Perhaps the reason Albert Einstein was unable to develop a unified theory of the universe is because he was trying to find it in the field of physics. He should have been looking in public health.
When we view the globe as a fragile blue object suspended in space, so memorably captured in an Apollo photograph, the improbable theory of chaos becomes graspable: it suddenly makes sense that the flutter of butterfly wings in a Netherlands tulip field can tumble weather systems into a tsunami off the coast of Japan. Everything affects everything else, however directly or tan-gentially. We can imagine connections and interactions. We can hypothesize causes and proximate causes. We can envision the intricate web that is global public health.
Tracing the threads of that web with our fingers, we find woven there an interdependent system of health, economics, politics, and the environment. Connections become clear: that children stricken with malaria are too sick to go to school; that their disability or lack of skills limit their productivity; that their countries consequently remain impoverished and their governments unable to invest in eradicating malaria; that global warming fueled by the developed world’s consumption is causing malaria to spread. Like a Mobius strip, we return again and again to the beginning.
Fortunately, our past achievements prove that we are not powerless before these dynamics, whether they involve malaria or other threats to global public health. Research and investments in the 20th century brought improved health to an unprecedented number of people worldwide. In 1945, global average life expectancy was 46 years; today, it is 66. We know that the more developing countries invest in health, the more likely it is they will achieve continued economic growth. That goes for developed countries as well. One estimate, for example, holds that since 1977, the total $32 million that the US invested in the global eradication of smallpox is returned to the US every 26 days. The World Health Organization (WHO) projects that global polio eradication will save the world $3 billion per year by 2015. That is money freed up for education, commerce, research, and civic infrastructure, money freed up for economic development—in short, money freed up for improving human living conditions worldwide.
The inextricable connections among global public health, the global economy, global politics, and the worlds environment have the following ramifications: (a) that it is in our own self-interest to improve global public health, (h) that debt, poverty, and deadly health threats in developing countries keep those countries in a steadily declining state of economic devastation, and (c) that our prosperity is intimately—and inversely—linked with their poverty and illness. Both moral and economic grounds support changing these dynamics, and we can do so by giving developing countries what they need, not just what we want them to have, and by seeking global cooperation in the fight against disease, disability, and environmental degradation.
Implications for the US
Our overseas investments in foreign public health infrastructure come back to us in healthier lives for our own people, expanded markets, and our own economic growth. Making this a healthy world for all is not only a moral imperative; it is also in our self-interest.
Public health isolationism is obsolete. Where a hundred years ago it took weeks, even months, to cross oceans, today it takes just hours. Over two million people cross national borders every day. Goods and microbes whip around the globe at speeds and volumes unheard of when turbojet technology was first invented in the 1930s. They bring with them infectious diseases, contaminated foodstuffs, and threats of bioterrorism. These have already hit our shores: dengue hemorrhagic fever, hantaviruses, avian flu, cholera, hemolytic uremic syndrome, malaria, West Nile virus, African sleeping sickness, yellow fever, mad cow disease, multidrug-resistant tuberculosis, and health-threatening microbes and pesticides on imported crops such as strawberries and raspberries. The film Outbreak may have stretched plausibility, but we have already seen cross-species migration of diseases and airborne viruses. These public health threats will grow to an unprecedented extent in the new millennium, here and abroad.
Global warming increasingly compounds the problem. The phenomenon is already incubating new, emerging, and reemerging infectious diseases. The climate change it causes brings birds adapted to warmer climates to regions they once avoided, spreading bird-borne diseases where they never existed. Coupled with new and intensified migration patterns of people, goods, and animals, global warming will bring more outbreaks of tropical diseases to places where it was once impossible for them to thrive.
Lets revisit the example of malaria. This potentially fatal infectious disease, which accounts for 25% of child mortality in Africa, is spread through human migration. It came to the New World with European colonists and
African slaves during the 16th century. The last major outbreak in the US, involving 600,000 cases, occurred in 1914, and in the 1950s, the CDC declared malaria eradicated in this country.
Since the 1980s, however, malaria has reemerged as a public health threat in the US. We have been calling it ‘airport malaria,” but the global spread of this disease depends on more factors than the air transport of infected people and malaria-carrying mosquitoes alone. Global climate change creates more mosquito-breeding grounds, increasing the incidence of malaria worldwide. Abroad, crushing poverty renders malaria-eradication projects impossible in developing countries. In Africa alone, malaria has stolen $100 billion in GDP over the past 30 years. The result? Both threats to world stability from increasing economic disparities and a growing potential for the resurgence of malaria in the US in the new millennium.
But malaria needn’t become a serious US health threat. What if the developed nations undertook to eradicate malaria? What if we boldly established domestic and international policies and standards to slow global warming trends and stuck to them? What if within US borders, we ensured universal health care, so that infected immigrants can be treated sooner rather than later? The answer is clear: our people would be safe from the risk of malarial illness and would enjoy the economic growth brought by economies abroad alleviated of the malaria burden.
Whether it is malaria or some other infectious disease, we must acknowledge and act on the fact that threats to health and economic development abroad are threats to our own people. It is no exaggeration to say that global public health is a national security issue. Fortunately, it is one that, with wise investments and thoughtful policy, we can do something about.