Wednesday, May 6, 2015

Poverty, demography and infectious disease: three warnings


This is the abstract for my keynote talk at a conference in March 2015 in Spain called the Impact of Environmental Changes on Infectious Diseases

The slides are available here

Generations of slash and burn neoliberal, almost laissez faire development policies, with only rhetorical nods to global conservation and equity, continue to erode not only many environmental determinants of health, but also many factors that underpin social and health development. Here are three warnings to all who will listen that we live in One World with One Health.

First, the hellish and tragic Ebola catastrophe in West Africa is rooted in abysmal heath care, poverty, health illiteracy, high fertility, low education, deforestation and, perhaps, a lack of cultural memory for it. Ebola and other exotic infections risk magnification and intrusion even to the well-being of affluent populations in wealthy countries, not only by the density of international air travel, but by increasing poverty, inequality and overloaded, often sub-optimal heath care systems in those countries.

Second, the extent of open defaecation in India has been linked to undernutrition even in middle-class Indian children with access to toilets. Nicholas Kristof,
in the New York Times, points out that infant mortality is lower for Muslims in India than for Hindus, even though Muslims are poorer, and that one reason may be that Muslim villagers are more likely to have and to use toilets.

If so, improved sanitation in India will bring co-benefits. Well-off Indians must overcome their fear of educating their oppressed.

Finally, we are experiencing Planetary Overload, manifest not only as climate change, but the depletion of many other ecological and environmental underpinnings of human affluence. Adverse consequences to global nutrition are already evident (e.g. implied by persistently elevated global food prices). Large-scale population immunity is at risk.

The Black Death in Europe (1348-1350 in London) has been speculatively linked to the Great European Famine, which occurred about a generation earlier (1315-1322).  The analysis in this paper finds otherwise but in my opinion the question is far from resolved.


We should not be complacent about this century. We should not be deluded that “walls and moats” are our best defence, nor be obsessed with the alleged human population health risk of avian influenza. Instead, health workers must lobby to reverse many trends; a fairer world is the only safe and sustainable escape from our peril. Re-thinking and deeper thinking is also required by many related disciplines that also underpin population health.