A Blueprint for Protecting and Improving Health in Critical Times

Bharat Dogra

While social, economic and technological progress has made possible significant improvements in health to a certain extent and within certain limits, at the same time it cannot and should not be ignored that several regressive factors have also been  at work and in some contexts these have been becoming more dangerous in recent times. An even greater threat is posed by wider changes in environment ( such as those relating to climate change and deforestation) and human society ( such as those relating to increasing inequalities and increasing strife) which can bring extremely difficult challenges for the health sector to cope with some of which it may be quite helpless despite all the technological advances.

The most recent changes unleashed by the spread of the COVID-19 have brought to fore some of the existing distortions in the health sector and in fact, sadly,  instead of being corrected some of the serious distortions in the health sector have been accentuated in the course of the pandemic. Hence this is a critical juncture for the health sector when all persons belonging to this sector (as well as others ) should be much better prepared to counter the dangers within the sector and to warn against the threats which come from wider sources.

1.         Climate Change and Environmental Threats
It is by now widely agreed that climate change is likely to bring extremely difficult health challenges for which humanity is not at all well prepared in many parts of world. This is particularly true if climate change is allowed to reach the stage of crossing certain critical tipping points. What is more climate change cannot be seen in isolation? A number of other critical environmental problems are linked to very serious harm to health. These include air pollution, water crisis, natural forest depletion and other related changes whose combined impact will pose extremely difficult challenges. Inequalities in health are likely to be accentuated as the poor are affected more by climate change and at the same time have less access to health care.

The health sector should give much more importance to climate change related emerging challenges in region specific situations. This should include timely warnings about new emerging problems and situations in various regions.

2.         Increasing Exposure to Hazardous Substances
Due to a complex of factors the chances of excessive and prolonged exposure to a range of hazardous and toxic substances are increasing particularly for children, leading to increase in a host of physical and mental disabilities and serious diseases, including occupational diseases and various cancers. As scientific research in several such contexts has not been adequate or is biased, the chances of remedial action in time are reduced.

Health sector personnel and researchers should watch out more carefully for these linkages so that people have timely warning and public regulation and policy are better informed.

3.         Increasing Difficulties in Accessing Safe and Nutritious Food.
While inequalities and poverty remain a major reason for denial of nutritious food to millions of people, other factors are fast emerging which may deny safe and nutritious food to an even larger number of people. Powerful multinational companies strive to control the world food and farming system in unprecedented ways, spreading genetically modified (GM) crops which have a range of adverse health impacts. Some trends make way for food to be contaminated by more and more dangerous agri-chemicals and food additives and preservatives. Availability of fresh safe food from nearby areas seems likely to diminish, according to recent trends and forecasts.

Health researchers and personnel should re-emphasise the important role of safe food from a health perspective, as also how access to safe food is likely to become more and more difficult given the recent trends in world food system, so that people and public policy are better informed on this issue of critical importance.

4.         More and More Destructive Weapons and Wars
In recent times countries like Iraq and Syria have witnessed the horror of how reasonably well-developed health systems can be destroyed by a few days of bombing, also leaving behind a legacy of longer-term health impacts, such as persistent adverse impacts (including cancer) of depleted uranium and disease outbreaks caused by the destruction of sanitation systems. Yet this is nothing compared to what may be unleashed by an exchange of nuclear weapons. Medical science, with all its technological advances, will appear quite helpless in coping with the impacts of any significant exchange (or one-sided use) of nuclear weapons. Yet the possibility of actual use of nuclear weapons are increasing in some significant contexts and new very dangerous weapons, such as robot (or AI or autonomous weapons) are fast emerging. The possibilities of very destructive wars are also increasing, with escalating tensions among the most powerful countries and the breaking down (or non-renewal) of existing nuclear arms control agreements.

The health sector should more clearly extend its support to the world peace movement and to the various peace efforts, while also giving adequate and timely warning about the much increased and unacceptably high price of  conflict and war in present-day world.

5.         More People Affected by Disasters  
Both as a result of and independent of climate change, disasters are increasing and have adverse impacts on the health of people in a number of direct and indirect ways , for example resulting in denial of safe water and food while at the same time the threats of disease and injury increase. High intensity cyclones have in recent times caused great destruction and created huge challenges for the health sector but this is only the more visible aspect of disasters, the harm done by less visible but prolonged , more frequent droughts is also enormous in terms of increasing hunger, under-nutrition and malnutrition as well as other health implications. High intensity earthquake risks are high in some densely populated regions which are ill-prepared to meet the threat.

