Stephen Leeder: Health possibilities

I ARRIVED at the Windsor Hotel, Melbourne and asked the concierge where I would find the health conference.

“We don’t have one”, he said, before sensing my puzzlement. “But we DO have a water conference!”

“Yep, the H₂O conference”, he explained. I inferred correctly that this was probably the H20 conference, but the H₂O label made me think.

Access to clean water is a massive global public challenge with 780 million people lacking access, particularly in developing countries.

As world populations migrate from a rice-based agrarian lifestyle to meat-based urban living, there will be less clean water. It takes 3500 litres of water to produce 1 kg of rice and 15 000 litres for 1 kg of beef.

In Sierra Leone, the centre of the Ebola epidemic, 40% of its population lack access to clean water and nearly 90% live in areas without sanitation.

Turn those facts over in your mind while you consider stopping the transmission of Ebola. In this blighted country, still recovering from a decade-long civil war, 10 000 babies a day die within the first month of life. For children up to the age of 5 years, the main causes of loss of life are pneumonia, diarrhoea, malaria, measles and HIV, with malnutrition contributing to more than half of all child deaths.

Charities help to drill wells and bores but much more remains to be done. To be concerned about the economy of countries such as Sierra Leone is to be concerned about the health of its people and vice versa.

The H20 was convened by the World Medical Association (WMA), the AMA and AMA Victoria to supplement the deliberations of the G20 held in Brisbane. The H20 attracted 150 participants from many clinical disciplines as well as public health professionals from Australia and beyond.

Three big themes emerged.

First, as the WMA states: “Health inequality between and within countries is … an urgent issue of social justice. It is clear that these health inequalities are the result of differences in living conditions; the environment in which a person is born, grows, lives, works, ages, and dies.”

The H20 called on the international community, including the health sector, to redouble efforts to reach a more fair and just society.

Unfair inequalities received repeated mention over the 2 days of the conference. Pope Francis, in a letter to Prime Minister Tony Abbott, as president of the G20, also implored the G20 heads of state and government to take into account “real improvements in the living conditions of poorer families and the reduction of all forms of unacceptable inequality”.

The second theme was about climate change. Earlier this year the MJA, through an open letter, had called on Tony Abbott to include it in the G20 agenda.

The dramatic intervention of US President Barack Obama, in his speech to students at the University of Queensland on 15 November, brought climate change onto centrestage despite reticence from Mr Abbott.

The H20 meeting was told that recent climate changes have had widespread impacts on human and natural systems. The WHO estimates 13 million deaths a year are due to preventable environmental causes. “Mitigating environmental risk could save as many as four million lives a year in children alone, mostly in developing countries”, it says.

The third theme at the H20 was non-communicable diseases (NCDs), which account for more than 36 million deaths a year, compared with an estimated 1.6 million from HIV/AIDS.

The Lancet NCD Series has calculated that action in relation to salt, tobacco, alcohol, essential drugs (for diabetes and hypertension) and physical exercise could result in a 25% reduction in preventable mortality by 2025 at a global cost of US$9 billion a year.

Dr Mukesh Haikerwal, chair of the WMA who convened and organised the H20, told the conference: “It is astonishing that health is ignored when our leaders meet. When you look down the agenda for G20 summits you will find issues like financial regulation, tax reforms and global trading, but never health. And yet without good health, other issues cannot be achieved. Politicians who ignore this are being very short-sighted.”

It is easy to come away from such a meeting feeling completely powerless. We should not. We need always to remember the strength of the medical profession in lobbying for better health.

As President Obama said at the University of Queensland, we all have an obligation to raise our voices for action to be taken by government on health, whether over Ebola, climate change and international trade agreements or NCDs — or even clean water. Silence is neither necessary nor desirable.

An aphorism attributed to St Francis of Assisi on acting in the face of apparently insuperable odds sums up the challenge: “Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.”

Professor Stephen Leeder is the editor-in-chief of the MJA and emeritus professor of public health and community medicine at the University of Sydney.