In 2017, American epidemiologist Anthony Fauci said there was “no doubt” that the country would be confronted by an infectious disease outbreak within the next three years. In June 2019, Fauci described public health’s “biggest nightmare” as a “respiratory-borne illness that spreads rapidly.” Less than a year later, Fauci’s greatest nightmare was realized with COVID-19, a new rapidly spreading respiratory virus that resulted in the deadliest pandemic in U.S. history. How did experts see this coming, and what could we have done differently to prepare for it?
The answer, it turns out, isn’t in a crystal ball. It has to do with infrastructure, surveillance technology, and pretty much our entire planet. Hi, I’m Vanessa Hill and this is Crash Course Public Health. In our last episode, we’re going to take a journey into the future.
One of the somewhat obvious problems with talking about the future is that we don’t know what we don’t know. Like if I walked up to someone in the mid-18th century and said I was scrolling on my iPhone and found a great Groupon for a dermatologist on Facebook, that person would probably be like, “What language are you speaking?”
So, sure, we don’t know what the next big scientific breakthrough is going to be, or what futuristic diseases we’ll encounter. But when it comes to our health, we actually have a pretty good idea of what could be next, and we also have some ideas about what we need to do today to prepare. It’s true that, in a lot of ways, the future of public health is as unknowable to us as the iPhone was to people in 1850 (and also for people in the year 2000, for that matter). But there are also a lot of ways in which public health is somewhat foreseeable. Like, consider COVID-19. plentiful and this can lead to further health problems like malnutrition and disease outbreaks so if we want to protect people’s health around the world we need to make sure that the planet’s resources are managed sustainably that means protecting land and water sources from pollution and overuse and investing in renewable energy sources like solar and wind power this is the kind of global awareness and action that a planetary approach to health requires
Experts didn’t necessarily see COVID-19 coming; instead, they recognized that disease outbreaks like COVID-19 had always been a part of human history and they also recognized that the current global healthcare system wasn’t equipped to deal with this kind of virus. That’s one reason we hear so much about infrastructure. Infrastructure includes all of the structures that society needs to operate. Traditionally, we think of physical things like buildings, roads, and power plants, but it also involves less tangible things like telecommunication and education systems and a workforce to operate those systems.
In public health terms, infrastructure means creating a health system that can handle any issue we throw at it, from mental illness to a global pandemic. One major piece of public health infrastructure that we hear about is disease surveillance. This basically consists of the systems that hospitals, health agencies, and entire countries use to track and analyze disease emergence levels and spread in a population. Like a meteorologist predicting the weather days in advance, health experts use disease surveillance to forecast things like the upcoming flu season or a new virus.
One of the first recorded instances of disease surveillance actually occurred as early as the mid 1600s when an amateur scientist in London by the name of John Grant began analyzing and surveying the London bills of mortality, a weekly report on disease and death released by the city. Grant published his findings in a book titled Natural and Political Observations Mentioned in the Following Index and Made Upon the Bills of Mortality, which people usually just called Observations. In his book, Grant analyzed publicly available death records with a population approach, which allowed him to notice larger patterns into disease and mortality. For instance, Grant noted that while rates of chronic diseases were pretty stable, contagious diseases tended to surge or fall depending on neighborhood or time of year.
Today, disease surveillance looks at more than just germs, like crowdsourced traffic data, Google searches, airline travel history, and in the case of COVID-19, even sewage (literally, your poop). At a time when people and information are traveling faster and more often than ever before, health experts are learning how to use all these data points to forecast emerging disease outbreaks and trends before they come knocking on civilization’s door.
When they’re working effectively, these surveillance systems create a global network of understanding and communication. However, when there are gaps in these systems due to a short-handed workforce, outdated systems, or lack of financial support, health experts lack the best tools and resources to keep people healthy and safe.
While disease surveillance remains an important public health tool, public health experts are also going beyond monitoring disease spread to understand how human systems can unwittingly cause or worsen illness. This is where some experts have proposed a planetary approach to health. If public health is the recognition that health is shared between all people, then a planetary approach to health is the recognition that the health of the entire planet is connected, from marine biologists working on the Great Barrier Reef to the levels of CO2 in the atmosphere to the shrinking of the Amazon rainforest to all of the animals that live in that forest.
And science has shown that a planetary approach to health isn’t just possible, it might be necessary. Let’s go to the thought bubble. Consider our food supply as it is; we already use about half of the planet’s livable surface to feed ourselves with agriculture and livestock. As climate change leads to more droughts and floods, experts project that there will be less food available. This will likely drive up the price of food, meaning that even more people will go hungry or rely on nutrition-deficient foods. This is already happening in many nations, leading to the migration of people to places where food is more plentiful, and this can lead to further health problems like malnutrition and disease outbreaks.
So, if we want to protect people’s health around the world, we need to make sure that the planet’s resources are managed sustainably. That means protecting land and water sources from pollution and overuse, and investing in renewable energy sources like solar and wind power. This is the kind of global awareness and action that a planetary approach to health requires.