Saturday, May 30, 2009

Global Health: challenges and solutions

Problems .. food, pollution, climate change and conflict .. excessive numbers of humans on the planet, inequality, indifference and fraudulent banksters. The list is long..

National Geographic June 2009 has an excellent feature on the global food crisis. This mentions CAFOs in China, by the way, plus the eminent demographer Professor Tim Dyson, warning the the spectre of Malthus has not vanished. Adolescents in Pakistan are being reported as being used as suicide bombers to perform payback murders in feuds [I heard this on the BBC .. I hope this is exagerated - while I can't find that link, there is abundant evidence of the exploitation of children for such barbaric purposes, not only in Pakistan but also by the Tamils in Sri Lanka], while more certainly, child soldiers are common instruments of war, waged by adults in several parts of Africa, including Somalia. Problems are multiplying.


What about solutions? I suggest we start by tithing 10% of our effort and - if we can afford it - 10% of our wealth to these issues. The election of Obama is very encouraging, but the infestation of the media and web by climate change deniers is deeply disturbing. More on that later, in another post. Though, for a taste, see Michael Ashley's brilliant review of Ian Plimer's book "Heaven and Earth".

Meantime, please support groups that try to look at deep causes of our interlinked global crises. If you live in a high income country (the North) - see PS - unless in parts of Scandinavia or the Netherlands [countries that already exceed the target], ask your government to give 0.7% of its revenue to foreign aid, as they long ago pledged .. and not "phantom" aid as Action Aid calls it. This target has been challenged - but while I haven't read more than the abstract it is clear that high income countries can be more generous .. that is, if they want low income countries to catch up, which of course they don't..

And, please, be sensitive to the beliefs of others. Look for what you have in common with others. When I was a medical student at a Christian Mission Hospital in Nigeria, in 1985, a practice had just been ended, by which patients (even if not Christian) had to say a Christian prayer before undergoing surgery. I'm glad that practice stopped. Yet I don't think this means every cultural practice followed by others should be uncritically accepted. If it were we'd have to acknowledge the right for some societies to practice female genital mutilation, or to keep slaves, or to have housemaids with no names and no rights. Or even to practice waterboarding in Guantánamo.

While the naming and defining of universal rights is tricky, to say there are no such rights is clearly worse.

If any of you have an academic bent, please visit the Faculty of 1000 Medicine [global health] to see some interesting academic perspectives on global health (disclosure: I am one of the faculty members - but this position is voluntary; I get no royalties!)

bye for now,


PS I will try to post a link re the North and South shortly - Butler CD. The North and South. In: Hedblad A, editor. International Encyclopedia of the Social Sciences. New York: Macmillan Reference; 2007. p. 542-4.

Saturday, May 9, 2009

The political economy of intensive farming

Probably everyone reading this in 2009 will have heard of swine (H1N1) flu. If you read this in (say) 2011 you may or may not know (or remember) what swine flu means. However, in 2011 and probably in 2021, Concentrated Animal Feeding Operations (CAFOs) will continue to exist.

However the bland-sounding acronym CAFO may vanish well before 2021; in fact it may disappear very soon after it becomes a household name linked with widespread understanding of what it actually is ("manure lagoon" being one of the CAFO keywords in the academic paper: Gilchrist et al. The potential role of CAFOs in infectious disease epidemics and antibiotic resistance. Environmental Health Perspectives. 2006;115:313–6.)

There are already CAFO precursors which are now rarely heard, such as "landless farm". "Factory farming" remains in the vernacular, but not in the scientific literature. That term (factory farming) probably never did appear there - too "emotional". There are precedents for shifting language in many other fields, such as the use of “friendly fire” as a euphemism, a disguise, for the accidental killing of one’s own troops. When and if “friendly fire” acquires emotional resonance (ie when people react with appropriate shock) it will be replaced, by another term with less political risk. Many such examples are given by Egan and Glover in their 2002 book Collateral Language: A User's Guide to America's New War.

I'd like to write an academic article about the political economy of CAFOs and health, but that will take time (months at least, and that's if I can get these ideas past the reviewers). So forgive me by allowing me to present my key arguments as points. Each point could be elaborated and better referenced; however you don't have time to read it and I don't have time to write it. (But fragments of what follows will appear elsewhere.)

