One world health - A conversation with Lord Nigel Crisp

"Public health is a shared issue and, together, we need to develop shared solutions," says Lord Nigel Crisp, the 2016 Douglas R. Wilson lecturer.

Rachel Harper - 18 October 2016

One world health-not first or third world health-touches all people in all communities.

Focused on the shared issues we face around the world, from epidemics to climate change, Lord Nigel Crisp explores the future of the health in our global community.

On October 21, 2016, the School of Public Health is pleased to welcome Lord Crisp as the speaker for the Douglas R. Wilson Lecture. This lecture is free and open to the public.

We spoke with Lord Crisp to learn more about his work, his philosophy and his upcoming trip to Edmonton.

Q: What are some of the shared issues that we face? How do issues in developing nations impact the developed world and, more specifically, Canada?

A: There are several shared issues that both developing and developed nations face. We are vulnerable to the same diseases, we are vulnerable to the climate and environmental impacts, and we are reliant on the same resources, like staffing.

To start off, let's talk about infectious diseases. We've recently had the Ebola outbreaks in West Africa where everyone else in the world became worried about it coming to their own country. In 2003, Canada had the dreadful experience of severe acute respiratory syndrome (SARS). Within about three days of it being identified in Hong Kong, SARS was able to travel across the world and kill people in Toronto. Given these two examples, the first thing we all share is our vulnerability to infectious diseases, whether it is new infectious disease or the resurgence of old infectious diseases like disease resistant tuberculosis. New diseases may grow and develop in an area where there isn't any decent surveillance and then, with modern transportation, can simply travel the world. What that means, is that all of us are as vulnerable as the weakest place in the world.

Secondly, our world is experiencing an epidemic of non-infectious diseases, like diabetes, heart disease and all of the things associated with affluence. None of us yet know how to deal with them effectively. While we have become rather good at dealing with infectious diseases in countries like Canada or the United Kingdom (U.K.), we have yet to discover how we stop people from getting diabetes or heart disease. These are issues that we are going to have to learn together.

Moving on from diseases, we then have climate change. In 1986, we had the classic example of environmental issues affecting the U.K. when the nuclear reactor blew up in Chernobyl. Some of this fallout was detected in grass in Wales, which could have contaminated the food chain in the U.K. from grazing sheep. We, collectively, are impacted by climate change but also environmental change. It is important to remember that these two things do not respect our administrative boundaries.

Finally, another type of shared issue is the global shortage of health workers. As there is more demand for health care globally, there is not a commensurate increase in health workers.

Q: Who is responsible for addressing these shared issues?

A: It's all of us; we just have different roles to play. We can't pin it on one person or one organization or we won't be successful in addressing these shared issues. The government has key responsibilities to inform and provide overviews of these issues, but the public needs to be aware and be vigilant.

For example, one of the problems with developing a vaccine for a disease like Ebola or SARS is that it is not profitable. If there isn't an outbreak, a company that develops the vaccine doesn't make any money because you can't sell it to the public. Therefore, we need our governments and international organizations to fund vaccines for infectious disease.

Q: Why is it important that we understand our common issues and address them together?

A: Simply put, so people won't die. A great example of this would be when human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV / AIDS) first appeared. Until 2005, there were enormous fears that HIV / AIDS was going to sneak around the world. There were predictions in countries like the U.K. that there would be over one million people infected by 2005 where the actual figure was closer to 15,000 people. In this instance, the public mobilized and changed their behaviour as they became aware of the risks associated with HIV / AIDS.

When it comes to common issues it is important that individuals become aware, know what is happening and understand what they can do to minimize the risk of being infected. With that said, these are complex issues. There are things governments, international organizations and the individual need to understand and do to address them.

Q: What can developing and developed nations learn from one another?

A: The obvious answer to this question is that lower- or middle-income countries can learn many things from developed nations. We can help them gain better medicine, develop better science or improve professional training to name a few.

Perhaps less obvious is that there are many things that we in richer countries can learn from countries that don't have our resources, our vested interest or our baggage. Therefore, they can be innovative and do things differently.

In 1976, a Kenyan doctor graduated top of her class from a Nairobi medical school, and then did her PhD on citizen and patient engagement in health care. That led to the development of community health workers-which is non-professional health workers-working with local citizens in villages in Africa. They have made significant advances in some parts of Africa using this model and are now transferring this knowledge to richer countries. In the last five years, that whole process has been transferred to New York City. They are using the same methods learned in Africa to work with some of the disadvantaged people in New York. By using local people in health care, they are able to reach people in ways that doctors and nurses can't.

It's a two-way trade; each party can learn from the other.

Q: Why is it important to engage the public in conversations about health and health care?

A: If we say that everyone has a role to play, everyone needs to have a better understanding that health is a concern of all of us. People need to be health literate, so they have a firm understanding of what will make them healthier, mentally and physically.

People also need to understand that "health" can't be achieved for them. We've been led into a consumer society where people often believe there is a pill for everything, but this is not the case. We have responsibility for our own health.

Q: As you look ahead, what do you see in terms of the future of health in our global community?

A: I believe there will be three major shifts. Science and data have been advancing at a great pace and we are going to understand much more about diseases and how to treat them. In recent years, we have had extraordinary triumphs. For example, 25 years ago childhood cancers were almost always fatal but now, in rich countries, only 5 per cent are fatal.

Second, I believe there will be changes in traditional professions as we know them now. I believe we will begin to see that the professionals-doctors and nurses-will become the agents of change, but non-professionals will start to take on these roles, as well.

Finally, I believe there will be a global push on the importance of health for everyone, and the remedy for our own health is in our own hands.

The Douglas R. Wilson Lecture takes place on Friday, October 21 from 12 - 1 p.m.
in L1-490 at Edmonton Clinic Health Academy. Everyone is welcome to attend.