The health sector must be better prepared to respond to higher frequency and intensity of disasters.

6.         Increasing Risks of Accidents
Despite the better availability of technology due to a number of factors the risks of a wide range of accidents (not just road accidents) is increasing in many parts of the world. Occupational accidents of some kinds can be very high without attracting much public attention. Higher possibility of accidents is troubling anywhere but is likely to have more dangerous consequences in more densely occupied areas.

The health sector must not only make better preparation for timely, early treatment of accident victims, but on the basis of its experience and research should contribute more to understanding and reducing causes of high incidence of various kinds of accidents,  accident injuries and deaths.

7.         Increasing Incidence of Violence and Violent Behavior
Due to a complex of factors everyday life is become more violent in many parts of world and the risk of injury and deaths from violence, including self-harm, is increasing.

On the basis of its careful observations and research, the health sector should contribute not just to better care and cure but also to better understanding and reduction of violence.

8.         More Risks for Mental Health
Several prevailing and accentuating trends can be seen in increased individualism, loneliness, a culture of instant gratification and much reduced stability / commitment in social relationships at various levels. There are also higher levels of aggressiveness in pursuit of increasingly narrow and self-centered goals. Requirements of quarantine and distancing as well as other aspects of pandemic have further increased the risks of mental health problems.

Wider social links of mental health are likely to get much more attention if warnings come from health personnel, doctors and researchers. Hence beyond better l treatment the health sector can contribute much more to proper understanding and prevention of mental health problems.

9.         Higher Substance Abuse
Despite efforts to check the consumption of and addiction to tobacco, alcohol and drugs, there are indications of overall higher substance abuse, including in new forms. This has implications for increase of a wide range of health problems. The health sector should play a more active role in spreading awareness of health impacts of substance abuse and helping society to reduce substance abuse very significantly.

10.       Shortage of Clean and Safe Drinking Water
Due to a number of reasons, despite more pipelines and hand pumps being installed, the number of people not having easy access to clean and safe water for drinking, cooking and hygiene is likely to increase. By drawing attention to emerging trends in problem areas and by giving timely warnings about health impacts about this, the health sector can contribute to timely increased attention being given to this aspect.

11.       More Vulnerable People
While the number of people living in poverty has been reported to be decreasing, there are reasons to suspect that some of these achievements may be over-reported and/or the problem may be defined in such a way as to underreport or hide some disturbing trends. For example, people reporting more assets than before may yet may be facing more problems in terms of sustainability of their livelihoods or access to basic needs like safe drinking water and safe food, or also may face the wrath of worse disasters in future. Overall, the number of vulnerable people may be increasing, particularly in terms of risks to their health and wellness.

The health sector can help by providing a more balanced and nuanced understanding of poverty and health, contributing to more well-informed policy.

12.       Inequalities Are Increasing
At world level inequalities are increasing sharply. This has an adverse impact on health in various ways, for example in terms of access to nutrition, medicines and health care. By drawing attention to adverse impact of inequalities on disease and health problems, the health sector can strengthen the case for policy reform for reducing inequalities.

If inequalities continue to increase this can lead to much worse implications in a situation of climate change , and this is another aspect that demands attention.

13.       Emergence of New Diseases, or Resurgence of Dormant Ones
Due to climate change, deforestation, fast changing social behaviors or other factors including adverse impacts of new technologies, new diseases and health complications may emerge more than in earlier times, while under-control or dormant diseases may show a tendency to re-emerge and spread. The health sector should be well-prepared to cope with this, to also give advance warnings and press for preventive and preparatory urgent actions. As the experience of the recent COVID-19 pandemic has shown the response has been of a knee-jerk and reactive nature and generally there have been few signs of well-preparedness to face pandemic, except perhaps in a few places. There should be much better preparedness for this, considering also the number of new infectious diseases that have been appearing with the potential to spread rapidly.

14.       Diseases of Poorer Countries and Population Segments
These should get adequate recognition and importance both in national and international health policy.

15. Social Discrimination and Health
Social discriminations existing at various levels in various societies such as gender, sexual orientation, caste, ethnicity, race, color etc. also get reflected often in access to health care and education and at some places, in some contexts such concerns may even be increasing .The health sector should be better prepared for this challenge.

