Sunday Times 2
Three global health threats
SAN FRANCISCO – The tragic Ebola outbreak in West Africa has underscored the imperative of strengthening health systems at both the national and global level. But, though Ebola has focused the world’s attention on systemic shortcomings, the goal must be to combat the abiding epidemics that are quietly inflicting suffering and death on populations worldwide.
A health worker checks the body temperature of a fan as part of an ebola screening ahead of the 2015 African Cup of Nations group D football match between Cameroon and Ivory Coast in Malabo on Wednesday. AFP
Ebola has undoubtedly wrought tremendous agony. But it is not the first – or the most devastating – pandemic the world has faced. In fact, smallpox is the deadliest disease known to humanity; until Edward Jenner developed the vaccine in 1796, it was the leading cause of death in Europe. Before its eradication in 1980, it killed an estimated 300-500 million people.
The Bubonic plague of the fourteenth century killed 75-100 million people – more than half of Europe’s population. Nearly 75 million people, or 3-5% of the world’s population, died in just a few months during the 1918 influenza pandemic – more than twice the number of people killed in World War I.
The world continues to grapple with HIV/AIDS, which has already caused more than 40 million deaths and infects a similar number of people today, with 95% of the epidemic’s victims living in developing countries. Only when HIV/AIDS began to gain traction in advanced countries were highly effective anti-retroviral therapies developed – therapy that most of the poor people suffering from the disease could not access or afford.
Similarly, the failure of governments, multilateral organisations, and NGOs to respond quickly enough to the Ebola outbreak reflects the fact that the disease has ravaged poor countries. But, at a time of unprecedented global interconnectedness, everyone has a stake in ensuring that adequate health-care systems and structures are in place to address such a pandemic. Achieving this requires providing the needed investment; after all, effective national health systems and agile surveillance are the first lines of defense against outbreaks of disease.
At this point, Ebola is not only a health crisis, but also a humanitarian, economic, and political crisis. To be sure, some progress has been made. The United Nations Mission for Ebola Emergency Response’s “70/70/60″ plan – to isolate 70% of Ebola patients and ensure that 70% of burials are conducted safely within 60 days – has largely been implemented, reducing the number of new cases considerably. But people are still suffering and dying – often owing to a lack of access to credible information or adequate treatment.
Of course, when it comes to safeguarding the health of populations, there is a fine line between protecting the public and impinging on individual rights. That is why all public-health interventions must focus first and foremost on scientific facts, and avoid emotional or panicked responses.
In this context, the imposition of mandatory quarantines on travellers from Ebola-affected countries was an obvious policy failure — just as they were when authorities tried to contain the Black Death of 1350 in Europe or the Plague of London in 1665. Instead of wasting time on fear-based strategies, the international community must leverage human and financial resources to ensure fact-based, concerted, collective action. Such a united approach is possible; indeed, it has happened before.
At the turn of the century, the establishment of institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the Bill and Melinda Gates Foundation, and GAVI, the Vaccine Alliance, coincided with a renewed effort to improve global health. The UN’s commitment to the Millennium Development Goals — which included four health-related targets, covering nutrition, maternal and child health, and infectious diseases — reflected a political consensus to improve health worldwide. This institutional architecture has facilitated considerable progress in many of these areas; for example, the under-five mortality rate has plummeted by 49% since 1990.
But there is far more to be done. In regions like Southeast Asia and Sub-Saharan Africa, maternal and child health and infectious diseases remain priorities. In fact, the ten countries with the highest child mortality rates are all located in Sub-Saharan Africa; a baby born in West Africa is 30 times likelier to die before the age of five than one born in Western Europe.
Even within countries, massive inequalities remain. For example, there is a ten-fold difference in infant mortality between municipalities in the Mexican states of Guerrero and Nuevo León.
Moreover, silent epidemics have taken hold, particularly in lower-income countries, as the combination of mega-trends like urbanization, population aging, obesity, sedentary lifestyles, smoking, and alcohol consumption has spurred the rise of chronic non-communicable diseases (NCDs). For adults in most countries, cancer, diabetes, and cardiovascular disease have become leading causes of disability and death.
Emerging infectious diseases like Ebola may be more compelling, but the health impact of chronic NCDs, not to mention their high and growing social and economic costs, is substantially larger. There is no time to waste. Policymakers must pursue aggressive action to curb the spread of risk factors like the consumption of tobacco, alcohol, and obesogenic foods.
The world is facing a three-prong health challenge: We must build sustainable national and global health systems that can respond quickly and effectively to crises like Ebola; eliminate or control infectious diseases; and address the quietly rising epidemic of chronic NCDs. To succeed on all three fronts, we need sustained investment in health infrastructure, management, and personnel.
Equality is key. This means improving access to health care and education. But it also means addressing the deeper social inequities that extend beyond the public-health agenda. In formulating the post-2015 development goals, world leaders must remember that health is a fundamental human right.
Jaime Sepulveda is Professor of Global Health and Executive Director of Global Health Sciences at the University of California, San Francisco.
Copyright: Project Syndicate, 2015. Exclusive to the Sunday Times
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