1. CAFOs are cruel and unethical, as are lots of things, such as the current crowding and abuse of Tamils in camps in Sri Lanka. The world is full of cruelty, double standards and lousy ethics.

2. A small amount of animal products, including of meat, is desirable for health for most people. CAFOs are the cheapest way to produce these on the scale needed to provide adequate [though, likely, far from optimal] nutrition for the 6.8 billion people currently alive. This almost certainly means that some form of CAFOs will remain in existence, if not essential, for decades at least.

3. CAFOs have numerous uncosted downsides, apart from their cruelty - most notably to the ecology and climate. However CAFOs are not the root cause of that .. a more fundamental problem is the number of people alive at the moment. (And, as Henning Steinfeld, the lead author of Livestock's Long Shadow told a questioner, at a meeting at which we both spoke in March 2009 in Aarhus, Denmark, organic or more humane forms of farming, if on a scale sufficient to feed us all, is unlikely to more environmentally friendly .. in fact it would probably be worse .. instead we need to reduce our total animal produce consumption, and to do that humanely and without harming health, we need to reduce our human population, and to do that humanely we need to do many things, and wait at least 60 years .. or make fantastic technological and ethical progress, and we are a long way from that at present.

4. In addition to these ecological costs, CAFOs are a significant risk to public health, as incubators not only of more virulent forms of influenza, but also of lesser known viral diseases including Nipah virus and Ebola Reston, both of which are spread from bats, themselves increasingly stressed by pressure from human populations growing in number, power, and expectations.

5. The corporations (and their allies, the public relations industry) who control and profit from these CAFOs do not want their industries linked with any large-scale threat to public health.

6. Disease surveillance is a well understood method to detect and reduce the burden of infectious diseases. However, like many public goods for health such systems depend on a high and sustained level of enthusiasm, expertise and financial resources. In low and middle income countries the development and maintenance of good surveillance systems is especially problematic. They also depend on transparency.

7. Issues of political economy (i.e. the way powerful interests, be they corporations, wealthy foundations, or the governments of nations with nuclear weapons) have a disproportionate influence on the agenda, including of public thought and talk. They also reduce transparency, not only with regard to CAFO related disease surveillance, but even the name of the current outbreak of swine (actually, plausibly, "swine-avian-human" influenza) which has now been re-labelled H1N1 influenza, including by the World Health Organisation.

8. These "political economy" factors provide the most plausible underlying cause for the lack of attention and amplification of the first report of the outbreak of an unusually severe epidemic of pneumonia in a poor area of Mexico near to a pig CAFO. That influenza can infect pigs has been known since 1930, and there has been gathering scientific awareness of the plausibility of a swine-avian-human flu outbreak, accelerated if not “incubated” by CAFOs. Yet this body of knowledge and concern has not yet translated into sufficient awareness or action.

9. The precautionary culling of large numbers of animals in CAFOs in order to protect public health is unpleasant but at times probably justifiable, given our present knowledge. However, such measures can also be applied in an overly zealous way, such as the impending slaughter of the entire Egyptian pig population, in response to the H1N1 outbreak, and probably too the prophylactic slaughter of pigs in the Philippines, after the outbreak of Ebola Reston, a disease with, to date, no significant human morbidity, let alone mortality.

10. A recent lead article on swine flu in the New England Journal of Medicine, with almost 20 co-authors and 10 pages in length, as far as I can see, entirely ignores these issues of political economy. This is unsurprising .. the suppression of discussion of political economy penetrates far into the scientific literature. Perhaps a topic to return to!

Finally, please note that I agree pork is safe to eat. I don't think it is safe to farm in CAFOs... but having CAFOs is a price we have to pay for the time being. Science, together with advocates for greater animal welfare, can make CAFOs safer, more humane, and over time, can make them rarer. There are already, in some countries especially, more humane alternatives to CAFOs, such as wider harvesting of "feral" animals for human food in Australia. If we eat meat we have to kill animals, but we can devise and incorporate more humane ways to do this. Also, of course, many other conditions, such as diarrhoea and childhood pneumonia, are far greater public health issues than swine flu. But if I wrote about them you would not have read this!