The Interdependence of Global Health

President Putnam explored the interconnectedness of world health

Earlier this year, Tammy and I were on our way to southern California for a conference. We boarded our second flight that day eager for warmer temperatures and a brief relief from the winter in Iowa. About midway through the two-hour flight, Tammy reached for my arm and quietly whispered, “I don’t feel well.” Looking at her carefully, I noticed she was pale and her skin felt a bit clammy. As a preemptive move, we agreed it would be best if she headed to the restroom. I stepped in the aisle to assist. As she passed in front of me, she appeared weak and in seconds she fainted.

Immediately, those surrounding us came to our aid. Some helped support her as I removed her coat; others opened air vents to make breathing easier. Within a short time, she was alert again and had sufficient strength to complete the short walk to the rear of the aircraft as the flight attendant ensured a clear path. All eyes were turned in our direction. Most were expressions of understanding, but one elderly gentleman looked at us with a face of fear.

The chance to cool down a bit and move through the cabin allowed Tammy the needed opportunity to regain her strength. In moments we were returning to our seats. As we passed the elderly gentleman again, his eyes were no less fearful, but now his face was covered with a surgical mask.

The images of that flight have stayed with me. We witnessed three different responses to Tammy’s brief illness:

  • Those nearby who assisted did so without any concern for themselves. There was no opportunity to assess her condition and make a reasoned choice about offering a hand of support. They simply responded to the need of a fellow passenger.
  • Those at more of a distance remained so, but with a measure of empathy. I could see their natural curiosity. I think they could each tell me a story about how they had fallen ill in a setting that was inconvenient and uncomfortable.
  • If the elderly gentleman had a parachute, I think he would have used it.

Each of these responses was understandable given the circumstances. There are those available and willing to help when need arises. Others may not be in a position to assist, but are equally concerned and supportive to the extent possible. A few more vulnerable by age or underlying condition need to be protected.

Cholera was the first truly global disease. It emerged in the Indian subcontinent in 1817 with an initial outbreak that lasted until 1823.This first pandemic traveled as far as Southeast Asia, Central Asia, the Middle East and Russia via trade routes. Since the early 19th century, a total of seven cholera pandemics have impacted the globe taking the lives of millions.

The early spread of cholera provides a few insights about the emerging interdependence of global health. In an article for National Geographic News, Sharon Guynup chronicled an outbreak of cholera that hit England beginning in 1831:

There was a lot of confusion about the disease, as in the early days of HIV, said Ralph Frerichs, professor of epidemiology at University of California, Los Angeles. Most physicians believed the disease was contracted by breathing noxious vapors, or miasma. “There was a lot of fear, because people can’t stop breathing air,” Frerichs said.

But one doctor, John Snow, published another theory in 1849: Cholera was transmitted by contaminated food or water. He argued that it couldn’t be airborne because it didn’t affect the lungs. But his theory was ignored, attacked by many among the medical profession because he couldn’t identify the “poison” in the water.

It wasn’t until the 1854 outbreak that Snow was able to prove his argument. He mapped the location of cholera deaths—and found high concentrations in certain areas. For example, about 500 people died in ten days near the intersection of Cambridge and Broad Streets—they shared a single water supply.

(Cholera: Tracking the First Truly Global Disease, National Geographic News, June 14, 2004)

Containing the threat of cholera around the world came through scientific discovery, through a commitment to change societal infrastructure in service of public health, and through the need to change the lifestyles of average citizens.

As I sat on the plane reflecting on Tammy’s health and the anxious feeling that had overtaken us, I wondered about the consequences if she actually had been carrying a highly contagious disease. This flight originated in one major metropolitan region and we were heading to another. Who was on this flight? Where would these passengers make their next connection? How many destinations in the world would they reach within the next few hours? Tammy’s condition was most likely the result of a combination of physical and environmental factors. Her symptoms subsided quickly and by the time we arrived at the conference she felt quite normal.

In the wake of this experience, however, I gained a new appreciation for the various roles we play in promoting global health. I admire the dedication of healthcare professionals, scientists and epidemiologists who work so hard to prevent the spread of disease. Their careful surveillance, prevention and intervention manage health risk for a swelling global population. I have increased respect for those who practice good global citizenship by maintaining their own well-being through healthy living and hygiene. This is great service in a global society where a single person can open the pathway to a global health risk. I accept increased responsibility for vulnerable populations. The very young and the very old, those with underlying health risks and women who are pregnant or nursing need to be the objects of our shared concern.

As an educator, I am increasingly conscious that the knowledge, skills, experiences and values we encourage through the educational process are an important contribution to promoting global health. We need to develop the next generation of health activists and advocates who will respond to the call of global health. We need to promote the well-being of society by sharing information and ideas for healthy global citizenship. We need to reach out to those in need and realize that in the end, their health and well-being is our own.

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