Health beyond the horizon

Flickr / ToastyKen

Recently, I was delivering a lecture to 500 young, inspired students. I made a clear and alarming point that the current young generation in many societies including our own, could be the first in history to be less healthy and have a shorter life expectancy than the one before.

NCDs (non-communicable diseases) or chronic diseases such as heart disease, diabetes, cancers and respiratory disease, constitute the largest contributor of deaths globally – 36 million per year and growing. Up to double by 2030.

I explained these are not diseases of rich, old, lazy, white American men. These are diseases that cause, result in and entrench poverty; with the world’s poorest populations and the poorest in our community bearing the largest brunt of suffering.

In some ways, I said, they’re a reflection of everything we as humanity have worked hard to achieve in the last centuries but ironically, NCDs now threaten the social, economic, cultural and environmental fabric of every community on the planet.

Suddenly, their eyes were fixed on me. Their mouths widened. The chatter hushed. A light bulb moment had occurred.

Later, I was reflecting on this light bulb moment. How could the biggest global health threat of the coming century, in a time when so many of us are affected by chronic disease, be a surprise? A surprise I see again and again – among government, non-governmental organisations (NGO), students and academics.

How can we expect to tackle the obesity epidemic, or climate change, or social determinants of health if we as a society cannot access the information necessary to take action?

This column aims to remedy this and provide a voice on global health issues in a format accessible to all.

Flickr / Cometstarmoon

What is global health?

It’s a speciality field and an area of study. An evolution of public health, this area of science has emerged rapidly in the setting of an increasingly globalised, inter-connected, mobile world. Global health addresses problems that transcend multiple national boundaries and are best addressed by cooperative global actions.

Global health is not simply a biomedical field. Addressing the defining health issues of our coming century involves the know-how, skills and thinking of economics, lawyers, urban planners, policy makers, social scientists and more. A multisectoral approach acknowledging health must be a priority, and it must involve the input and support of everyone.

So join me on this journey as we explore beyond the horizon of our community, medicine, time and even conventional global health ideas – and hopefully provide you with a light bulb moment or two along the way.

For more on global health, explore Translational Global Health, from Alessandro and PLoS.

Join the conversation

10 Comments sorted by

  1. John Quay

    Senior Lecturer in Education at University of Melbourne

    A fabulous initiative Alessandro. Education obviously plays a part in this quest. I look forward to further discussion.

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  2. Craig Minns

    Self-employed

    Alessandro, I take issue with your central thesis, although I realise I'm being a bit curmudgeonly to do so. Firstly, previous generations of young men have been all but wiped out by war in some cases, along with many women. Second, the industrial revolution brought many benefits, but it also reduced the life expectancy of those who were conscripted to fill the needs of the mills and those who lived within the vast clouds of pollution that the engines powering the mills generated.
    Third, there is…

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  3. David Briggs

    logged in via Facebook

    Sandro, lets make a bet now.... I predict that life expectancy will continue to improve, in contradiction to your proposition.

    What we might agree with is the cost of health care will continue to grow and that will become a burden on communities.

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    1. Nick Parr

      Associate Professor in Demography at Macquarie University

      In reply to David Briggs

      Alessandro,
      I agree with David that life expectancies are likely to increase.
      Is your claim to the contrary based on anything more than the (unsourced) 36 million deaths figure you cite in the article? Surely changes to this number will be driven by population numbers and population aging. And have you looked at the ages at which deaths from NCDs are occurring? Or changes to age-specific rates?
      Pessimistic prophesies and bad news stories grab the headlines. However both in Australia and, according to UN estimates, globally life expectancies have been increasing, despite changes to obesity rates. Jackie Li's recent paper in the journal Population Studies is the latest of a whole series of papers to project Australian life expectancy will increase in the future. Increases in life expectancy have also been projected for Europe, Japan and North America (Babel et al. 2007 in the Journal of Population Research).

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    2. Alessandro R Demaio

      Australian Doctor; Harvard Fellow & PhD Fellow in Global Health at University of Copenhagen

      In reply to David Briggs

      Thanks for your input David and Nick.

      I would direct you to a few landmark sources:

      Chronic Emergency: Why NCDs Matter, World Bank Health, Nutrition and Population Discussion Paper (2011)

      World Health Organization, Global Status Report on Noncommunicable Diseases 2010 (Geneva: World Health Organization, 2011).

      David Bloom et al., The Global Economic Burden of Noncommunicable Diseases (Geneva: World Economic Forum, 2011).

      World Health Organization, Widespread misunderstandings about…

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  4. Ian Clarke

    Director, Pacific Strategy Partners

    Alessandro, really interesting initiative. There is clearly a need to think this through, as conventional measures used in health economics (QALYs) often fail to take into account that everyone will die from something and avoiding acute disease will necessarily increase chronic disease. I also think like expectancy will continue to rise for a while as today's 60 & 70 year olds are in better shape than the previous generation, and school age kids have access to vaccinations & a better safety culture than their previous generation. So the thesis will all become clear in about 2050!

    Anyway, the answer is simple - more people should play football. There are players of both genders up to 60 in O35 leagues, delivering health benefits to all and an additional income stream to orthopedic surgeons. Since FIFA has more members than the UN, it is a truly global solution!

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  5. David Leigh

    logged in via Facebook

    Part of the reason is over diagnosis of diseases. Another reason for so much growth in NCD's is the treatment. Cancer is an example, where the symptoms are attacked, rather than the cause. It has been known for around 100 years that poor condition in human cells (IE a lack off oxygen, lowering ATP production and poor lipid content of cell membranes, lowering cell potential difference) allows bacteriological infiltration. Microbes that, incidentally, should have been destroyed by an efficient immune…

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    1. Stephen Prowse

      CEO at Wound CRC

      In reply to David Leigh

      I think the problem is a lot less complex than portrayed above. As a society we eat too much, consume too much sugar, salt and fat (especially harmful fat), eat too much processed food, drink too much alcohol containing and high sugar processed beverages and 20% of us still smoke. In addition we do not exercise enough. This leads to chronic NCD, the prevention of which is mostly in our hands.

      It will be most interesting to see if this has an impact on life expectancy within our generation and beyond.

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  6. Margo Saunders

    Public Health Policy Researcher

    The original predictions about shorter life expectancy are credited to Dr. William Klish of Texas Children's Hospital (in 2002) and to Dr. S. Jay Olshansky and co-authors (NEJM, 2005). These predictions have been strongly criticised as being 'more advocacy than evidence', as the evidence appears to be conflicting.
    What if the critics are right and the predictions are based more on 'collective judgment' than on empirical, scientific evidence? Is this the sort of thing where action should wait on…

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