Mutable frontiers in public health and economy post-COVID-19

SINCE THE CORONAVIRUS outbreak in Wuhan in China became a matter of public knowledge as it spreads through the continents, a consistent finding is that the death rates are higher among the seniors and people with underlying health challenges. This is understandable as age and some chronic ailments tend to weaken the body and compromise the immune system, predisposing those affected to infectious diseases. Prominent among them are tuberculosis, diabetes, cancers, liver problems, circulatory systems disorders (including cardiovascular system crises and compromised lymphatic system) and renal system dysfunctions. Almost all of these are non-transmissible or non-communicable, except in some cases involving the circulatory systems and reproductive tracts as in HIV/AIDS, or some urinary tract infections. Overall, a category of health conditions known as non-communicable diseases (NCD) has evolved. At the global policy level, this received some attention at the United Nations meeting of September 2018.

The Coronavirus (COVID-19) outbreak has exposed a lingering crisis in a sub-set of the health systems that has been under the radar for so long, although widely recognised. The sudden prominence of non-communicable diseases in the wake of COVID-19 outbreak was aroused by what is generally described as underlying health conditions in many Coronavirus-infected patients. These are, precisely, the non-communicable diseases. The other, which may or may not have any associated underlying condition, is the case of the seniors. In countries with high rates of COVID-19 mortalities, the elderly and those with underlying health conditions are reportedly predominant among those who die. Is it therefore safe to tentatively infer that the complications in health systems in those countries are like in the case of still waters running deep? Can it be rightly said that COVID-19 has exposed a fundamental weakness in such an advanced system with complex health management innovative ideas, metrics and other creative designs?

Although the figures of COVID-19 mortalities reported in China need to be taken with some doubts and misgivings, those from Iran, South Korea, European countries of Italy, Spain, the United Kingdom, and those of the United States reflect something in common: the elderly and the previously sick in the majority. The impact of health financing models on health and longevity in the US, UK or other advanced countries of the West needs closer scrutiny. The effectiveness of politicians’ pet projects on health intervention needs to be re-evaluated. A prima facie case can be made of a strong positive correlation between the prevalence of NCD and the patients’ vulnerability to infectious diseases. It can also be argued with some validity that NCD cases don’t attract government’s attention the same way infectious diseases do. First, on campaign trails, politicians will have a hard time celebrating victories over silent killers compared with those that take sudden sweeping moves across their countries. Statistics of expenditure on infectious diseases are easier to roll out at press conferences than of those incurred to stave off the morbidity in COVID-19, for keeping NCD patients alive or for prolonging their lives.

Despite the fortunes many countries spend on treating people with NCD, regarded as underlying conditions during the on-going COVID-19 pandemic, many patients still end up dying. The issue of appropriate prioritisation, stratification and allocation of health and human resources in periods requiring emergency health care becomes more relevant. In Nigeria, and many underdeveloped countries or those with retarded development, the statistics of those with NCD will be most difficult to obtain. Many NCD patients are poor and their cases go unreported. Many are rich and their cases are only documented in hospitals abroad where they go for treatments. Deaths or recoveries are not systematically documented. No robust policy to address NCD and the plights of those suffering from them. Drugs and pharmaceuticals for NCD treatment are beyond the reach of many patients and helps don’t come from the public authorities. The same goes with surgical procedures when applicable. Public facilities are ill-equipped – humanly and technologically – to cope. These include teaching hospitals, federal medical centres and specialist hospitals. Worst of all, officials in policy environment seek medical services abroad rather than improve the situation at home. The folly of such decisions is made obvious during the COVID-19 outbreak as situations were unfavourable for foreign treatments for most of them.

For good and impactful policy and planning, screening for NCD and use the database for macro and micro interventions are necessary. These will safeguard people’s health, provide for longevity, ensure that no one falls through the cracks and contribute positively to national productivity, thereby improving the economy. Data on NCD available to Nigeria-based foreign investors in the health sector are proprietary and unavailable to the authorities for official interventions. They may, however, be useful for expatriate health professionals in their countries of origin. Beyond the Nigerian federal authorities’ present knee-jerk reactions to the COVID-19 pandemic, an all-out plan to take the intervention beyond the few weeks window that is globally debated is needed. Unlike Nigeria, a tropical country, various countries at the peak of COVID-19 spread right now are either in the temperate region or in the sub-tropics where very low temperatures at this time favour the survival and spread of flu generally. This applies also to COVID-19. The flu period in the tropics comes up during the rainy season. How would asthmatic patients survive if infected? Nigeria’s COVID-19 intervention thus needs to be radically different. Beyond the observance of social distancing and the personal hygiene measures of hand washing, nose masking, avoidance of handshake, and other routine practices, COVID-19 intervention needs an extended timeline running into summer months.

