The Next Great Plague?
As the global health and development correspondent for NPR, Jason Beaubien has covered a range of health issues, from circumcision drives in Kenya to drug-resistant malaria in Myanmar and abortion in El Salvador. He was part of a team of NPR reporters to win a 2015 Peabody Award for their extensive reporting on West Africa’s Ebola outbreak.
Last September, Beaubien, an alumnus of U-M’s Knight-Wallace Fellows program, returned to campus to give the 30th Graham Hovey Lecture on “emerging epidemics in a globalized world.” Beaubien described various scenarios that could give rise to “the next great plague,” and warned that we are poorly prepared to address such an eventuality. “The great conundrum today in global health,” he said, “is that powerful forces are bringing economic well-being to more and more people—but they’re also bringing more disease.”
Prompted by Beaubien’s remarks, we asked U-M SPH experts in global public health to tell us what they think are the greatest threats to health in the next decades:
Cancer is the number one killer worldwide—and its global burden is growing, as more and more people live longer and develop cancer in lower- and middle-income countries (LMICs). These countries typically have too few doctors and resources to pay for chemotherapy and other treatments, so the ratio of mortality to incidence in LMICs is much higher than in countries like the U.S. Early diagnosis helps. We need to invest in infrastructure to encourage early screenings, and we need standards of care for early diagnosis. If we can downstage cancers through early diagnosis and treatment, and give people an extra decade or two of life, that can mean the difference between a sustainable existence for a family and poverty. Personalized medicine is also promising. By using genetic technologies to identify those tumors that will respond best to particular drugs, we can tailor treatments, reduce costs, and make a huge impact in resource-poor LMICs.
Laura Rozek, Associate Director, SPH Office of Global Public Health
Climate change is fundamentally altering our thinking about future threats to human health. Already we’ve seen an unprecedented number of injuries and fatalities from severe weather events. We’ve experienced changes in vector ecology and the spread of illnesses like dengue, and we’ve seen how changing water and food supplies are leading to more diarrheal illness and malnutrition. We’ve also seen how environmental degradation can spawn forced migration and civil conflict. These are just a few examples.
Matthew Boulton, SPH Senior Associate Dean for Global Public Health
I would argue that the epidemiologic transition of low- and middle-income countries—and the accompanying aging of populations worldwide—is going to have a huge impact on global health challenges in this and the next century. Along with this goes the nutrition transition. The increased global availability of high-caloric foods, in combination with an aging and more sedentary population, is creating a potentially devastating public health crisis through various chronic diseases. Two other issues will be critical to maintaining public health: water availability and disorders associated with civil strife. As we’re already seeing, the latter leads to refugee crises and is accompanied by infectious and nutrition-related diseases, as well as mental health problems.
Mark Wilson, Professor of Epidemiology
Estimates are that in the next 15 to 35 years, climate change will cause an additional 250,000 deaths per year from conditions like malaria, diarrheal disease, heat stress, and undernutrition. That’s a huge health burden, and unless we make some very dramatic changes, we can expect it to worsen. Coupled with climate change is the ‘nutrition transition.’ That’s the idea that developing countries are increasingly experiencing the kinds of diseases we’ve experienced in the West for many decades, especially diet-related chronic illness. This transition is happening in the context of countries that lack the infrastructure and health-system capacity to handle these changes. In many ways, these countries are experiencing a ‘double burden’ of malnutrition—a burden of persistent, intractable infectious illness, and at the same time a rapidly rising prevalence of obesity and chronic disease. To me, climate change and the nutrition transition are the two most pressing public health challenges facing the globe right now—and they both have roots in dysfunctional food systems.
Andrew Jones, Assistant Professor, Nutritional Sciences
To me, the greatest global threats to health are large-level structural factors: poverty, inequality, oppression, discrimination. Yes, a new virus may come onto the scene, but most likely that virus is going to end up in marginalized populations. If we don’t combat the underlying structural and social/cultural factors that affect health, then we’re vulnerable to anything. We don’t have a pill for racism, we don’t have a vaccination for oppression, and it’s a lot more challenging to address those issues than it is to find a bacteria or virus. I work in HIV, so I often think of that as an example. What has continued to fuel the HIV epidemic—even in highly industrialized countries like the U.S. —are structural inequalities.
Gary Harper, Professor of Health Behavior and Health Education
As the refugee crisis reminds us, war and conflict are a major threat to health on a global scale. Climate change is another. And if we think about last year’s Ebola crisis, it’s clear we need to strengthen our health systems. But I think one of the biggest global threats to health is complacency. I see it with a disease like polio, which is so close to being eradicated. I see it in my own research on HIV. There have been major achievements in the response to HIV—15 million people worldwide on HIV treatment, that’s a great global achievement—but to make sure these achievements continue, we have to keep up the momentum, and complacency is a big threat. It influences the level of response, it influences funding. And often those who suffer the most from our complacency are the most vulnerable populations, the hidden and marginalized populations.
Elizabeth King, Assistant Professor, Health Behavior and Health Education