Ban Ki Moon once said, “climate change, demographics, water, food, energy, global health, women’s empowerment - these issues are all intertwined. We cannot look at one strand in isolation. Instead, we must examine how these strands are interwoven [1].” The interconnected nature of the human condition, as well as healthcare systems, was amplified during the pandemic. COVID-19 was a global equaliser, uniting humanity in a quest to address a pernicious pandemic that was undiscerning in terms of politics, geographical borders and socioeconomics. Biotechnology companies, pharmaceutical giants, physicians, nurses, allied health professionals and nation states rapidly mobilised to share knowledge, resources and policies to develop mechanisms to effectively address the situation. The accelerated discovery, manufacture and dissemination of a vaccine in less than a year was a miraculous event. In 2024, it’s easy to perceive that society has returned to normalcy. In light of lifted mask mandates, loosened travel restrictions and return-to-office policies, many people view the pandemic through the rear view mirror. Yet, an indelible and lingering impact has been left on the world. The planet is facing major global health challenges, such as a rapidly ageing population coupled with a shortage of clinicians, a heightened prevalence of mental health disorders and a lack of preparedness for future health crises. Health systems in many countries are also in a precarious state due to global political instability and macroeconomic gyrations which are unlikely to abate in the near future. Moreover, climate change has resulted in myriad health problems like heat-related illnesses, malnutrition and the spread of infectious diseases.
Even before the pandemic placed incomprehensible strains on the global healthcare workforce, tremendous gulfs in accessibility were widening due to a rapidly ageing populace and a dearth of healthcare workers. In 2022, the World Health Organization (WHO) published a seminal report focused on the state of the European healthcare workforce. The analysis uncovered that “13 of the 44 countries that reported data…have a workforce in which 40% of medical doctors are already aged 55 years or older [2].” In the United States more than 100,000 nurses left their occupation from 2019 to 2022 and US health systems could face a shortage of 200,000 to 450,000 nurses by 2025 [3]. Ageing populations and exhausted clinicians are not just impacting the Western world. A projected 80 million health workers will be required in order to meet the demands of the global population by 2030 [4]. This situation will fuel additional inequities in healthcare access since “high-income countries have 6.5 times more health workers per population than low-income countries [4].” Given supply and demand elasticity, healthcare workers residing in lower income countries will likely migrate abroad to arbitrage wages in higher income geographies, remitting wages to their home countries in order to support families. This migration will further weaken healthcare systems among the 55 countries that the WHO has included on the health workforce support and safeguard list (SSL) [5]. The result may be particularly pronounced across the African continent, which has only 4% of the global workforce yet faces a quarter of the global disease burden [4].
Mental health and psychological well-being is a crucial component of overall human prosperity. As defined by the WHO, it encompasses “a state of well-being in which every individual realises [their] own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to [their] community [6].” Despite its importance, achieving optimal mental health remains a persistent challenge for a vast segment of the global population, with more than a billion people affected by mental or addictive disorders [7]. These conditions are leading contributors to disability and significantly increase the risk of early death. The burden of these disorders is escalating across all socio demographic segments, further compounded by the psychological and psychiatric impacts of the pandemic. Research indicates that these disorders incur high costs, not only in terms of direct healthcare but also through indirect expenses like lost income and productivity due to disabilities, leading to absenteeism and reduced work capacity. Globally, the economic value associated with this burden is a staggering $5 trillion USD [8]. In North America alone, the macroeconomic impact could account for upwards of 8% of gross domestic product [8].
While the world successfully rose to the challenge of COVID-19 by rallying to discover a vaccine, history indicates that this will not be the last global epidemic [9]. There is a persistent threat of zoonotic infections coupled with increasing antimicrobial resistance [10]. The overuse and misuse of antibiotics in humans, animals and agriculture are leading to a growing number of pathogens that are resistant to drugs, making once treatable infections increasingly dangerous. Public healthcare systems and leaders must remain vigilant and develop pandemic preparedness measures to avert another global catastrophe. As stated by Professor Ali Zumla, “the pandemic exposes weaknesses of current leadership of global public health systems, inequities of resource allocation to Africa, and broken promises by wealthier nations for vaccine equity and resource allocation. This status quo is unacceptable [12].” In April 2023, the WHO launched an initiative designed to provide guidance on integrated planning to address the future potential of respiratory pathogen outbreaks. The Preparedness and Resilience for Emerging Threats Initiative is an important step forward in strengthening health emergency preparedness and response capabilities [11]. Tackling future pandemics will require global coordination and integrated, multipronged approaches.
