Dr. C.V. Alert, MB BS, DM. FCCFP.
Family Physician.
If you were born between 1870 and 1940’s, the so called “infectious diseases era”, you were likely to be infected by many germs, generally bacteria but sometimes viruses, and your survival options included disinfection, quarantine, and mass vaccinations. If you were born after the 1940’s, you came into the world in the chronic diseases era, which, and persists even to today. The germs gave way to risk factors such as poor diet, sleep and exercise habits, and the intake of toxic substances like nicotine and alcohol. These risk factors serve to identify targets for preventing epidemics of non-contagious chronic diseases like cancers and atherosclerotic disorders, and their main complications (and our leading causes of sickness and death) like heart disease and strokes.
We have been living (and dying) through the chronic non-communicable diseases (cncds) pandemic, characterized by diseases such as obesity, diabetes, hypertension, and dyslipidemias (including high cholesterol). While mental health issues and cancers, and even the respiratory illness asthma, fit the cncd inclusion criteria, inclusion of these conditions as a cncd is erratic. Nonetheless, these illnesses account for around 75 % of our annual deaths. These conditions are correctly described as preventable, as careful attention to our eating, exercise and sleeping habits, avoidance of smoking and illicit drugs like marijuana and cocaine, using alcohol in moderation (if at all), getting regular preventive check-ups and cancer screening for breast, colon, uterine and prostate cancers, are important steps to be taken if these conditions are to be prevented. The Heart and Stroke Foundation of Barbados (HSFB), through it’s Childhood Obesity Prevention (COP) program, and the Cardiac Disease Prevention and Rehabilitation (CDP&R) program, offer preventive health programs for individuals. We need more people to get into these programs, and we need more of these types of programs. Ideally most persons should not have their health determined by an Emergency Room Physician, or on a hospital ward. Disease prevention is critical.
Unfortunately these cncds fill our hospitals, morgues and cemeteries, and place tremendous and increasing stress on our limited medical and financial resources. The last 50 or so years have seen an expansion of these conditions, but as populations we have not been able to modify our lifestyles sufficiently to maintain good health.
In the last few years, global warming and climate change have joined the lists of threats to our health and well-being. Climate change means more frequent and intense drought periods, severe storms including more hurricanes, heat waves, rising sea levels, which are occurring both with increasing frequency and are of increasing severity, and wreak havoc on people’s livelihood and lives. Sometimes this change can occur naturally, such as changes in the sun’s activity, or large volcanic eruptions. The weather phenomena El Nino is also a contributor to the changed weather patterns. However, human activity is the main driver of climate change; an urgent change in behavior is critical for human survival.
Globally 2023 was the hottest year ever. Global average air temperatures began exceeding 1.5 C of warming on an almost daily basis in the second half of the year. With this 1.5 C rise in temperature, we’ve seen floods, we’ve seen droughts, we’ve seen heat waves and wildfires all over the world, and we’re starting to see less agricultural productivity and some problems with water quality and quantity. A landmark UN report in 2018 said that the risks from climate change, such as intense heat waves, rising sea-levels and loss of wildlife, were much higher at 2 C of warming than at 1.5 C. And the consequences of a 2 C rise in temperature may be irreversible.
Limiting long-term warming to 1.5 C above “pre-industrial” levels, before humans started burning large amounts of fossil fuels, has become a key symbol of international efforts to tackle climate change.
The year 2024 could be even warmer than 2023, unfortunately. At the UN Climate Change Conference COP 28 last November/December, countries agreed for the first time on the need to tackle the main cause of rising temperatures: fossil fuels. But we need to convert talk into action, before it is too late. And we need all hands on deck.
We need to plan for water and food scarcities, to build more resilient communities, and in the short term we need to change behaviors that in the long term will reduce our carbon production. Every little bit of avoided future temperature increases results in less global warming which would otherwise accelerate the deterioration planet earth. Burning fossil fuels (like coal, oil and gas), cutting down forests and livestock farming are increasingly influencing the climate and leading to global warming. These add enormous amounts of greenhouse gases which trap heat and leads to the rising global temperature.
Changing our main energy sources to clean and renewable energy is the best way to stop global warming. These include technologies like solar, wind, and geothermal power. Urgent action to cut carbon emissions can still slow warming, scientists say.
But even while the cncd pandemic was the dominant medical force affecting our national health, the infectious diseases haven’t completely disappeared. As we speak, acute dengue fever is affecting large numbers in people in many Caribbean islands and in South America. We are coming off a corona pandemic which brought regular activities almost to a complete halt almost worldwide. Before that Chikungunya and Zica raced up and down the Caribbean. And HIV/AIDS has been around so long that it is sometimes considered a chronic disease. Meanwhile, diseases like influenza and Respiratory Syncytial Virus (RSV) float around in the background, causing a number of coughs and colds and disrupting workplace productivity.
The cncd pandemic followed the infectious disease pandemic, but the infectious diseases are still hanging around (and threaten to have a big impact in the future). In some cases there are interactions between the two pandemics that caused further compromise to our health and health services. For example, during the corona virus pandemic, there was limited access to many medical institutions and medications; now the Emergency Department is being overwhelmed by persons who simply ‘stayed at home’ during Covid-19 pandemic while their chronic illness deteriorated, and now severe illness is forcing them out.
We are seeing the convergence of Global warming with both the non-communicable pandemic and the infectious disease pandemic, and this convergence is projected to bring even more health challenges. Our health services need to evolve in anticipation of three simultaneous pandemics.
When confronted by the cncd pandemic, our health services have focused on drug therapies, building bigger Emergency Departments, and contemplated adding on more hospital beds or a new hospital. When challenged by the covid-19 pandemic, we were able to convert an unused facility into an infectious disease hospital at Harrison’s Point. We thus has one hospital for non-covid-19 patients, and another (including multiple satellite locations) for covid-19 patients. What will happen in the future? Can we afford to rapidly expand our health intrastructure?
As a retired Navy Admiral once famously said, “if you can’t do the little things right, you will never do the big thinks right”. Another writer noted “Big things are accomplished when we master the little things”. The time to act is now.