Another New Year
Another New Year
As I reflect on the year ending and the new one beginning, I cannot help but notice how slowly some things change in the midst of a civilization that prides itself on its miraculous cures, astounding technology, and rapid movement. To be sure, when I think about how much the practice of medicine has changed since I graduated from medical school almost 20 years ago I am amazed by the development of new knowledge and practical approaches to the amelioration and prevention of disease.
But before we collectively pat ourselves on the back, we would be well advised to take a broader view, beyond our offices, medical schools or hospitals, to parts of the community where we do not often travel. Or better still, we should consider countries where interaction with any health professional, let alone access to any of the wonderful medicines or treatments, is very rare indeed.
In our inner cities, children continue to meet up with barriers and obstacles to healthcare despite the best intentions of the politicians who vowed to "leave no child behind." Day-care programs to enable parents to work outside the home are still in high demand, but are not always widely available. Vaccination rates are increasing, but in many pockets of America, cities lag behind the necessary 85% to 90% rate required to achieve herd immunity. And rates of childhood obesity, poor physical fitness, and a host of poor health habits are skyrocketing.
Those of us who treat adolescents cannot help but be concerned about the rates of substance abuse, ranging from legal drugs such as tobacco and alcohol to illicit drugs such as marijuana, cocaine, and Ecstasy. And even though several indicators suggest that these rates have gone down slightly, there should be no illusions that the war on drugs has been won -- nor is it likely to be won as long as we continue to approach it as a punitive, legal issue rather than the major public health problem that it is.
Across the ocean, these problems seem rather small indeed. In the last hour alone, more than 1500 people died of an infectious disease. Most of these deaths were entirely preventable, and about 90% were in children. Here's an astounding fact that keeps me awake at night. Last year, there were more than 44 million cases of measles and approximately 1 million children died of this so-called "conquered" exanthema. Consider measles -- a disease for which we have had a safe and effective preventive vaccine for over 40 years. And a cheap one at that; the average measles shot costs about 24 cents to make, store, and administer. Surely in a world that has been able to amass more money and create more luxury than any other human society in history, we can raise enough funds to make sure every child around the world is protected against this scourge.
And what about the rise of diarrheal diseases around the globe -- also a leading killer of children? Millions of kids die each year -- especially in developing nations -- because of a lack of decent sewage systems and the direct commingling of human and animal wastes with drinking water.
Or consider AIDS. Not only have the United Nations and World Health Organization predicted an additional 65 million cases of HIV infection in the next decade (in addition to the already 45 million people who are HIV positive today), but more than 15 million young children around the world have already become orphaned because of this disease. The hottest zones for this pandemic, by the way, are sub-Saharan Africa, the nations of the former USSR, Asia, and India.
What about tuberculosis, which kills 3 million people a year and has already infected one third of the people living on the planet?
Or malaria -- which attacks hundreds of millions of people and kills at least 1 million people each year?
And in an era in which war is making a comeback, all pediatricians must be deeply concerned about those children living in nations such as Iraq or Afghanistan --not to mention those countries afflicted by natural disasters such as the earthquake that devastated Iran last week. Both types of crises have destroyed essential public health safeguards such as clean water supplies and hospital facilities.
The advent of the New Year is, indeed, a good time to reflect on the immediate past and to make resolutions of how to approach the present. The poet John Donne's wonderful line about "no man is an island" should come to mind as we consider the health risks of the world and attempt to improve everyone's living conditions or access to medicine. If the humane impulse is not enough, let's take a more selfish view. We simply cannot afford not to pay closer attention to the world's poorest nations -- cannot afford not to invest human and financial resources -- if we ourselves wish to stay healthy. An investment by the healthier nations of the world of about $50 billion would make a significant dent in reducing the rates of tuberculosis, malaria, and AIDS; cut by more than half the rates of maternal-infant mortality; and improve access to clean drinking water and provide nourishing food for those who need it the most. Such an investment breaks down to a contribution of about 10 bucks per year for those of us who live in the developed, "Westernized" nations.
The exciting thing, then, about 2004 and the health of the world, is that there is so much we can actually do to improve life for so many. We just have to want to do it.
