Ebola outbreak a wake-up call to the world
For generations, Americans have seen advertisements featuring children with wide eyes and distended bellies, or faces marred by birth defects. Some of us have written checks before moving on.
But our collective attitude toward sick people on the other side of the world has slowly been shifting.
Illnesses abroad no longer seem so far away. A sick person anywhere in the world can get on an airplane and arrive in Paris, London, or Boston in a matter of hours.
And our success providing affordable AIDS medications to ravaged regions of the world has shown that the problems are not as hopeless as they once seemed.
Today, with the outbreak of Ebola raging in West Africa, there is unprecedented recognition that global public health, long the redoubt of do-gooders, is now everyone’s concern.
Ebola is a “wake-up call to the world,” said Dr. Sandro Galea, chairman of the epidemiology department at Columbia University’s Mailman School of Public Health, who is scheduled to take over as dean of the Boston University School of Public Health in January.
“It is the incontrovertible truth that this world has become dramatically more interconnected over the past two decades and dramatically more urban,” Galea said. “Those shifting demographics have removed any pretense we may have once had that problems over there are problems over there.”
Just in the last few weeks, the United States promised to spend $750 million to fight Ebola and send troops to provide logistical support; nations from Cuba to China to South Africa joined the effort; and the UN Security Council, in its first-ever emergency meeting related to a public health crisis, called for greater cooperation and action.
Long before the outbreak, there was evidence of growing interest in public health, including:
ª Efforts in many nations to limit the number of smokers and restrict where people can smoke.
ª Concern about obesity, as a societal problem, not just a personal one.
ª Outrage over gun violence and growing recognition that gun control is a public health issue.
ª Increased awareness that climate change is leading to new diseases and the spread of older ones.
ª A rising number of countries providing universal health insurance to guarantee all residents have coverage.
ª The Affordable Care Act’s focus on disease prevention.
ª The unprecedented donation last month of $350 million to the Harvard School of Public Health — one of the biggest contributions ever to higher education.
Most specialists traced the interest in global public health to the AIDS epidemic. In the 1980s and ’90s, watching the AIDS crisis unfold both in the United States and abroad “made it very clear that health affects every facet of society,” said Dr. Julio Frenk, dean of the Harvard T.H. Chan School of Public Health, who was Mexico’s health minister when that nation adopted universal health insurance.
“Economic development cannot happen without good health and good health systems,” he said. “Security is threatened every time health is poor.”
The Internet has also turned every local problem global, said Dr. David Hunter, dean for academic affairs at Harvard’s School of Public Health. Immediately after the devastating earthquake in Haiti in 2010, students at Harvard, Tufts, and elsewhere used social media to generate real-time data about people trapped in the rubble — sending help their way. Even from home, people could make contributions to public health, Hunter said.
Student interest in global health has ballooned, even at the undergraduate level. Public health is now the most popular minor at Harvard, and hundreds of colleges and universities offer it as a major.
The experience of Gerald Chan, a real estate developer who graduated from the Harvard School of Public Health and steered his family’s recent donation to the school, shows that public health degrees are relevant to a wider range of fields than the government jobs that once were the students’ primary destination, said Dr. Robert Meenan, dean of the BU School of Public Health.
Public health is popular among students, said Harvard’s Frenk, because it’s a “field of scientific inquiry, we go out and do stuff, and it’s guided by an ethical framework. That combination is very attractive.”
Part of what makes global public health work rewarding, Hunter said, is the ability to help vast numbers of people with relatively little investment. Buying a few thousand bed nets, for example, can make a profound difference in a village prone to malaria, at a price within reach of average donors.
“Investment in this field pays off by far more than the actual sum of the investment,” he said.
That has become evident over the last two decades. According to the White House, which compiled figures before a summit this summer with African leaders, cases of HIV in Africa have been cut in half; tuberculosis and malaria deaths on the continent have been reduced by more than 30 percent; deaths during childbirth have been halved; and 50 million children’s lives have been saved by better access to medical care and drugs.
The success against HIV/AIDS has been particularly important, several specialists said. Dramatic reductions in the cost of drugs allowed many more people to get treated and changed the model of drug delivery in the developing world, Hunter said.
The focus on HIV testing and drugs created an infrastructure that allowed other drugs and lab tests to reach vast numbers of people, said Jen Kates, vice president and director of Global Health & HIV Policy for the Kaiser Family Foundation, an independent health information organization.
But as Ebola shows, major public health issues remain.
The lack of medical infrastructure — hospitals, doctors, basic medical equipment — in Sierra Leone, Liberia, and Guinea allowed the virus to rage out of control. If the wealthier countries don’t help build such infrastructure in these countries and elsewhere, another health catastrophe of the same scale or worse is inevitable, Hunter said.
And then there are the chronic health problems that loom large: the need to reduce tobacco use, for example, and diseases such as obesity, cancer, and diabetes that are expected to increase in developing countries as people live long enough to contract age-related conditions.
Can the current interest in global health be sustained long enough to make headway against these other problems?
“I do think something has shifted,” Kates said. “The big question in my mind is will this be a lasting effect?”