The Covid-19 pandemic reduced global life expectancy by almost two years, from 72.8 to 71 years, widened socioeconomic inequalities and exposed weaknesses in health systems to care for these 8 billion inhabitants.
The risk scenario began to be designed well before the world’s biggest health crisis and did not end with it. Among global health experts, there is a certainty that new epidemics lie ahead. They just don’t know when and how serious they will be.
Among the causes are the increasingly marked social inequalities and the accelerated urbanization movement that took place in recent decades in Latin America, Asia and Africa, which produced cities without the necessary infrastructure, such as basic sanitation networks. This had a direct impact on some diseases, such as dengue, which followed the resurgence of Aedes aegypti in the 1970s.
“The lack of infrastructure makes the poorest people store water as best they can, in barrels, in containers. This has provided a very favorable environment for Aedes”, explains doctor Jarbas Barbosa, new director general of PAHO (Pan American Health Organization ), who takes office in February 2023.
The lack of planning also brought health problems that were hitherto concentrated in rural areas closer to urban areas, such as hantavirus, a disease caused by a virus transmitted by rodents. “Some of the outbreaks we had in Latin America were related to the construction of condominiums and housing projects in areas that were previously wild”, explains Barbosa.
The biggest Ebola epidemic recorded in West Africa between 2013 and 2015, which led the World Health Organization to declare a state of “global health emergency”, is another example.
“The virus has not changed, the circumstances have. In the past, Ebola caused self-limited outbreaks in isolated villages. In 2015, it became an epidemic in large poor cities, with tremendous potential for dissemination”, says Barbosa.
Deisy Ventura, professor of ethics at USP and who coordinates the postgraduate program in global health and sustainability, reinforces the relationship between the environment and health crises: “In the region that was the epicenter of the Ebola crisis, maps of deforestation coincide with the case maps. The bat no longer has a forest and goes to the houses on the outskirts.”
The Covid-19 pandemic itself, whose beginnings are attributed to a wholesale market in Wuhan, China, is related to the migration of people from rural to urban areas, argues Barbosa. “That exchange of animals and viruses that was previously limited to villages now has tremendous expansion potential. How many markets like the one in Wuhan do we have in the poor peripheries of Asia, Africa and Latin America? Thousands.”
Ventura, from USP, says that in May 2023 a new international health regulation should be adopted to face these new threats. The latest version of the document is from 2005. At the same time, the creation of an international treaty on pandemics is being discussed. “The big issue is the flexibilization of intellectual property to face situations like the one that Tedros Adhanom [diretor-geral da OMS] called vaccine apartheid”, says the teacher.
In July 2021, the term was used to describe scenarios in which most of the unvaccinated were so not because of individual choice or anti-science stance, but because of lack of doses. “Until now, we continue with a brutal concentration of vaccines in the richest countries”, analyzes Ventura.
For her, however, the danger of new regulations is in treating the symptoms without attacking the causes. That is, increasing surveillance in developing countries so that they comply with health rules, in terms of notification and information, but without solving structural problems that can cause pandemics.
The specialist argues that tackling health inequities is crucial in all aspects, including ethics and safety. For that, it would be necessary to resume debates on universal health coverage, interrupted since the beginning of the health crisis. More than 800 million people (almost 12% of the world’s population) spend at least 10% of their household budgets on health care.
All United Nations member states have agreed to aim to achieve universal health coverage by 2030 as part of the Sustainable Development Goals. One of the proposals is a kind of “basic basket” of health services.
“The interval between these health crises will be smaller and smaller. Before the end of Covid, we already had monkeypox. It’s no use covering the sun with a sieve, it will be one crisis after another”, says Ventura. “We haven’t changed our way of producing food, our relationship with animals [em confinamento para abate], urbanization only deteriorates, the concentration of income only increases, the climate crisis, deforestation. There’s nothing improving.”
The accelerated demographic transition, especially in Latin America and Asia, is another major challenge within the overpopulation scenario. For example, Alzheimer’s disease and other dementias, which 30 years ago had no epidemiological weight in these regions, are now among the top ten.
UN estimates show that the average life expectancy at birth, which in 1950 was around 46 years, is now at 73.4 — after recovering from the drop in the pandemic. Another important indicator, infant mortality, has dropped: an average of 26.7 babies die for every thousand live births. 70 years ago, the ratio was 143 per thousand.
Barbosa ponders that living longer does not mean living better. Life expectancy grows more than the proportion of years of healthy life, that is, people are aging poorly. There is a lack of investments in health promotion, prevention and early diagnosis of preventable diseases such as diabetes and hypertension.
The doctor believes that most countries have not prepared their social and health systems for these challenges. In addition to scarce resources, there is a lack of training, training of professionals and adequacy of primary care to deal with problems associated with aging.
For this, developing countries need to increase health financing. “If there is not at least 6% of GDP from public spending on health, we cannot have a universal access system with the minimum quality.” In Brazil, public spending represents 3.8% of GDP, and private spending, 5.8%.
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