Last week I had the happy opportunity to participate in the grand opening of the Global Health Center at the University of California, San Francisco. An elite group of local and visiting dignitaries attended. At my table were the dean of the School of Public Health at Harvard and a past president of the Institute of Medicine in Washington. Many hurrahs.
The field of global health is in a transformative phase. Just a decade ago the virtual entirety of attention was centered on those threats caused historically by infectious agents, malaria, polio, TB and their co-conspirators. Much progress in all these domains has and is occurring. Even rumored is the imminent elimination of AIDS as a global threat. I still feel that the fulfillment of this prediction is still a ways off.
But attention is now turning on its heel to the NCDs, the non-communicable diseases: the heart, stroke, diabetes, cancers that have been my life work as a busy geriatrician. I've lived a grand career with 54 years in the trenches as a busy general internist. I have lived the scenarios posed in Atul Gawande's new book "Being Mortal" 1,000 times. (1) I have relished the complexity and uncertainty posed by most clinical encounters.
Yet as medicine constitutes a central pillar of our society I note that it hurts badly. I make the diagnosis of "total body pain" in my 2012 book "Next Medicine" to reflect the multiplicity of symptoms which it presents. (2) My principal critique is that it is "irrelevant." It sells the wrong product. It sells repair. It should sell prevention. Current medicine sells disease. It should sell health, which is where my field of geriatrics enters the discussion. Since aging is not a disease it fails to find a comfortable slot in current medicine as the recruitment problems of geriatrics training programs are a testament to this fact.
Aging and geriatrics are all about health. The subtitle of my "Next Medicine" book was "the science of health." My lens focuses on health and in so doing it shows how out of focus our current medicine is. Current medicine's principal tools are technology and pharmacy. They pay well, but are mostly after the fact, and thus usually irrelevant. They succeed occasionally.
My wide-angle lens shows that the main threats to global health are obesity and aging. Current medicine is notably non-competent in these areas. In my view current medicine is anachronistic representing a square peg trying to fit in a round hole.
My stern remedy for this misfit is an intensive insistence on health literacy. This implies a massive transfer of responsibility for health to the individual from the system that is currently faltering. Until now there simply has not been sufficient knowledge of the essentials of the health curriculum. No longer. We now know what health is and what it isn't. I advocate sharply for health literacy for everyone regardless of cost, language, socioeconomic position or other non-biologic issues. The expanding social media competency offers a powerful megaphone for the distribution of our new health knowledge. I reserve technology as a safety net, but only as a fail safe after failure to embrace a full program of self-care. I advocate strongly for an increased emphasis on behavior as a health determinant albeit mindful of the socioeconomic contingencies it holds.
Global health literacy emerges as my top priority. I am personally pledged to plow this field for the rest of my time in the pasture of humanity.
1) Gawande, A. Being Mortal 2014, Henry Holt, NY.
2) Bortz, W. Next Medicine 2012, Oxford Univ. Press, NY.