The spread of the deadly Ebola virus in three West African countries, namely, Liberia, Sierra Leone and Guinea has created a public health crisis in these countries and the virus threatens to spread not just to neighbouring counties in the region but to the rest of the world as well.
This prospect has naturally alarmed the leaders of the developed countries, global institutions like the World Health Organisation and others, compelling them to plan and execute a concerted global response to contain the spread of the disease. At the root of the crisis is the poor state of the economies of the countries that have been directly affected, coupled with their rudimentary healthcare services and the ineffective social infrastructure. Many commentators have compared the Ebola crisis to the HIV/AIDS epidemic that posed a major threat to public health several decades back. Since some the countries affected by the HIV/AIDS epidemic then were rich and powerful with the resources and the institutions needed to stem the tide, i.e. the US and Europe, a multi-pronged response involving public education, development of drugs and treatment methods, etc. were mounted to contain the epidemic. Yet, many African countries continue to severely suffer from HIV/AIDS to this day despite significant external interventions, largely due to the poor socio-economic and political conditions prevailing in some of these countries.
The Ebola epidemic however is different. It is highly contagious and has affected several of the poorest African countries that do not have the capacity to mount an effective, coordinated response to contain the epidemic. It is this situation that has demanded a global response which the developed countries led by the US, global health institutions and civil society organisations are desperately trying to put together.
As is widely recognised, Ebola is a potential threat to global public health. This is understandable given the fact that population mobility is a major aspect of globalisation that most countries around the world have become part of. So, it would not allow global leaders and others concerned to remain complacent and do nothing. We can rest assured that everything will be done to prevent the spread of the virus to the rest of the world, though many more lives are more than likely to be lost in the affected part of the world.
On the other hand, there are many potential threats to people’s health in different parts of the world but they do not generate the same kind of interest outside the localities, regions and countries that are affected by this localised threat to public health. Yet, a close examination would reveal that their impact is not less devastating for the individuals and population groups directly affected by them. Death is death, no matter whether it is caused by Ebola or Dengue.
The threats to public health vary widely depending on their nature and the specific causes that are too numerous to even identify, let alone to provide an analysis. But, what is perhaps common to all these is that they are mostly preventable. While some of these threats are structurally rooted, i.e. socio-economic, environmental, cultural, etc., others are the result of irrational or unsound public policies, pursued at national and global level by governments and global institutions. Space does not permit a detailed discussion of even a few of such threats to public health ,so what is attempted in the remainder of this article is to indicate the kind of threats that persist or have emerged in recent years in many parts of the world and point out that the WHO’s global strategy around the Determinants of Health provides a sound perspective for countries to adopt as a way of responding to persisting and emerging threats to public health.
As mentioned before, threats to public health emanate from diverse sources. Some of these are connected to public policies that governments and other entities pursue. When we look at public health issues connected with the environment, agriculture, transport, employment, food consumption, settlement planning, etc., it becomes quite clear that many public health issues are caused by public policy failures. Today, Beijing in China is known around the world as much for the blanket of smog that envelopes it from time to time as for its impressive built environment. The rapidly rising population there coupled with equally rapidly rising fleets of motor vehicles provides the background to the worsening environmental pollution there that poses a grave threat to the health of the city population. This is not confined to Beijing alone and can be observed across the developing world.
The increasing density of population in the cities of the developing world with no corresponding efforts on the part of governments and private capital to address the issues of housing and social infrastructure has created ideal conditions for the spread of diseases like Dengue as is clearly evident in the metropolitan areas in some of the Asian countries like Sri Lanka. Official records show that there were over 32,000 cases of Dengue in urban areas of Sri Lanka last year, in particular, Colombo, where nearly a third of the country’s population is concentrated today. Our leaders boast about how beautiful the local cities and towns have become but one only has to walk through the narrow lanes in congested urban settlements to realize how badly neglected the inner city areas can be. Moreover, due to the labour crisis in the country, many neighbourhoods are overgrown with weeds, providing enough breeding grounds for parasites. One only has to travel in a badly neglected train to realize that it is with difficulty that trains squeeze through weeds that often cover either side of the railway track in many places along the way.
The lack of sound human resource development and employment policies in many countries has persuaded many people to look for employment outside their own countries leading to mass migration of labour. This has also become a threat to public health as migrant workers become carriers of communicable diseases. Though migration of people cannot be arbitrarily curtailed, migration should not become a way of life for a large part of the population due to unsound public policies.
As is well known, careless use of toxic agro-chemicals in agriculture has posed a grave threat to human health not just in countries where such practices prevail as food produced using such methods is consumed by a wider population. Contamination of the food chain and waterways continue to pose serious public health risks in many countries including Sri Lanka.
Moreover, the spread of unhealthy food habits, often propagated by big multinationals, has become a public health menace not just in developing countries but in the most developed parts of the world as well, i.e. America, Europe, Australasia and elsewhere.
Recognizing the wider background to growing public health risks in different parts of the world, the WHO commissioned and published several years ago a well-articulated report on Social Determinants of Health (SDH) . The argument there in a nutshell was that many diseases are caused by factors connected with the wider social, economic, political and cultural environment and, therefore, the interventions should address the issues of the wider environment as well. In other words, the emphasis should be at least as much on public health interventions as on curative care, which has taken precedence over the former in many parts of world including our own country. It might be useful to find out where we stand today with regard to this important global initiative on the part of the WHO.