Nothing is possible without man, nothing is sustainable without institutions
Uncertainty and mindlessness characterize a significant portion of our current moment in history; mounting insecurity in man’s forward journey; limited prospects down the road for a better life for many, with little room for manoeuvrability to avoid an increasingly unstable and hostile future. Dealing with denial in the political pose is a major issue. Strengthening of autonomous institutions is a large part of the answer. Competences and added altruism are others. Each national election, each new treaty, convention and probe into humanitarian crises, each new attempt to ban nuclear weapons, provide fleeting windows of opportunity to deal with significant institutional issues for countries, regions and the world. The vitally important Convention on the Rights of the Child (CRC) however, does not cover all children now engaged in child labour and where most of them live in conflict zones or the 70 million children affected by disasters each year. Climate change is now characterized as a devastating "threat multiplier" connected to global temperature rise, damage to agriculture, mass migration, and instability precipitating increased mortality but much greater in more vulnerable regions of the planet. Informed opinion says that greenhouse emissions currently unsafe may become irreversible by 2020 if not checked. Many cities may become much more intolerable and inhospitable.
Some of the troublesome issues are wrapped up in global health; the global burden of disease, health inequality, global warming. Some are wrapped up in irritating questions: Equality to what degree; is disease stemming from narcotics, gluttony, alcohol and smoking, self inflicted; what are the responsibilities of big tobacco, drug cartels etc? The contrasting and equally complex world is one of impressive diversity, with longevity and wellbeing. Without political support, it can all be lost! Then the impoverished and disenfranchised can never inherit even a small part of the earth. The well to do, affluent and super rich can all go down too!
A global security system that emphasizes public health is urgently needed. It should provide reliable information, vital for preparedness, mitigate disaster and help in crisis response. It should also help anticipate potential disasters and when one arrives their outcomes and the needs for rehabilitation. Public health can aid human security and reduce galloping inequality, which is driving a runaway train towards a much more pronounced status of population vulnerability. The current model of enlightened leadership working through the United Nations and the international community to some extent is inadequate to the task of reducing inequality and human suffering and to improving global population health. In the political arena public health is a much disparaged strategy until disaster strikes.
More meaningful main stream activities are desperately needed to deal with global health issues. Sustained political support for the international community and its institutions [United Nations and the World Health Organization] is necessary and mandatory. Health is threatened by climate change, globally; loss of biological diversity and cultures, and by political inconsistencies and ineptitude.
We need a better articulated agenda for global health commensurate with the complexity of the problem space. It must start with deliberate, consistent and unrelenting political support for public health and unfold through effective science and policy, efficient and accessible services as well as better professional education. The broad application of health diplomacy and human security with appropriately applied scientific medicine and universal education should be givens. A revolutionary agenda can be built on a tremendous and existing legacy. Reform thinking, usually advanced and ahead of its time usually undergoes a changing image on the way to either partial application or failure and can result from the influence of strong lobbies or a lack of resources. We should not be lulled into the false thinking that infectious diseases are of little threat, that locust and famine will cease; that global upheaval will be completely and overwhelmingly held in check by denial and that peace in our time will prevail. Some strengthened form of world governance is the only way to stem looming massive social unrest and political instability and replace it with sustainability. It should come with added ethical value embedded in democracy and equality.
Currently, conditions detrimental to health are emergent in our own back yard, aiding resurgence of eradicated diseases such as malaria, rabies and tuberculosis. In some back yards where vulnerability is even higher and resources minimal, outcomes of mounting social disruption may be worse especially in the presence of military conflicts and climate change.
One or more apocalyptic horses those of pestilence, disease, hunger or war, now gallop or have galloped over the land (Yemeni, Somalia, Sudan). Such hoof beats have been interpreted as Mother Nature going wild with drought, blight, famine, forest fires, floods, and earthquakes, or result from governmental folly causing displacement of whole populations or frequently as a result of man’s sin. Most often, disaster stems from the thoughtless, brutal and inhumane actions of man as in Syria by withholding public health services from suffering victims, in the Yemeni, which now faces cholera and chaos or with the tragic loss of life in the Mediterranean. Drought, famine and more recently imposed austerity measures result in complex, slowly encroaching creeping disasters with significant socio-economic and environmental impact. Drought is the cause of more deaths and population displacement than any other natural disaster. Insidious austerity in Greece is pushing up infant mortality and reducing life expectancy, this, in the European Union.
