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Walter M. Bortz II, M.D. Headshot

Dare to Be 100: Reformulating Global Health

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It's been quite a while, but I don't recall that we med students at Penn were given any coursework on global health at all. If we were it was probably confined to once a week in a musty dusty corner of our curriculum. Sixty years ago, global health was not on our radar screen.

Unfortunately, the remoteness of this story involving illnesses in remote corners of our globe insulated us from a sense of worry. Their problems did not seem to pertain to us. The many reasons behind this callousness are a huge stain on our species' moral record. We have died by the hundreds of millions with little anxiety to mourn our largely unknown, foreign, early deaths.

John Donne's lines in "No Man Is an Island" speak to this point.

"Any man's death diminishes me,
Because I am involved in all mankind.
And therefore no need to know for whom the bell tolls.
It tolls for thee."

In passing we are little more than the Neanderthals who surely had their Ruandas and Kosovos and Syrias. With very few exceptions, we all live too short and die too long.

Slowly, the collective hurt spread. The sense of guilt has narrow margins of time and space. Religious groups, NGOs, even governments stepped in to provide us with a pretension of a new approach to global health. Faster communication generated a shortened latent period between alien hurt and proximate pain.

The Gates Foundation has been the poster child of a global concern for those of a different color, who speak different languages, and suffer from different conditions. Bill and Melinda have committed billions of their well-earned dollars to global health. Carefully, they have calculated the metrics which define the global burden of disease. They have studiously sought the biggest bang for their bucks. The fantastic total eradication of smallpox at a global level stands as a signature success.

Polio is an easy condition for me to identify with as my parents with terror in their eyes evacuated me from my boyhood Philadelphia home to the New Jersey seashore simply so that I could escape from the mean villain that was loose on the streets. Now, in an instant, my grandchildren don't even know what polio is.

The collective effort addressing the infectious diseases has resulted in a huge shift in the burden of illness. Now as the infectious disease terrors are easing other new demons are eager to imprint their distress. Ironically, these new concerns that appear in the developing and underdeveloped world are the same ones that we in the developed world have been steadily cultivating in our own midst. Cigarette smoking and its widespread malevolence leads this list, but obesity and its immediate partner, diabetes, follows closely behind. On a recent trip to China I was alerted to the possibility that in a few years China may be facing an epidemic of diabetes that far eclipses any possible infectious disease threat. And now we come to the consideration that there may be more fat kids in Africa than skinny ones. The Third World is catching our illnesses.

All of this transition in less than a lifetime.

While global obesity is the new leader of the curriculum in global health, not far behind is frailty, which arises as a direct byproduct of the world population aging. The entire economic issue of whether the new old global census will contribute as a resource or as a threat is challenging. Increased economical political ramifications loom. Several countries already face potential and real shortages of caregiver capacity. China with its disfiguring gender allocation stands to face huge challenges. From afar it seems that the progress against infectious diseases has resulted from successive targeted vaccines against the grim bacteria and virus that inhabit our neighborhoods. The new global threats of obesity and frailty do not present the opportunity for a countervailing vaccine. Or do they? Maybe health literacy, in its broadened sense, could become the effective vaccine about the prevention of these new non-communicable diseases.

They do lend themselves to possible public health preventive strategies.

The new global health focus has a big agenda to confront, but we are fortunate that the system at last seems to be waking me up to the new reality. We envision, for the first time, a One World in which all may achieve their lifetime potential, not foreshortened by ignorance or other human inadequacy.

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