The Coming Catastrophe in International Health

Abstract

INTRODUCTIONDuring the 20th century, developments in science and technology and their application in medical practice have transformed the nature of health care and improved the lives of many people. In the 21st century, advances in genetics have the potential to transform medical practices even further through a revolution in applied genomics and molecular medicine. Some examples of what could be achieved include the ability to determine genetic susceptibility to disease and to prevent disease by linking environmental control measures to those at particular risk; the use of gene therapy to correct genetic defects; and the use of new molecular biology techniques to design new, more specific therapeutic agents. New functional imaging diagnostic techniques, less invasive surgical methods, and specifically designed target drugs could contribute to more efficient treatment of many disorders. The global reach of communications technology, which can bring appropriate health care knowledge to health care workers worldwide, also offers the possibility of enhancing health and well being globally. This is an exciting and challenging time for medicine and health care professionals.Changes in the world economy, especially in the past 50 years, have generated great wealth, which has also enhanced the lives of many people. Some believe that continued economic growth is the primary factor in improving human life. However, current economic trends are both widening the gap between rich and poor and exacerbating the extent of absolute poverty. Because health care systems are shaped by both societal values and the distribution of wealth and power, the result is striking disparities in health care expenditure and health research priorities, neither of which mirrors disease burdens. Lack of access to modern communication facilities, unwise use of new biological power, and a failure to make basic health care widely accessible are widening rather than narrowing the gap between rich and poor - as vividly illustrated by the lack of access of millions of people to modern treatment for HIV/AIDS.At the end of a century in which spectacular scientific and technological progress greatly enhanced the lives of about one-fifth of the world's population but available knowledge and resources were not used wisely the warning signs of an impending catastrophe in international health were increasingly apparent. Intense poverty, widespread hunger, and preventable diseases, the emergence of many new infectious diseases, environmental degradation, profound human suffering, and internecine conflict on a large scale (adversely affecting the lives of up to 80 per cent all people in the world) can be interpreted as malaise and instability within a complex global system. These features are late manifestations of humanly determined processes that have been under way for many years. They warn us of the potential for a phase in human history characterized by malnutrition and rampant infectious disease pandemics as a result of multidrug resistant organisms on the one hand and a growing burden of morbidity and mortality from obesity, diabetes, vascular disease, and malignancies on the other.(1)Economic growth, progress in science and technology, and the unprecedented potential power of gene-based health care should not blind us to the fact that threats to the health status of billions of the planet's citizens could today be greatly attenuated by improving access to essential drugs and vaccines and through well recognized public health measures. Today, more than ever, it is necessary to acknowledge that equitable access to health care is a morally required basic need for humans to grow to maturity and achieve their potential. Advances in knowledge and the application of technology alone are not sufficient to achieve such goals.We will have to make major shifts in the way we think about the health of individuals and populations, present and future, to encourage the policy changes necessary to achieve more widespread human well being. …