The dynamism of the international political economy, which has experienced a variety of macroeconomic and geopolitical shocks over the past few years, is inextricably linked with global health outcomes. In the US, the 2024 presidential election may have implications for federal government financing and interest rates, which are connected with unanswered questions about the future financing of Medicare and Medicaid [13]. Hospitals in the US face ongoing unit economic challenges, including a 200-basis point gap between reimbursement rates and cost inflation [14]. In the UK, economic turmoil is straining the NHS. At a Board meeting in October 2022, NHS England suggested that the budget was £6-7 billion short of what would be required to maintain services. With a funding settlement on the horizon in 2024/25 and 7 million people on NHS waiting lists, it’s clear that difficult fiscal decisions may need to be made at a time when funding needs to increase [15].
Protracted geopolitical challenges in Ukraine and the Middle East are creating additional tumult and fragility for myriad healthcare systems. Wars, migration, and political unrest lead to health crises, disrupting services and making populations more vulnerable to disease and poor health. This chaos often leads to increased mortality and morbidity from both violence and a rise in preventable diseases due to lack of access to basic health services. Large scale migration and displacement create overcrowded conditions, exacerbating the spread of infectious diseases and making it difficult to carry out effective health interventions. The instability undermines long term public health efforts, erodes health system resilience and diverts resources from development to immediate crisis response. These economic and geopolitical factors then have a tangential impact upon capital markets, driving up interest rates and decreasing financial market liquidity, which minimises investments that could be made to foster innovation to solve vexing global health challenges [14].
For years, leaders around the world have been sounding the climate change alarm, illuminating the widespread impact that will not just be felt on the health of the planet but also on the health of the world’s populace. According to recently published World Bank data, the climate change crisis could lead to an incremental 21 million deaths by 2050, which result from only five health risks: diarrhoea, malaria, stunting, dengue and extreme heat [16]. This data vividly illustrates that as the climate crisis intensifies globally, its destructive effects on human health and welfare are set to rise proportionally. Research illustrates that 3.6 billion people are living in areas that are highly susceptible to climate change [17]. These issues place immense pressure on healthcare systems, increasing the demand for medical services while simultaneously compromising their capacity to deliver care. Additionally, the climate emergency is eroding fundamental necessities such as access to pure air, nutritious food, clean drinking water and sanitation.
While it may seem as though global health challenges are insurmountable and rising exponentially, I am heartened by an array of positive data points. One of my favourite books was written by the Swedish physician and statistician, Dr. Hans Rosling. In Factfulness, which was published in 2018, Dr. Rosling leverages data to ground readers in myriad global factors which are improving. For instance, between 1996 and 2016, new HIV infections per million people reduced from 549 to 241.18 From 1800 to 2016, the percentage of children dying before their 5th birthday dropped from 44% to 4% [18]. From an immunisation perspective, the share of 1-year olds who received at least one vaccination increased from 22% in 1980 to 88% in 2016 [18]. I take solace in the data and remain optimistic that society is headed in a positive direction and that I can help to make a tangible difference by serving as a leader in the global healthcare community.
Work Cited
“UN Secretary-General: Sustainable Energy Key for Minimizing Climate Change Risk | News | SDG Knowledge Hub | IISD.” SDG Knowledge Hub, 7 December 2011,https://sdg.iisd.org/news/un-secretary-general-sustainable-energy-key-for-minimizing-climate-change-risk/. Accessed 28 December 2023.
