By the late 20th century it was evident that pervasive threats to global health were not being adequately addressed. These threats included wide disparities in health; recrudescence of old infectious diseases and emergence of new ones, some of which are associated with close contact between animals and humans in unhygienic and cruel circumstances. Enduring poverty with billions of people deprived of basic life-needs, ongoing conflict, clashes of cultures and civilizations and mass forced migrations, were aggravated by environmental degradation (land, sea and air), climate change, and ecosystem disruption.
It was in this context of ongoing neglected threats that a safer and healthier future for individuals and whole populations was aspired to. A new imaginative spectrum of global thinking was proposed to facilitate a move beyond a narrow, individualistic, competitive, exploitative anthropocentricism towards a more balanced, co-operative, socially cohesive and eco-centric perspective on life and health. Little attention was paid to such proposals.
The need to move in this direction has now been made strikingly apparent with the recent sudden emergence and rapid spread of Covid-19 as the greatest threat to all aspects of life world-wide. Through its domino effects in an unstable global system, multiple tipping points have been triggered, with implied radical alterations to the trajectory of life as we have known it. The pandemic is bringing out the best in many people but also aggravating inadequacies of our humanity. It is a stark reminder that, despite all the major advances in science, health care, health and longevity since the enlightenment, and despite all the promises of genetic medicine and artificial intelligence, health and the long-term survival of our species are now more intensely threatened.
Here we raise some illustrative questions and tentative answers to practical and ethical challenges to improving health on an overpopulated and seriously wounded planet.
Q. What diagnosis can we offer for the multitude of escalating 21st century global health challenges?
A. Life and health on our planet today should be viewed within the context of a complex, humanly constructed, global/planetary organic crisis. This arises from increasing dysfunctionality, and even entropy, of a long-evolving and transforming intricate planetary life system that is losing the equilibrium and resilience required to sustain the health of a wide range of interdependent life forms. If this diagnosis is correct, then it is a potentially fatal diagnosis for our ‘civilization’ as we know it, and indeed for the planet.
Q. Do we understand the complex historical, geographic, social, economic and ideological background to such a profoundly troubling situation (pathophysiology in medical terms) portending the impending collapse of a complex system –analogous to the effect of HIV on the human immune system?
A. Arguably we do have this understanding, and know that to a significant extent it implicates a fraudulent, corrupt and dysfunctional global political economy driven by greed and an obsolete ideology with a short-term perspective. But to further unravel the interaction of associated complex causal roots requires analysis and integration of insights from a wide range of intellectual fields of inquiry – history, economics, political science, psychology, philosophy, social science, international relations and many more disciplines working in transdisciplinary collaborations.
Q. How far has this global malaise progressed?
A. Some critical planetary limits are close to being, or have actually been, exceeded. Uninterrupted continuation of the causal processes will continue to breach these boundaries with dire implications for all globally, although at different speeds and with different distributions of effects in different geographic regions and across socio-economic groups.
Q. What could and should be done to avert future likely outcomes of suffering on such a grand scale and the possible annihilation of human and much other life on our planet?
A. The first step in working towards an answer is to move beyond denial and proceed to the stage of accepting and openly acknowledging the diagnosis of a potentially fatal planetary crisis.
A critical next step would be to rectify the paucity of concern for the future, as portrayed by wasteful consumerism within a ‘market civilization’ in which the main goals are consumption for the sake of economic growth and profit.
Concerted and sophisticated methods should be used to bring the above-mentioned issues to the attention of all potential stakeholder groups (at leadership and public life levels), with creation of ‘common space’ for these to be explored and confronted. Ambitious actions to more comprehensively address global health challenges and the planetary crisis will require, inter alia, as yet unprecedented changes in human behaviour founded on stimulating our sociological, ecological and moral imaginations.
Radical interventions could comprise the social equivalent of a combination of ‘surgery’ (excision, amputation, transplantation etc.), ‘radiotherapy’, ‘chemotherapy’, ‘psychotherapy’, and any other socially innovative remedies we could devise through the almost boundless ingenuity of our species. Such interventions will need to be imaginatively investigated and creatively pursued. The same, if not more energy, resources, ingenuity and resolve would be required as those dedicated to seeking solutions to complex medical and technological human problems. In addition to the knowledge required to achieve these goals there is a crucial need for wise leadership in the application of knowledge.
Arguably, such essential changes for sustainable, peaceful and productive lives for a majority of the world’s people could be driven by an impetus towards responding to the message of environmental degradation and ecosystem imbalance. A paradigm shift in global thinking and action to radically reduce wasteful consumption of non-renewable resources would embrace the idea of learning to ‘do better with less’, and the need to reshape the global political economy by shifting from unrealistic goals such as sustainable development to the much more credible notion of developing sustainability.
It would also be crucial to redefine poverty less parsimoniously to enable more successful narrowing of egregious economic disparities. In turn this would require major reductions in a wide range of consumerist expectations, as well as dietary modification to discourage excessive meat eating and thus reduce the adverse ecological impact of wet-markets and factory-farming of animals.
Such new, socially innovative activities Inspired by the transdisciplinary work of imaginative thinkers and social movements linked to effective economic and political agency could promote a new trajectory towards lifestyles that relate to nature in a less ecologically destructive manner, and ameliorate looming environmental and other tragedies.
Q. Are any of these solutions possible?
A. While it is unlikely that major shortcomings in individual or group human behaviour can be easily corrected, it should at least be recognized that a more peaceful and sustainable future could be achieved through ethically motivated intentions and well-conceived actions based on a deeper understanding of the fragility and inter-connectedness of all lives, including those of privileged and powerful people. Generating a global mind-set and undistorted implementation of values we claim to cherish, requires visionary leadership and social solidarity.
Solomon Benatar DSc (Med)
Emeritus Professor of Medicine, University of Cape Town
Adjunct Professor, Dalla Lana School of Public Health, University of Toronto