What determines the health of a population?
In a college classroom in North Carolina a professor of Global Health Ethics puts a deceptively simple question to the class: “what causes disease?”
A political science major blames poverty; a sociology major responds that inequality is the root cause; an engineer that weak infrastructure breeds infection; and, finally, a pre-medical biology student raises his eyebrows and deadpans, “pathogens.”
All of those answers, and so many more, would be justifiable responses to the question. Health and disease are complex concepts and cannot be unilaterally addressed by any one sector in isolation. Organizers of this year’s World Affairs Council Global Health Summit know this. Last year they looked at global health through the lens of water issues. This year: hunger and food security.
Clean water undoubtedly has a significant role to play as a determinant of health. Cholera illustrates this point well. Biologically, cholera is caused by the V. cholerae bacteria, making it the agent of the disease. However, the pathway or mode of transmission of the disease is as important to understand as the disease’s biological agent.
In the case of cholera, a person will not develop an active cholera infection unless they ingest the bacteria within five hours of it passing through the human GI tract. So, on contexts where populations do not have access to water or sanitation facilities, cholera flourishes. When, in the 1850s, a researcher discovered the link between clean water and cholera, disease rates began to decrease. The actual bacterial agent for cholera was not even discovered until 1883 when infection rates had already begun to fall because of infrastructure improvements.
Hunger and food security are no less important to consider if we are to fully examine the social determinants of health. Tuberculosis is a largely opportunistic disease and will develop into an active deadly infection in people with compromised and weakened immune systems. This means that stress, fatigue, malnourishment, lack of social support, sub-par education, and inadequate water and sanitation facilities all increase an individual’s chances of contracting the disease. Like cholera, TB incidence rates had dropped dramatically by the time that antibiotic interventions for the disease were introduced, largely because of improved housing, nutrition, and sanitation measures.
This year on May 20th, Atlanta’s World Affairs Council, in collaboration with the Center for Strategic & International Studies and CARE, will host a Summit on Global Health & Hunger. The Summit will invite participants to explore the critical connections between food security and health. Hopefully, by attracting attendees with diverse backgrounds and areas of expertise the summit will spark the types of meaningful dialogue necessary to comprehensively address the numerous determinants of health and well-being.
In the future, the conference organizers should consider expanding on the theme of the social determinants of health, perhaps by exploring the less obvious determinants such as stress and social inclusion.