The immediate and long term demographic impact of COVID-19 on Europe deserves attention. The high mortality of the elderly in Spain, Italy and the UK (despite Brexit) underscores an existential threat to the Europe’s future as younger people become fewer as a result of their preferred social practices. Consider the marriage institution. Many young Europeans today prefer not to marry at all, or get married but not keen on childbearing. In Germany, the government has to incentivise many women to have babies. Some European married couples prefer to have only one child. All of these dispositions are now taking negative tolls on the EU as the population shrinks. Although this will affect the workforce, the option of artificial intelligence to replace human labour in many areas of work is already in the pipeline. Pensions business, retirement benefit contributions for the future elderly and health management business could become less attractive in the future. How soon these realities unfold remains a matter of conjecture, extrapolations or an educated guess based on the foreseeable. Would the case be same in Japan or with the Chinese under the new strict two-child policy?

In spite of consensus on the various causes of NCD in medical literature, business publications, politics, governments, NGOs, civil societies and rights activists’ groups, the commercial and industry interests aggressively shape the official policies and relevant narratives in ways most suitable for them. Take the soda drinks industry. A 2019 report, published by Research on Global Markets on ‘Global Carbonated Beverage Market (2018 – 2023),’ based on projected performance of the global carbonated beverage market over a five-year assessment period, forecasts the value of the global carbonated beverage market. According to the report, the global carbonated beverage market is projected to expand at a compound annual growth rate (CAGR) of 2.8 per cent during the 2018 to 2023 period, and will generate revenues of approximately $412.5 billion by 2023. In another study, revenue from soft drinks is estimated to reach $739,267 million in 2020, of which most revenue (about $248,552 million) is generated in the United States. Another study, conducted by Grand View Research, Inc., projected the U.S. soft drinks market size to reach $388.4 billion by 2025, a significant upsurge from the market size valued at $253.7 billion in 2016. The implications are clear.

Power relations are involved. The spending power of these business pressure groups is enormous. Their ability to spend fortune on subliminal adverts and promotions to keep people spending on soda attests to their soft power and influence, to which consumers willingly succumb. Their pervasive influence is exerted on politicians and public policies through relentless lobby with mindboggling spending to force laws and legislations on the people. Yet cases of diabetes are on the rise. Some would argue that positive correlation between the rise in consumption of soda and that of diabetes are mere coincidence, not causation. Any need to dispute that here now when some facts and figures provide circumstantial evidences? The International Diabetes Federation (IDF) approximated 463 million adults of between 20 and 79 years) as living with diabetes in 2019. By 2045, this will rise to 700 million. The proportion of people with type 2 diabetes is increasing in most countries and 79 per cent of adults with diabetes were living in low- and middle-income countries. Whereas one in every five of the people who are above 65 years old in 2019 had diabetes, one in two (about 232 million) people with diabetes were undiagnosed. It caused 4.2 million deaths and caused at least $760 billion dollars in health expenditure in 2019 – 10 per cent of total spending on adults

Cancers of diverse origins and types have various causes. Many are industry-induced. Mining of coal, lead, gold or cement factories are known to be culprits in many cases. But the populist arguments about keeping jobs, generating revenues and corporate social responsibilities tend to overshadow public health concerns as victims are unable to make strong cases against deep pocket organisations which influence government policies and define their own limits to pollution. Arguments about tax revenues to government from the alcohol industry appear more appealing than associated cases of liver-related health complications. Considering the fears of most anti-GM foods campaigners, could the rising popularity and consumption of the Genetically Modified (GM) foods be truly positively correlated with any form of cancer? Although the absence of conclusive research results on absolute safety of GM foods brings this fear to the fore, big spenders on GM food promotion through collaborative research and development are not relenting. The European Society of Cardiology (ESC) provides some insights from a ten-year study that was recently made public. Summarised, it opined that cardiovascular disease was the most common cause of death overall. According to the American College of Cardiology, “cardiovascular disease (CVD) remains the leading cause of death in the United States, responsible for 840,768 deaths (635,260 cardiac) in 2016.

Some industry’s perverse influences on human health have backfired and put some corporate reputations in jeopardy. Johnson & Johnson, the world’s largest healthcare company, but sadly the fall guy in the opioids crisis, was ordered by a court to pay a whopping $572 million as fine in 2019 in a landmark case that was described as “a tremendously complex public health issue.” Beyond Johnson & Johnson, the wider pharma industry was put on the spot through revelations on how opioid manufacturers colluded to drive up sales by using their huge resources to influence medical policy and doctor prescribing despite their understanding of the “risks of opioids, particularly the risk of abuse, addiction and overdose.” The opioid crisis, is widespread and vicious, wreaking great havoc in Asia, Africa and the Middle East. Opioids have gone beyond pain relievers. They have moved into the dangerous territory of abuse. And so, as the world grapples with high impact, but infrequent and unpredictable health emergencies, enduring factors that amplify their impacts need to be known and disaggregated to better understand, effectively deal with them and keep mankind safe. Quiet killers, often ignored or treated with relative levity, would require greater and more concerted attention. Compared with the knee-jerk, heroic and heavily publicised COVID-19 emergency responses of many interventionists, many champions in the fights against NCD go unsung, unrecognised and not commensurately rewarded. The fight against NCD must, however, not be abandoned or left to convenience as these killer diseases do much more harm to humanity than is generally known or acknowledged.