Health for nobody by the year 2050

Urbanization is one of the leading global trends of the 21st Century that has a significant impact on health. By 2050, over 70% of the world’s population will live in cities. The factors influencing urban health include urban governance, population characteristics, the natural and built environment, social and economic development, services and health emergency management, and food security. While cities can bring opportunities, they can also bring challenges for better health. Today’s cities and those of tomorrow are facing a triple threat: infectious diseases like HIV/AIDS, TB, pneumonia, diarrhoeal diseases; noncommunicable diseases like asthma, heart disease, cancer and diabetes, and violence and injuries, including road traffic injuries (www.who.int/topics/urban_health).

Sombre news

In a sweeping statement placed on its website, the World Health Organization (WHO) estimates that by the year 2050, 70% of the world population will live in cities, where there will by then be so much disease that it is difficult to envisage anyone being able to remain healthy. The ‘triple threat’ (infectious diseases, noncommunicable diseases, violence and injuries) that we will be exposed to hardly comes as a surprise for it effectively includes all diseases known to man conveniently grouped under three main headings. This is either very sombre news (for both the 70% city dwellers and the receding rural population), or exceedingly good news if you happen to be involved in the health care industry.

Commercially the future has never looked so good. The health care industry has, during the past decades, gone through a piranha-like feeding frenzy to become one of the world’s leading industries, second only to warfare. Increasingly large proportions of the GNP of most countries are directly or indirectly channelled towards health care, underlining the schizophrenic reality of the global free market economies we have built up. It seems likely that by the year 2050 only the CEOs of the large health and weapons industries would be able to afford to live outside the cities in relative illness-free bliss, if they were not too busy making money.

The WHO meanwhile has completely reversed its outlook in the last quarter decade. From the somewhat supercilious ‘Health for all by the year 2000’ that was its ill-advised slogan of the 1970s, the WHO now predicts that there will be no health for anybody by the year 2050.

Misguided belief

Health for all by 2000 had to be quietly and unceremoniously dropped as the end of the century drew closer and it became clear that not only was the ‘battle’ with nature not going very well, but it was a battle that we would inevitably lose even if we won. There was, and still is, a firm and misguided belief in WHO circles that all illness was preventable, so the focus has traditionally excluded almost all aspects of health care that did not involve prevention. Riding the coattails of the end of the smallpox epidemic, prevention promised to lead us into a better and healthier world, making the WHO at once successful and redundant. Much of the current drive to send some astronauts to Mars is a relic of the idea that we can control and even improve on nature, and if we could only start from scratch we should be able to set up a better and more manageable (more logical) environment. All you really need for that, apparently, is a bit of water in some rocks on an uninhabitable airless desert… The WHO, however, continues here on earth and having failed to make itself redundant by the year 2000, must soldier on, adopting along the way many of the methods and techniques used by large corporations. It is very likely that highly paid committees spent much time debating the exact wording of this unwieldy but all-inclusive ‘mission statement’ (or am I confusing it with a vision statement?) that we may condense into the simple marketing and T-shirt slogan ‘health for nobody by the year 2050’.

The real triple threat

The ‘triple threat’ used to justify this depressing position neatly includes practically all illness know to man, including those rebranded ‘diseases’ the pharmaceutical industry has become so fond of, but inexplicably does not take into account, the real triple threat of: insufficient food, water and clean air. Perhaps by definition those do not count as real health problems and anyway they would be problems for the FAO and the various environmental organisations and not something the WHO should be concerning itself with.

The drive towards urbanization is closely linked with the trend of globalized commerce and the current economic model of infinite growth. You need a large urban population to not only manufacture the goods but also buy them, and an urban setting effectively provides both.

Peanut butter

The WHO, instead of maintaining a general supervision and control of the health industry is increasingly pressurized to aligning itself behind the large health industries. Declaring a pandemic at the drop of a hat to ensure healthy vaccine sales, or buying vast quantities of the expensive commercially produced fortified peanut butter that was developed with the help of starving African children but may not be produced by the countries where it was developed because of patent restrictions.

Future of rural population

It has become clear that there may be no real solution if we continue our current model of obligatory economic growth, for a restricted population as it ages will inevitably make the entire structure top heavy. This has now been discovered in China, where the only large scale experiment with population restriction (one child per family) is about to be abandoned. The problem is how we will maintain the supply of food to the increasing masses who cannot fend for themselves any longer by growing their own food, when the usable stretches of land for industrial food production have been exhausted and ultimately prove insufficient. Small-scale subsistence farming is only possible with a rural population. But perhaps the colonists on Mars will by then have discovered a solution for the food problem that we can use…if they are still alive… and if we are still alive.

The combination of democracy and capitalism has been predicted to be terminally destructive. The environment will probably survive, but there may be no one to admire the sunset.