Top Ten Global Health Threats

June 18th, 2019 by Bryce Loder

The World Health Organization (WHO) has identified ten of the biggest threats to global health.   In preparing to teach a class at the hospital here in Honduras, it seemed more relevant to share these global health concerns rather than watch eyes roll as an outsider gives another class about the proper way to take a blood pressure or to wash hands or to manage simple fractures.   There are no simple solutions proposed here – just observations and facts.  We have to educate ourselves and listen.  People who have a medical service to sell might not agree with the WHO, but it’s likely that their observations about our big threats are actually pretty much spot-on.

 

“Global Health”  includes all of us in our spacious homes in rural and suburban Kansas or California or in apartments in New York and Alaska.  These threats aren’t confined to the “third world” or “low resource” countries  as we are prone to believe.  We all live in this world and share the air, the oceans, and the pollutants that move around the world easily. 

 

Three of the big ten threats to global health that are the focus of the WHO and their partners in 2019 are clearly applicable to situations I faced just yesterday and today at Hospital Loma de Luz in the Colón province of Honduras (and also face in Kansas and Alaska to some degree): 

1. Antimicrobial Resistance
2. Dengue
3. Weak Primary Health Care

 

Antimicrobial Resistance

Five year old Rudy Gareth Gonzales Guevara (let that slightly altered name roll off of your tongue a few times) was here for a consult regarding tonsillectomy.  Mother had been told that he needed tonsillectomy.  She treated him every few weeks for tonsillitis with an antibiotic purchased without prescription at a local pharmacy.  The diagnosis of a bacterial infection had never been confirmed, but he was now taking a fourth generation cephalosporin antibiotic costing the parents about $34, a huge sum here.  He’s had multiple courses of mother-prescribed antibiotics, but possibly no bacterial infections.  Antibiotics have saved millions of lives.  But worldwide we’re seeing organisms resistant to multiple antibiotics.  WHO predicts that by 2050 (not far away) we might be more likely to die from simple infections which are resistant to antibiotics than to die from cancer.  It’s a global problem that will have to be addressed globally.    Oh…and back to Rudy.  His tonsils looked great.  Grandma and I both talked to mother about bringing him here for an exam before he is “mom-treated” in the future.  And grandma and I both agreed that he should stay away from a surgeon for now–and I really admire surgeons.

 

Dengue

As the world warms up, the geographic area of world at risk of contracting dengue, a mosquito-borne illness, continues to increase. 

 

Last night in ER I saw my first case of Dengue, in a 25 month old child who had two days of febrile seizures.  Treatment will be acetaminophen (Tylenol), and he’ll probably do well.  They stayed in the low cost “Samaritan House” here last night rather than make the 2.5 hour trip home in the middle of the night.  I saw him again in the clinic today before they made the trip home.  This made Dengue real to me.

 

Strategies to control this will need to be global.  It’s not going to hit Kansas or Alaska anytime soon as a major cause of death, but it will keep moving north from the tropics.  We all have a stake in this.

 

Weak Primary Health Care

This most basic of problems continues to worsen in all countries that don’t have a strategy to bring primary health care to the majority of citizens. This includes the USA, my home country, and Honduras where I’m working this month.  Bypassing primary care, and treating conditions when they are already advanced is just more expensive, even if one forgets the human suffering part of the equation.  While the excellent secondary and subspecialty care that we all treasure and depend upon in both the developed and underdeveloped part of the world is a necessary part of health care, the provision of primary care services to the whole population reduces health care costs and reduces human suffering. Oh, and it also makes for a healthier population. Many countries have systems in place to make access to primary care available to almost everyone.  Unfortunately my native country , the USA, does not, and the increasing cost in productive days of life lost to illness and conditions which could have been prevented will keep us from achieving full human potential.  We won’t be able to compete economically with the remainder of the world.   Countries which haven’t achieved good access to primary care will need to learn strategies from countries which have been more successful in bringing primary care to their citizens.  Many models, all imperfect, have been tried, and some have been quite successful.    

 

Here in Honduras today (less than one hour ago) I saw a walk-in patient at the hospital with a complaint of feeling dizzy and tired.  He was 76 years old.  He was fairly certain that the last time he saw a doctor (if ever) was when he was a young child.  He’s had no primary care and monitoring.  He was actually quite strong, and he swings a machete all day for a living. He looked pretty good, and he might be the one who actually should stay away from us!  The poor guy was lost in this rural hospital and this fairly advanced health care system here in the jungle.  There are health posts and doctors in this area of Honduras, and there is transport by road to those health posts, but the number of primary health care workers isn’t enough to support the population.  This is exactly what we face in much of the USA now.  And we aren’t even in a terribly remote area here near Balfate,  even though it feels like it when the 2 hour trip to La Ceiba takes 5 or more hours because of roadblocks and burning tires from the almost daily protests on that road.

 

So those ten urgent threats to global health were interesting reading last month.  Today they’re more real, and if I’m objective in looking at this, they don’t just apply here in Honduras.   Again, don’t let yourself think for a minute that we aren’t all in this together.  Well…if today is your birthday, or if you have a big test tomorrow, or you’re preparing for a big family gathering, go ahead and study or have the party and don’t think about this until tomorrow.