Global Health and the Myth of Sispyphus: keep on rollin’

As the work in defining and calculating DALYs moves forward, some interesting patterns begin to emerge. For example: Group I diseases (communicable, maternal and perinatal) represent 65.9% of the burden of disease in Sub-Saharan Africa, but only 7.1% in established market economies.

However, about 80% of DALYs in market economies were attributed to Group II or non-communicable diseases such as cancer, stroke, and diabetes. This accounted for fewer than 20% of DALYs in Sub-Saharan Africa.

What do these numbers tell us about the epidemiology of disease? In what ways is “getting sick” an accident of fate, determined by the flip of the celestial coin? Or to what degree can health be determined and predicted by such factors as where you live, how much money you make and what ethnicity you are.

More and more, the answers seem to be pointing to the social factors of disease.  For all the articles, magazines, commercials, and advertisements doling out advice on how to maintain ones health, it appears a surprising amount of what determines whether and for how long we stay healthy is already embedded in our very lives.  

Look at the article in the NY Times written about a clinical trial done in the 70’s to study the effects of different drugs on preventing heart attacks. Amazingly, those who religiously took the placebo fared better than the control group who took no medication; only 15% of them died compared to 28% of those who took nothing. What does this mean? Apparently sickness is as much about what kind of a person you as the medicine you take.  If you’re the type of person that regularly takes their medicine, chances are you’re the type of person who goes often to the doctor, eats relatively well, gets some exercise etc. 

Even more staggering than this are the statistics behind the determinants of poverty, ethnicity and geography on health status.  The overall probability of a fifteen-year old man in the United States surviving to the age of sixty-five is 77%. This same survival rate, when narrowed to the black male population living in NYC drops to 37%.[1] Child mortality rates are about 12 times higher in Africa than in high income regions, while adult mortality rates are at least twice as high.

Why is this important? If we continue to treat disease in an individually driven manner, we may be undermining progress to achieve truly groundbreaking health advancements on a population-wide scale. We cannot continue to ignore the fact that social factors, such as something as simple as where you live,  is possibly the single most important determinant for getting sick or dying young. Additionally, until we address these underlying social structures, new emerging diseases will continue to disproportionately affect poor and marginalized populations. As soon as we battle and conquer one disease, such as diphtheria and measles, another arises to take its place, like HIV/AIDS. In this way our health system is like the eternal struggle of Sisyphus, who was cursed to spend his afterlife rolling a rock up a hill, only to have it come crashing down and have to start all over again.   

More and more academics and educators are realizing the far-reaching implications of health, and that health policy should not and cannot stand alone.  Health policy must be approached in tandem with economics, development and governance. As we are learning, health has as much to do with economic development and urban design as medical procedures and treatments. Until we learn to tackle health from all these angles we continue the sisyphean task of battling diseases one at a time, which is a battle plan in which we are destined to be behind.  

[1]  Marmot, Michael. The Influence of Income on Health. The Nation’s Health


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