Editorial: Why do We Choose to Address Health 2020?

Abstract

Recommended Citation: Flahault A, Martin-Moreno JM. Why do we choose to address health 2020? Public Health Reviews. 2013;35: epub ahead of print.What can we predict for 2020? Solar and lunar eclipses? Without a doubt. Climate change? Most likely. Rising sea levels? Signs point to yes. Beyond that, however, in world of human events, it is best to be cautious. In field of health and medicine (or anywhere else, for that matter), no one predicted most important discoveries of twentieth century. Economists were no more successful in foreseeing financial or economic crises. The pundits did not forecast any of recent wars, disruptions or even recent Arab Spring movements-indeed, political experts turned out to be only slightly more accurate than dart-throwing chimpanzees in divining what was in store for future.1 As World Health Organization (WHO) and wider scientific community looked to East Asia in anticipation of next outbreak of H5N1, influenza H1N1 pandemic took hold in Mexico. Tsunamis, volcanic eruptions, earthquakes, drug scandals, outbreaks of emerging diseases and political disruptions are notoriously unpredictable, as Nassim Nicholas Taleb brilliantly highlighted in his book The Black Swan.2Under these circumstances, where change is only constant, Peter Drucker used to say that we have to prepare for the future that has already happened,3 that is, we must examine our present to glean clues about our future. When Charles Townes's research on light diffraction led to invention of laser, he could not foresee thousands of applications it would have in field of home video and music, nor major impact in eye surgery and medicine. But innovative scientists and engineers transformed it into a tremendously beneficial tool for humankind by envisaging potential fruit of a tree whose seed had only just been planted.Policymakers and public health professionals are thusly charged with preparing health systems and populations for future challenges as best as possible, relying upon knowledge available to us now. There are some weighty trends whose mechanisms have already been set into motion; these will to a great extent shape our future. Demographic trends within populations and workforces, current prevalence of important disease determinants (obesity, smoking)... these are fundamentally reliable indicators that we can use to plan for appropriate health system responses. While we cannot shut door on surprises that future holds, it is highly probable that up to 2030, cancers, coronary heart diseases and stroke will remain, three primary causes of mortality in developed countries.4 It is also foreseeable that unipolar depression, diabetes and dementias will become foremost causes of burden of diseases in these settings.4Beyond those trends, it is difficult to predict breakthroughs that will change people's lives and revolutionize how we deal with disease. A few months ago, we might have imagined that stenting would dramatically change prognosis of stroke in intracranial stenosis. Yet, a 450-patient randomized trial was stopped early due to increased mortality one year after treatment in intervention arm.5 It is hard to anticipate if mammography will remain gold standard for early detection of breast cancer due to emerging doubts and controversy raised about its true efficacy.6 By contrast, early detection of lung cancer with spiral low dose tomodensitometry may be recommended in near future, after publication of a large NIH-funded clinical trial involving more than 50,000 heavy smokers or former heavy smokers aged 55 to 74.7 This trial was also terminated early, but in this case it was due to a significant decrease in all causes mortality, as well as in lung cancer specific mortality. Promising breakthroughs against two of scourges of developing world, malaria8 and HIV/AIDS,9 could also dramatically change global disease burden. …