By Evan Carron-Kee
In an issue that documents the return of the Taliban to Kabul, a migrant crisis that threatens the foundations of the EU, and the breakdown of democracy in America and Uganda, and Moldova, you may be hoping for a morsel of good news. Well, you will not find it here. The COVID-19 pandemic was only one manifestation of a global public health crisis which is cutting lives short and threatening the dream of prosperity in the developing world. Public health scientists hold the insights for policy-makers that could prevent a future of ill-health, misery, and economic malaise - and we just are not listening.
Globalization is increasing the risks of novel infectious diseases. Yet, the global response to infectious disease is not only unfair but incompetent and irrational. Over 75 percent of vaccines produced have gone to a group of ten rich countries, whilst 98 percent of the African population are yet to receive their first shot. Governments have also failed to pay enough attention to potential outbreaks. A 2018 study found that the time between the announcement of a public health emergency by the WHO and resulting global collective action was unaffected by the number of people affected or the severity of the initial outbreak. Instead, the researchers found that response times were fastest when it was American citizens that had been infected, and when the emergency was not declared on a public holiday.
Researchers found that response times [to public health emergencies] were fastest when it was American citizens that had been infected, and when the emergency was not declared on a public holiday.
As the world population grows older, we face another threat to public health: age-related disease and in particular, dementia. Global cases of dementia are forecasted to grow threefold by 2050, to a total of 155 million cases. Costs of caring for the victims of the disease will double in the same timeframe to $2 trillion. What is more, this rise will be concentrated in low-to-middle income countries, where healthcare systems are weak and the tax base is already stretched to breaking point.
Public health scientists operate at the intersection of medicine and the social sciences, with research teams often being composed of economists, psychologists, and anthropologists, as well as medical doctors. The discipline is extremely relevant in guiding public policy and decision making, whether it is on how to distribute vaccines or how to improve dietary health. For example, neurologists estimate that almost 90 percent of Alzheimer’s cases, within the average lifespan, could be prevented by changing behavioral and environmental factors such as diet and exercise. The improvements that could be made to quality of life for millions of people are astonishing, but the difficulty of implementing these changes stands in its way. Public health science is the study of how to circumvent this issue.
Yet public health is woefully underfunded, both domestically and on the international level. The problem is most striking in the US where, for every $100 spent on acute care, $3 is spent on public health. This imbalance results in dire health outcomes. The US has appalling maternal mortality rates, for example, ranking below both Kazakhstan and Bosnia and Herzegovina. British public health bodies currently face an estimated £3.2 billion funding gap next year. Of course, Irish healthcare is also notoriously poor and is no better when it comes to public health. A failure to invest in preventative measures and primary care within the community has led to undue strain on central hospitals. Across the world, there is a pattern of investing in treatments which are often far more expensive, rather than preventing illnesses through public health measures.
Global public health infrastructure is inadequate: the WHO’s budget over the next five years, which is funded almost entirely by member states, is less than 0.002 percent of the total national healthcare spending in 2020 alone. The vulnerability of this system was clearly illustrated by former US President Donald Trump’s reckless decision to withdraw his country from the WHO because of ideological differences with medical doctors. This has left the global community unable to react appropriately to threats from infectious diseases.
The WHO’s budget over the next five years, which is funded almost entirely by member states, is less than 0.002 percent of the total national healthcare spending in 2020 alone.
Underappreciation of public health begins with a lack of education: in the Irish Junior Cycle science curriculum, for example, students are taught biology, chemistry, and physics, but are not taught about vaccines and herd immunity, or about the significant impact behavioral change campaigns can have on population health. This failure in the curriculum contributes to the underfunding of public health measures. People are more likely to support investment in infrastructure to deal with rising cases of heart failure, as opposed to a public health programme that could change eating habits, preventing those illnesses in the first place. If people are not taught the power of lifestyle change in preventing illnesses, they will be less likely to act on this advice too. Poor education also leaves people vulnerable to lies about vaccines and ‘alternative medicine’, a risk that is especially salient during the COVID-19 pandemic.
What could public health scientists do with better funding? First, they could help governments to allocate resources more effectively. Social factors including safe housing, workers’ rights, and levels of poverty have an enormous impact on health outcomes. While these factors aren’t what we usually think of when we consider ‘medicine’, countries which tackle these problems often face fewer health problems. Researchers from Yale found that in countries where healthcare spending was high, but other social spending was low, infant mortality and life expectancy were much worse. In countries where social spending was prioritized over healthcare, outcomes were much better. When politicians oppose social spending on housing and welfare, they take years off the lives of their constituents.
Researchers from Yale found that in countries where healthcare spending was high, but other social spending was low, infant mortality and life expectancy were much worse.
Public health scientists can help governments design more effective behavioral change campaigns, too. By changing the way in which choices are presented to consumers, significant alterations in behavior can be achieved. For example, when fruits are placed on the middle shelf in school canteens, and chocolates and crisps are placed on higher or lower shelves, children are more likely to choose the healthier option. Researchers in Britain found that nearly 30% of online grocery shoppers bought healthier products when the healthy alternative was presented to them at checkout. The scope for reducing the prevalence of dementia, heart disease, and other chronic illnesses by changing lifestyle choices is inspiring. Even if a fraction of the millions of potential future cases of dementia can be prevented, the benefits would be felt by individuals, the economy, and society as a whole.
Finally, public health science can inform an improved global response to infectious diseases. By increasing the prominence of epidemiologists and behavioral scientists in policy-making, governments will respond more quickly to public health emergencies. Increased funding for the WHO would enable it to carry out better surveillance of diseases poised to make the crucial jump from infecting other animals to infecting humans, so that we are better prepared for whatever the next coronavirus may be.
Public health science is more than R numbers and daily case updates. Appreciating the insights of this vital field should help us to avoid the twin dangers of increased age-related disease and greater risk of infectious disease. Integrating its insights into government policy should be a priority for politics after the pandemic.