Trevor Hancock: The health costs of business as usual

A couple of weeks ago I noted that in addition to COVID-19, other major infectious diseases kill millions of people annually, mostly children, and mostly in low-income countries. But globally, and certainly in high-income countries, infectious diseases are not our major causes of death, disease and injury.

The World Health Organization reports that of the 57 million deaths worldwide in 2016, more than a quarter were due to heart disease and stroke, almost one in six was caused by cancer and one in 10 was due to a combination of chronic obstructive lung disease (five per cent) and pneumonia and bronchitis (another five per cent). The only other infectious diseases in the top 10 killers were diarrhoeal disease and tuberculosis, but dementia, diabetes and road crashes claimed more victims than either.

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Moreover, these chronic diseases sicken and disable many more people than they kill, often for years, if not decades, imposing a heavy burden on patients, families, communities and the health-care system. So we should think of them as pandemics, which, after all, are simply large epidemics, ones that are found “over a very wide area and usually affecting a large proportion of the population,” according to the Dictionary of Epidemiology.

But as always in public health, we need to look behind the causes of death and look for the causes of the causes. The WHO reports the following factors that contribute to this annual death toll: Tobacco (eight million deaths), outdoor air pollution (4.2 million), indoor air pollution (3.8 million), insufficient physical activity (3.2 million) and alcohol use (three million).

Meanwhile, the Global Burden of Disease Study (based at the Institute for Health Metrics and Evaluation at the University of Washington) reported last year that in 2017, 11 million deaths were attributable to dietary risk factors, including high salt intake (three million), low intake of whole grains (three million) and low intake of fruits (two million).

What distinguishes these chronic disease and injury pandemics, and the risk conditions that lie behind them, is that they are largely caused by our industrial society and way of life. While often called “non-communicable” diseases, that is not exactly the case; many are literally communicated, through deliberate marketing intended to increase sales of unhealthy products. Others are the byproducts of our industrial society and way of life, which we have transmitted globally along with its accompanying cultural changes.

So I prefer to call them industrial society disease and injury pandemics. Taken together, their death toll is not far off the worst-case scenario for COVID-19, occurs every single year, and in many cases, the toll is increasing.

But these risk conditions have become so much part of our way of life that we barely register them and simply accept or at least tolerate them as the way the world is; the price of growth and progress. However, in reality, while it is largely rich nations and rich people that reap the benefits in higher standards of living, it is the poor nations — and poor people in rich nations — who actually pay the price of our “progress.”

That price, ironically, has been partially revealed by the COVID-19 pandemic. By shutting down large parts of the economy and dramatically changing our way of life, we have seen air pollution fall dramatically, and with it we know that pollution-related deaths will have declined.

Meanwhile, Agence France-Presse recently reported that both road accidents and related deaths were down about 40 per cent in March compared with 2019; similar impacts have been reported in some states in the U.S.

So let’s consider the moral equivalency here. Why is it OK to take a massive economic hit to save lives from COVID-19, but not OK to take the much smaller economic hit to save lives from these other pandemics by changing our practices?

Why is it not considered unethical to swiftly reboot the current death-dealing economy, going back to the bad old ways as fast as possible, knowing full well we will once again increase these deaths, diseases and injuries?

Surely it is a bad idea to address the consequence of one pandemic by worsening the impact of other pandemics? These are key questions we should ask in our post-COVID-19 world.

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor at the University of Victoria’s School of Public Health and Social Policy.

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