World Health Organization. “Ticking timebomb: Without immediate action, health and care workforce gaps in the European Region could spell disaster.” Ticking timebomb: Without immediate action, health and care workforce gaps in the European Region could spell disaster, World Health Organization, 14 September 2022, https://www.who.int/europe/news/item/14-09-2022-ticking-timebomb--without-immediate-action--health-and-care-workforce-gaps-in-the-european-region-could-spell-disaster. Accessed 28 December 2023.
Berlin, Gretchen, et al. “Assessing the lingering impact of COVID-19 on the nursing workforce.” McKinsey & Company, May 11, 2022, https://www.mckinsey.com/industries/healthcare/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursing-workforce.
Ageman-Manu, Kwaku, et al. “Prioritising the health and care workforce shortage: protect, invest, together.” The Lancet Global Health, vol. 11, no. 8, 2023, pp. E1162-E1164. The Lancet, https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00224-3/fulltext.
“WHO health workforce support and safeguards list 2023.” World Health Organization (WHO), 8 March 2023, https://www.who.int/publications/i/item/9789240069787. Accessed 28 December 2023.
World Health Organization. “Comprehensive Mental Health Action Plan 2013–2020.” World Health Organization, Geneva, Switzerland: WHO2013 https://apps.who.int/iris/bitstream/handle/10665/89966/9789241506021_eng.pdf?sequence=1. Accessed 28 December 2023.
Rehm, J., Shield, K.D. Global Burden of Disease and the Impact of Mental and Addictive Disorders. Curr Psychiatry Rep 21, 10 (2019). https://doi.org/10.1007/s11920-019-0997-0
Arias, Daniel, et al. “Quantifying the global burden of mental disorders and their economic value.” eClinicalMedicine Part of The Lancet Discovery Science, vol. 54, no. 101675, December 2022, p. 101. The Lancet, https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00405-9/fulltext.
Van Barneveld K, Quinlan M, Kriesler P, et al. The COVID-19 pandemic: lessons on building more equal and sustainable societies. Econ Labour Relat Rev. 2020;31(2):133–157. doi: 10.1177/1035304620927107
Dafale NA, Srivastava S, Purohit HJ. Zoonosis: An Emerging Link to Antibiotic Resistance Under "One Health Approach". Indian J Microbiol. 2020 Jun;60(2):139-152. doi: 10.1007/s12088-020-00860-z. Epub 2020 Mar 4. PMID: 32255846; PMCID: PMC7105526.
“WHO launches new initiative to improve pandemic preparedness.” World Health Organization (WHO), 26 April 2023, https://www.who.int/news/item/26-04-2023-who-launches-new-initiative-to-improve-pandemic-preparedness. Accessed 28 December 2023.
Lane, Richard. “Ali Zumla: respiratory medicine and global health supremo.” The Lancet, vol. 399, no. 10323, 2022, p. 427. The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00116-7/fulltext.
Frank, Richard G. “The Uncertain Future of the Medicare Trust Fund.” Commonwealth Fund, The Commonwealth Fund, 13 October 2020, https://www.commonwealthfund.org/blog/2020/uncertain-future-medicare-trust-fund. Accessed 29 December 2023.
Patel, Neha, and Shubham Singhal. “US healthcare developments in 2023 and beyond.” McKinsey, 9 January 2023, https://www.mckinsey.com/industries/healthcare/our-insights/what-to-expect-in-us-healthcare-in-2023-and-beyond. Accessed 28 December 2023.
Charlesworth, Anita. “Economic turmoil and its impact on health and care.” The Health Foundation, 27 October 2022, https://www.health.org.uk/news-and-comment/blogs/economic-turmoil-and-its-impact-on-health-and-care. Accessed 28 December 2023.
The World Bank. “Health and Climate Change.” The World Bank, 1 December 2023, https://www.worldbank.org/en/topic/health/brief/health-and-climate-change. Accessed 29 December 2023.
World Health Organization (WHO). “Climate change.” World Health Organization (WHO), 12 October 2023, https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health. Accessed 29 December 2023.
Rosling, Hans, et al. Factfulness: Ten Reasons We're Wrong About the World--and Why Things Are Better Than You Think. Flatiron Books, 2018.
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