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Health and Civilization:
Challenges for the 21st Century
Dr Shigeru Omi
Regional Director
World Health Organization
Western Pacific Regional Office
1
History of disease and civilization
Period
Event
Disease
Prehistory
human beings lived as
hunters and gatherers of food
No major communicable
diseases
1st Wave
Hunter-gatherers ‘settled’ into
agrarian villages
small pox, measles,
chickenpox,Tuberculosis
Contact between different
civilizations (through trade
and travel )
small pox, measles
From Europe to Asia via the
Silk Road
“Black Death” /bubonic
plague
Started in Europe in the 6th
century
Smallpox, measles,
influenza, typhus
To America from Europe
(destroyed 90% of the
population)
Syphilis
To Europe from America
Malaria, yellow fever
To Europe from Africa
(5,000 –2,500 years ago)
2nd
Wave
(2500(2500-700 years ago)
3rd
Wave
(700 years ago and
onwards)
4th Wave ?
Trans-oceanic movement of
seafarers
?
?
Place
Sumeria, Egypt
?
(McMicheal, A.J., Human frontiers, environments and diseases
Cambridge University Press, 2001)
2
At least one out of four people dies
from a major disease of the time.
Time
Place
Disease
450 BC
Athens
Plague
1348 AD
Europe
“Black death”
16th
century
America
Smallpox,measles,
influenza,typhus
Today ?
Developed countries and
Noncommunicable
some developing countries diseases
Tatukawa ,Syoji Byoki no syakaishi NHK books, 1970
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Disease and Civilization
Interaction
Disease
Civilization
4
Characteristics of civilization today
1. Globalization
The flow of people, goods and
information is unprecedented
2. Urbanization
There are more than 20 megacities
today
3. Consumerism Consumption has become an end
in itself
4. Pervasiveness of science and
technology Science and technology is
penetrating every corner of the
world
5
Health issues today
6
Issue 1. Emergence of new
infectious diseases
•
Globally in the past 20 years,
on the average, one new infectious
disease emerges each year.
7
Emerging disease
Human Immunodeficiency Virus 1 (HIV 1)
Human Immunodeficiency Virus 2 (HIV 2)
Enterocytozoon Bieneusi
Human Herpesvirus 6 (HHV 6)
Hepatitis C virus
Hepatitis E virus
Guanarito Virus
Barmah Forest Virus
Bartonella henselae
Sin Nombre Hantavirus
Cyclospora cayatenensis
Sabia Virus
Hendra Virus
Human Herpesvirus 8
Lyssavirus (in Australia)
Nipah Virus
New Variant Creuzfeldt-Jacob Disease
West Nile Virus (in the United States)
SARS CoV
Monkeypox (in the United States)
Date identified
1983
1985
1985
1986
1989
1990
1991
1992
1992
1993
1994
1994
1994
1994
1996
1996
1996
1999
2003
2003
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Issue 1. Emergence of new
infectious diseases
•
Globalisation, urbanization
- Unprecedented mobility of people and
goods, and concentration of population
(SARS would have been a local disease)
•
Consumerism
(For example, Avian flu)
- Insanitary and unhygienic husbandry
practices
9
Issue 2. Re-emergence of
infectious diseases
(SARS
•
Death ≒ 800 )
Tuberculosis
Death = 50,000 per day, worldwide
(Communicable diseases were believed to be
things of the past)
10
Issue 2. Re-emergence of
infectious diseases
•
Urbanization
- Urbanization often results in unhygienic and congested
living conditions for vulnerable groups such as the poor
and migrant populations.
- Urban slams and squatters represent fertile breeding
grounds for emerging infectious diseases
•
Globalisation, consumerism and
pervasiveness of science and technology
- ageing society
11
Issue 3: Increase of
noncommunicable disease
Disease burden in developing countries
49
15
9
1990 (%)
27
Infectious disease
Maternal disease
Trauma
22
21
14
Psychiatric disease
Non-communicable
disease
DALY = Disability-Adjusted Life Year
43
2020 (%)
(Source: WHO, Evidence, Information and Policy,122000)
Issue 3. Increase of
noncommunicable disease
•
Urbanization, globalisation
- Environmental degradation
Air and water pollution, climate change etc –
- Unhealthy lifestyle
Sedentary lifestyle
Unhealthy diet
Tobacco use
13
?
Death rate
Per 100,000
30
25
20
15
10
5
0
1993-1997
1998-2002
14
Suicide
Death rate
Per 100,000
30
25
20
15
10
5
0
1993-1997
1998-2002
15
Issue 4. Increase of people
suffering from mental health
problems
•
Urbanization, globalisation
-highly competitive society associated
with excessive stress
-lack of connectedness due to the
breakdown of communities and families
16
Issue 5. Low level of
satisfaction among consumers
with the quality of health
services despite advances in
science and technology
•
Only 55% of patients diagnosed and treated adequately.
(United States of America, Report of Institute of Medicine, 1999)
•
Around 10% of hospital patients suffer adverse events.
(United Kingdom, An Organization with a Memory, Department of Health, 1999)
17
Patient Satisfaction
100
90
80
70
60
50
40
30
20
10
0
Denmark
Sweden
USA
Japan
Health care expenditure per capita
(OECD Data, 2002)
18
Issue 5. Low level of
satisfaction among consumers
with the quality of health
services despite advances in
science and technology
•
Globalisation, pervasiveness of science and
technology
-negligence of psychosocial factor as well as
patient safety due to excessive reliance on
technology and mechanistic approaches.
19
Health issues and civilization
Characteristics of
civilization
Health issues
1. Globalisation
Issue 1. Emergence of new infectious
diseases
2. Urbanization
Issue 2. Re-emergence of infectious diseases
3. Consumerism
Issue 3. Increase of noncommunciable
disease
4. Pervasiveness of
science and
technology
Issue 4. Increase of people suffering from
mental health problems
Issue 5. Low level of satisfaction among
consumers with the quality health
services despite advance in
science and technology
20
Redefine the ways in which
humans co-exist with other
species.
21
Strengthen
cross-boundary cooperation.
22
Revitalize the community.
23
Concept of “New Community”
Members of community:
(Previously decision-making was top down.)
„
participate in decision making
(Previously communities were closed and self-contained without
dynamic interactions. )
„
are open to innovative ideas and other
communities.
(Previously the interest of the community had to come first, recently
the interests of individuals have been over-emphasized.)
„
strike a balance between their individual interests
with the collective interest of the community.
24
Empower individuals
including consumers.
25
Promote corporate
social responsibility.
26
Provide safety nets for
vulnerable populations.
27
Bring psychosocial factors into
the mainstream of development.
28
Patients with moderate to severe coronary heart disease
who changed their intensive lifestyle, (with vegetarian
food, aerobic exercise, stress management training,
smoking cessation, group psychosocial support )
reversed coronary arteriosclerosis by 7.9% of diameter
after 5 years, whereas those who didn’t change worsened.
JAMA. 1998;280:2001-2007
Patients who received coronary artery bypass graft, with
moderate to severe depression had higher rates of death
than those without depression
Lancet. 2003;362:604-609
29
Summary of actions
Redefine the ways in which humans co-exist with other species.
Strengthen cross-boundary cooperation.
Revitalize the community.
Empower individuals including consumers.
Promote corporate social responsibility.
Provide safety nets for vulnerable populations.
Bring psychosocial factors into the mainstream of development.
30
Message for the Future
•
•
•
Depart from narrow vision, fragmented
approach and turf mentality.
Shift emphasis from economy driven to
human-centred society.
Nurture that which is good and be bold in
creating the better.
31