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Ebola and the weak link of public health

Epidemiology: Three groups of individuals (S, I, R) with only individuals in S and I travelling between the three patches. Philippe Giabbanelli 2010. http://commons.wikimedia.org/wiki/File:MovingPopulation.jpg

Epidemiology: Three groups of individuals (S, I, R) with only individuals in S and I travelling between the three patches. Creator: Philippe Giabbanelli 2010. Source: Wikimedia Commons.

It has long been my contention that one of the chief symptoms of the age of constraints we have now entered would be the decline of public health systems globally. This comes at a time when our vulnerability to a worldwide epidemic is increasing because of widespread international travel, the proliferation of densely populated megacities and the general trend toward urban living. Of course, urban environments are ideal for spreading disease because of the proximity of the residents.

The sudden re-emergence of the deadly Ebola virus is testing whether public health systems are adequate to the job of containing such threats. While we know that there is a link between the general health of a population and public health expenditures, it is difficult to find statistics on expenditures worldwide by country to assess the direction of public health spending. We do have evidence that declining health spending in Greece in the aftermath of the financial crisis there was followed by demonstrably worse outcomes. And, the medical community thinks the United States is spending too little on public health, just $251 per person (in 2012). Keep in mind that this is distinct from spending on medical care which totaled $8,086 per person.

So let's be clear; public health refers to the following according the American Heritage Dictionary:

The science and practice of protecting and improving the health of a community, as by preventive medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards.

Public health measures are at the heart of increased longevity and health outcomes for most societies. It is disease that is prevented--AIDS and other sexually transmitted diseases; diseases associated with improper disposal of human wastes such as cholera and typhoid that are reduced and even eliminated through proper treatment of sewage; diseases for which there are now effective inoculations such as tuberculosis--that makes the most difference in our overall health. Accident prevention is also key: safer automobiles and workplaces are major reasons we are leading longer and healthier lives.

For all its benefits, public health has been shortchanged recently in many countries and localities because the sluggish world economy of the last several years has meant less revenue for the governments financing such expenditures. This slow economy is a puzzle only to those who do not understand that the economy runs on energy and energy, particularly oil, has been much more expensive than in the past. This makes the Greek economic blowup, for example, more of an energy crisis than a financial one. The Greek government and society were fine with all that debt until energy prices vaulted skyward and made it difficult both to service the debt and pay for the energy needed to run the country's homes, factories, commercial establishments and vehicles.

And, Greece wasn't the only country burdened by the double burden of debt and high energy costs. All of Europe has been hit by it to one degree or another. Much of Africa suffers from one or both burdens. And Africa also suffers from a higher degree of social and political chaos that results from weak central governments, governments less able for financial and administrative reasons to deliver adequate public health services to their populations.

This means that public health is consistently underfunded given its huge benefits and given the true threats. This is partly because the most obvious and dangerous threat--a fast-moving and deadly worldwide epidemic--tends to appear episodically at long intervals. The last truly major worldwide epidemic began in 1918 and ended in 1920. It was dubbed the Spanish Flu and killed an estimated 3 to 5 percent of the population. The equivalent death toll today would be 210 to 350 million people based on a world population of 7 billion.

The economic stagnation of Europe has made it difficult for countries such as Greece to maintain public health expenditures. The stress on health systems in the states of the former Soviet Union--the breakup of which still reverberates in many ways through the health systems there--has only been increased by the AIDs epidemic which is partly responsible for a population decline in Russia from the time of the breakup of the Soviet Union to today. But perhaps the most vulnerable areas are many countries of sub-Saharan Africa where governments are weak, economic vitality is low (which limits government revenues) and health infrastructure is limited.

It's not just our poor prevention efforts, however, that are increasing our vulnerability. It turns out that our energy and resource policies are adding to our risk. Climate change, mining and deforestation appear to be playing a role in the latest Ebola outbreak. The very energy system that drives our economic engine using primarily fossil fuels leads to climate change which leads to increased stress on and fragmentation of forests where Ebola hides. Animals, particularly bats which can carry the virus, are seeking places to live among humans when habitat is lost. And, the need for human residents to make a living through exploitation of forest resources including mining drives people further into the African forest where they risk exposure to the virus.

And, of course, war is a perfect activity to engage in if you want to spread disease. In World War I, 44 percent of all active-duty deaths among American service personnel in 1918 were due to influenza. This was, of course, during the time of the Spanish Flu epidemic mentioned above. And, we now have plenty of war in the Middle East, in Libya, in Israel and the Palestinian territories, and in The Ukraine.

Finally, there is the growing problem of antibiotic resistance. Two years ago the head of the World Health Organization warned that overuse of antibiotics in people and in animals is setting us up for a world in which "[t]hings as common as strep throat or a child's scratched knee could once again kill."

The article linked above also stated that "many drug companies see no point in investing to develop better antimicrobial drugs because they will just be rendered ineffective in a few years because of overuse." Our carelessness is moving us back into a pre-antibiotic world.

If the current outbreak of Ebola is not contained, few people will understand it is because of the way our global system is structured and the vulnerabilities it creates: forcing people to seek livelihoods and food ever deeper in the remaining forests; logging those forests relentlessly; the burning fossil of fuels to power almost all our activities and the climate change it creates with its dangerous consequences for the spread of epidemic diseases; easy international travel which has already helped to spread the Ebola virus; densely populated, ever growing cities; and for bacterial diseases (not Ebola) pushing the use of existing antibiotic drugs because it is good for drug company profits (while ignoring the longer-term issue of antibiotic-resistant microbes).

Most people, however, will look at the Ebola outbreak as merely an external force of nature that we humans somehow had the misfortune to encounter. That kind of thinking will prevent us from learning the deeper causes of our public health vulnerabilities and therefore prevent us from addressing them as part of a larger project to create a healthier, more sustainable way of life.

What do you think? Leave a comment below.

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