 426 basic ingredients, 164 have been implicated in causing cancer, reproductive effects ranging from impotence to birth defects, genetic mutations or irritant reactions.
Several giant companies producing hazardous products such as chemicals, tobacco, alcohol and above all armaments, have exerted strong-arm pressures to increase local sales and/or exports of their products. The result is that in the world as a whole, death from hazardous products in increasing at a fast pace.
Dr. David Werner, the internationally acclaimed health expert stated, “Attempts have been made by non-government organizations, the UN and the governments of various countries to try to limit the damage caused by these powerful industries. But in the case of each and everyone of these killer industries, the US government has defended their interests at the expense of the health, quality of life, and often survival of millions.” (The same is true of the government of many other powerful countries).
The profit motive also plays havoc within the health industry, The New Internationalist (quoting “Which Way to Health”) reported : “Surgeons in the US are usually paid on a fee-for-service or piece-rates basis. This is the land of private health care. Statistics show that people there are twice as likely to have operations as people in Britain, where there is still a National Health System and surgeons are paid simply a salary for doing their NHS work. American surgeons who are paid salaries have much lower operation rates than their fee-for-service colleagues…The connection between profit motive and unnecessary medical operations continues within the UK. Data shows that British women in the private beds in NHS hospitals have more than twice as many caesarian births as those in the nonpaying beds. It could be that doctors have the financial incentive to operate. It could also be because some patients with private health insurance can claim for caesarian, but not for a normal delivery.”
Due to the domination of the profit motive in the medicine industry, many essential medicines are priced out of the reach of poor people while at the same time the market is flooded with several high-profit superficial medicines of dubious utility.
More generally, growing poverty inequalities and exploitation in many parts of the world have contributed significantly to the worsening of the health situation. Another major factor that has contributed to this is the debt-burden of the poor countries leading to transfer of resources from already poor countries to rich countries.
The WHR stated “Today’s crisis is likely to get worse before it gets better. Internal and international movements of populations including refugees and migrants, haphazard and uncontrolled urbanization, economic development and changes in patterns of land use as well as ecology and climate are creating new opportunities for the spread of infections. Because of rapidly increasing international air travel, there is also a growing risk that diseases will spread within days or even hours from one continent to another. The expanding world trade and marketing of foods carries with it the threat of food borne diseases.”
The Global Environment Outlook Report voiced a similar warning, “The effects of climate variability and change are already increasing the incidents of familiar public health problems and leading to new ones, including a more extensive reach of vector borne diseases and a higher incidence of heat related illness and mortality.”
Thus a combination of factors has led to a serious threat for world health in the near future. Different aspects are emphasized by different specialized reports, but there is agreement that despite all the advances in science and technology the world faces a serious health crisis which can get worse in the near future. What is even worse, profit orientation is distorting the pattern of medical research and medical care, provision of essential medicines, equipments and vaccines.
Dr. N.H. Antia, a famous community health expert of India, interviewed by The Times of India said, “The medical profession has converted health into illness and illness into industry”. The prestigious New England Journal of Medicine stated in an editorial , “a glut of medical men is now begetting a glut of money-making medical mythology.”
Ultimately this has become increasingly one of the most serious problems now as most medical and health options, decisions and budgets are being decided more on the basis of profit considerations and other narrow considerations ( such as gaining control) than on the basis of the reducing distress and disease. The objective of improving health in a holistic sense, including physical, mental and spiritual health is getting even lesser attention. The various justice related issues linked closely to health are neglected and violated widely. These problems need to be overcome at a wider level if real and sustainable improvements in health and medicine are to be achieved. A world-level health movement which integrates holistic health and medical ethics with wider concerns of justice, nutrition, environment protection and peace is needed for this.
Bharat Dogra is a journalist and author. His recent books include Man Over Machine and Protecting Earth For Children.