Thursday, August 27, 2015

Uncertain Health in an Insecure World – 54


When a cardiac patient suddenly loses their vital signs, as their pulse or breathing stops, doctors call it "crashing". The medical team’s response to the critical situation must be swift and decisive, if the patient is to survive. And even then, the outcome is always in doubt.

This week saw the crash of global stock markets… oddly named a “correction”. This week saw crude oil prices drop below US$40 per barrel. This week saw reports of a 165o F heat index in Iran, and of the hottest July on record in the U.S. since 1880, averaging 0.85o C above the 20th century average.

My question is simple. What does this all mean for global health?

We have previously explored the interconnectedness of economic and environmental hits on the health of people around the world.  People are displaced as food supplies dwindle in the face of drought. Medicines are misappropriated by war and corruption. Killer epidemics emerge from the depths of jungles. Epigenome and microbiome cell milieus shift in response to water and air borne toxins. And lifestyle-driven obesity adds to chronic disease prevalence.

These slow moving, inexorable adverse trends are constantly shifting the tectonic plates of global health. But when a sudden worldwide earthquake hits, what are the short and longer term sequelae?

Life has a poor prognosis. And nobody can predict the future… of markets, the weather, natural resources and viral mutations.

History repeats itself. Can we learn from the past, and use past experiences to shape the future?

The last time the price of a barrel of crude oil fell below US$30 per barrel was 1986. That year, the global oil glut drove the average price down to US$26.80 a barrel. That year, the world’s population was only 4.9B and the average life expectancy in the U.S. was 74.7 years. The U.S. space shuttle program was put on hold after the Challenger blew up off Cape Canaveral; the average age of the crew was 40.1 years.

That year in the U.S., the violent crime rate rose to 54.8 per 1,000 population. The Congress passed an immigration bill preventing the hiring of illegal aliens. Back then, there was no U.S. presidential candidate/reality TV magnate connecting the two.

Before the global economy was declared “flat” by author Tom Friedman, the world had begun to think of itself in global terms. The best picture of the year went to Out of Africa, and the number one hit record was We are the World (USA for Africa).

What kind of health was the world experiencing in 1986?

In the U.S., the FDA approved the first genetically engineered vaccine for Hepatitis B. The CDC reported that the year’s H1/N1 Influenza strain originated in North China, beginning a global Asian flu epidemic. In the then Soviet Union, the Chernobyl nuclear reactor core melted down, radiation poisoning thousands for generations (below, left). In Bhopal India, Union Carbide agreed to settle with thousands of toxic gassing victims (below, right). 

Rita Levi-Montalcini and Stanley Cohen received the Nobel Prize in Medicine & Physiology for describing how neural growth factor (NGF) and epidermal growth factor (EGF) regulate cell growth and differentiation, opening a new era of research into dementia, wound repair and cancer.

Nearly thirty years have passed. Nothing and everything have changed.

The globe is now hotter, flatter and more crowded.

The world is telling us something. The patient is crashing.

Like you, we in the Square are white-knuckling it. But by learning hard lessons from what history teaches, we can rally before hitting bottom.  

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