16.       Resistance to Antibiotics
The growing resistance to antibiotics is a serious and well-recognized problem which should get adequate attention.

17.       Low-cost and Good Quality Medicines
Low cost, rational and good quality medicines should be available to all those who need them. This responsibility should be accepted by the public sector to provide all essential good quality medicines at low cost and very low profit margins. International and national philanthropic organizations should help in this Essential and rational medicines should be identified clearly, including essential medicines needed by relatively smaller number of people. The existing patent laws need to be challenged to the extent that these conflict with this objective. The existing serious distortions in the medicines sector should also be challenged in this context and strong efforts made to restructure the medicines industry in keeping with the real needs of people.

18.       Need-Based, Rational Vaccines
Profit-driven distortions have increased even more in the vaccine industry. Control over vaccines is likely to be increasingly used by powerful organizations and forces to not only push for distorted, high-profit orientation of the vaccine sector but to also use vaccine sector as an entry point for growing dominance and control of health systems. In the process irrational decisions may be taken ignoring real need as well as serious side-effects, all this posing serious problems for health sector and its limited budget. Gates of developing countries may be opened for bills of billions of dollars, that too for products of dubious merit. These problems are already arising in a big way in the context of the controversies relating to COVID-19 vaccine. Decisions regarding vaccines should be taken very carefully on rational, ethical and unbiased basis. All irrational vaccines or those of dubious safety and suspect need should be avoided. As far as possible, manufacture of all vaccines should be with the public sector.

19.       Preventive Grassroots Public Health , Better Sanitation Should Get More Attention
Preventive aspects of health care at the grassroots level should get much more attention. Primary health care centre should be run by the public authorities and decentralization institutions with strong support of community participation. Preventive health covering all aspects - from sanitation to checking substance abuse, from non-violence to accident prevention - should be a very important aspect of primary health care and should be well supported. All people should be covered by primary health care centres. These should also have all essential facilities for child births, maternity care, treatment of ordinary diseases and injuries. This should be free or at very low cost, so as to be accessible to all.

19.       Facilities for Advanced Medical care
For more serious disease and injuries the public sector should provide advanced hospitals, including specialist hospitals, most of which are attached to medical education aimed at grooming doctors to serve in public sector and also more particularly in rural areas, or in other areas where doctors are most needed. This should be low-cost medicare with a separate fund for providing entirely free medicare or highly subsidized care where needed.

20.       Profits and Ethics
Any domination of high profit motive in providing medical care, medical tests and medicines sector, particularly to the extent that consideration of profits hinder rational medical care, should be resisted firmly. Medical ethics should be emphasized and publicized adequately by professional organizations, philanthropic organizations and public authorities. Laws necessary for this should be carefully enacted and implemented with the true spirit of legislation.

21.       Adequate Funds, Careful Use
Adequate budget should be made available for public health and medicine, but at the same time equal care should be taken to ensure that it is used carefully for real needs. If higher budgets are sucked up by high profiteering then the purpose will not be achieved. Use of public funds for enriching private insurance companies should be stopped.

22.       Areas of Special Need
International organizations helped by professional bodies of health personnel everywhere should draw up special plans to meet the special requirements of most needy areas of world for medicines and medical personnel. These include areas of extreme poverty or those affected by disasters and epidemics, or conflict zones. Within various nations rural and remote areas with a shortage of medical personnel should get special attention.

23.       Changes in Medical Education
Medical education should be linked from the outset with real needs and priority concerns, linking high standards of education and expertise with critical concerns of  needs of people and medical ethics. Along with treatment prevention of disease and injury should get higher attention.

24.       Holistic Approach
An approach which integrates modern medicare very well with preventive aspects, social concerns and alternative therapies (which have given good results in particular contexts), an approach that integrates physical, mental and spiritual health, an approach that links professional high attainments with medical ethics, which can integrate present day needs with a futuristic vision, will be most useful.

25.       Improvement in International Cooperation and Regulation
This is needed badly to ensure better observance of medical ethics all over the world and ensure availability of low-cost, good quality rational medicines, medical devices and vaccines all over the world. This is necessary also for developing wider acceptance of a holistic vision. Genuinely philanthropic organizations can contribute much to this effort.

The writer of this document is a journalist and author who has been involved closely with several social movements and initiatives. He is Convener of   Save the Earth Now Campaign and its SED Demand. Web-site www.bharatdogra.in

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Frontier
Jun 17, 2020