As I reflect on the year ending and the new one beginning, I cannot help but notice how slowly some things change in the midst of a civilization that prides itself on its miraculous cures, astounding technology, and rapid movement. To be sure, when I think about how much the practice of medicine has changed since I graduated from medical school almost 20 years ago I am amazed by the development of new knowledge and practical approaches to the amelioration and prevention of disease.
But before we collectively pat ourselves on the back, we would be well advised to take a broader view, beyond our offices, medical schools or hospitals, to parts of the community where we do not often travel. Or better still, we should consider countries where interaction with any health professional, let alone access to any of the wonderful medicines or treatments, is very rare indeed.
In our inner cities, children continue to meet up with barriers and obstacles to healthcare despite the best intentions of the politicians who vowed to "leave no child behind." Day-care programs to enable parents to work outside the home are still in high demand, but are not always widely available. Vaccination rates are increasing, but in many pockets of America, cities lag behind the necessary 85% to 90% rate required to achieve herd immunity. And rates of childhood obesity, poor physical fitness, and a host of poor health habits are skyrocketing.
Those of us who treat adolescents cannot help but be concerned about the rates of substance abuse, ranging from legal drugs such as tobacco and alcohol to illicit drugs such as marijuana, cocaine, and Ecstasy. And even though several indicators suggest that these rates have gone down slightly, there should be no illusions that the war on drugs has been won -- nor is it likely to be won as long as we continue to approach it as a punitive, legal issue rather than the major public health problem that it is.
Across the ocean, these problems seem rather small indeed. In the last hour alone, more than 1500 people died of an infectious disease. Most of these deaths were entirely preventable, and about 90% were in children. Here's an astounding fact that keeps me awake at night. Last year, there were more than 44 million cases of measles and approximately 1 million children died of this so-called "conquered" exanthema. Consider measles -- a disease for which we have had a safe and effective preventive vaccine for over 40 years. And a cheap one at that; the average measles shot costs about 24 cents to make, store, and administer. Surely in a world that has been able to amass more money and create more luxury than any other human society in history, we can raise enough funds to make sure every child around the world is protected against this scourge.
And what about the rise of diarrheal diseases around the globe -- also a leading killer of children? Millions of kids die each year -- especially in developing nations -- because of a lack of decent sewage systems and the direct commingling of human and animal wastes with drinking water.
Or consider AIDS. Not only have the United Nations and World Health Organization predicted an additional 65 million cases of HIV infection in the next decade (in addition to the already 45 million people who are HIV positive today), but more than 15 million young children around the world have already become orphaned because of this disease. The hottest zones for this pandemic, by the way, are sub-Saharan Africa, the nations of the former USSR, Asia, and India.
What about tuberculosis, which kills 3 million people a year and has already infected one third of the people living on the planet?
Or malaria -- which attacks hundreds of millions of people and kills at least 1 million people each year?
And in an era in which war is making a comeback, all pediatricians must be deeply concerned about those children living in nations such as Iraq or Afghanistan --not to mention those countries afflicted by natural disasters such as the earthquake that devastated Iran last week. Both types of crises have destroyed essential public health safeguards such as clean water supplies and hospital facilities.
The advent of the New Year is, indeed, a good time to reflect on the immediate past and to make resolutions of how to approach the present. The poet John Donne's wonderful line about "no man is an island" should come to mind as we consider the health risks of the world and attempt to improve everyone's living conditions or access to medicine. If the humane impulse is not enough, let's take a more selfish view. We simply cannot afford not to pay closer attention to the world's poorest nations -- cannot afford not to invest human and financial resources -- if we ourselves wish to stay healthy. An investment by the healthier nations of the world of about $50 billion would make a significant dent in reducing the rates of tuberculosis, malaria, and AIDS; cut by more than half the rates of maternal-infant mortality; and improve access to clean drinking water and provide nourishing food for those who need it the most. Such an investment breaks down to a contribution of about 10 bucks per year for those of us who live in the developed, "Westernized" nations.
The exciting thing, then, about 2004 and the health of the world, is that there is so much we can actually do to improve life for so many. We just have to want to do it.