Reduction of hunger and starvation and ensuring clean water, dealing with the threat of a nuclear accident or war or counteracting denial of global warming, demands a much greater international effort and all efforts must be linked to fundamental human rights and peace.
For centuries devastation of populations has resulted from plague, smallpox, tuberculosis, cholera, typhoid and malaria. Infectious diseases are always deceptive space time travellers. Threats can be newly emerging (AIDS, Zika) or re-emerging (cholera, tuberculosis) and appear anywhere, anytime in some new guise. They can bring fear (SARS), wreak havoc (mad cow) and spread disability in children (polio).
Development of global partnerships between the structures for public health and disaster health management, human security, and international health diplomacy with their universal application are the only pathways to resolution. Those pathways are only possible with the application of political will. As health concerns do not recognize national boundaries, the importance of international perspectives and cooperation in the teaching of public health cannot be overemphasized. To reflect the fact that public health problems and solutions have global determinants and implications, its approach to teaching must employ a global perspectives.
The public health community through its various Associations (ASPHER, EUPHA) and Federations (WFPHA) are developing global partnerships that will improve the implementation and skills for public health management, design and evaluate policies and strategies as well as cultivate the concepts and language of global health. In its Athens Accord, ASPHER expresses grave concern for public health problems that have engulfed European peoples as a result of austerity, migration, terrorism, environmental degradation and epidemic threats. Efforts to stem the tide are recognised as an uphill struggle! They have not yet caught the eye of politics.
Charles Simic an American poet laureate from the Balkans, says, that the American poet Levine could not bear living, thinking that man’s need to oppress, hate, kill, will never change. He goes on to say that if more young people had read Levine they might have thought again before voting as they did, in the last election. Sigmar Gabriel, German Foreign Minister says that anyone accelerating climate change by weakening environmental protection or sells more weapons in conflict zones, and who does not want to politically resolve religious conflicts, puts peace in Europe at risk. Anders Foldspang (ASPHER) has said that the challenges of public health do not follow national borders, neither do the basic principles for coping with challenging problems and that everything is more or less, international (Global).
It is time for politicians to find the nerve, scientists the imagination and government the understanding, to better support public health before population inequality and environmental mismanagement pushes the world over the brink. Public health professionals must take bold actions to put population wellbeing on the political agenda. The German focus for example for global health is on effective health crisis management, the support for resilient national health systems around the world, and strengthening of the WHO as main coordinating actor of the international community on health issues. We should all support pushing up population health, strengthening global health development and give greater support for the WHO. Our demand must be to push these issues higher up on the international political agenda.
When and where the next disaster will strike is an unanswerable but a pertinent question? London, Manchester, Alexandria? Some distant shore, one’s own back yard? Governments, the international community and individuals must be prepared, but other poets (Hendrik Marsman, Dutch; C.P. Cavafy, Greek) tell us that in any region the voice of water murmurs of endless disaster; when one strikes, it instils fear and the disaster not contemplated, hits suddenly... Finding us least prepared, it leaves little time for response... Then, we are swept away.
Public Health is a cross-culture lingua franca and catalyst for peace, an integral factor for socio-economic development. Public health’s deceptive appeal of neutrality is powerfully political and can be used as an instrument of foreign policy and a tool to foster international relations. Global health can help build a more resilient world.
Beaglehole R, Bonita R., Global Public Health: A New Era. Oxford: Oxford University Press (2009).
Catherine Panter-Brick, Mark Eggerman, and Mark Tomlinson, How might global health master deadly sins and strive for greater virtues? Global Health Action Vol. 7 , Iss. 1,2014 Charles Simic, A Voice for the Voiceless June 22, 2017
Levett Jeffrey, From cradle of European civilization to grave austerity: does Greece face a creeping health disaster? Prehosp Disaster Med. 2013;28(6):1-2.
Levett Jeffrey, Political Determinants of Disaster: Kosovo. 15th World Congress on Disaster and Emergency Medicine