Influenza was so named because it was thought to be under divine influence: epidemics were thought to be divine visitations upon (epi) the people (demos). Once more an infectious disease — Swine Flu — is scaring the hell out of us.
Yet heart attack and stroke (cardiovascular disease) globally cause millions upon millions more deaths than all infectious diseases, flu included. While we worry about infectious causes of maternal deaths, cardiovascular disease accounts for four times as many deaths in mothers in most developing countries than do childbirth and HIV/AIDS combined. Worldwide, HIV/AIDS causes three million deaths a year: stroke and heart attack cause 17 million.
In the US, there are slightly over 100 deaths per 100,000 men aged 35-59 from heart disease and stroke each year; in Russia, the latest figure is 800. India and China each have three million deaths a year from these causes.
Developing economies, including those in the Pacific and, as I saw last week, arrayed around the Arabian Gulf, are seeing devastation to their workforces that western countries experienced 50 years ago but have since escaped. Bypass for coronary disease is now common in Saudi Arabia in men aged less than 35 years. Obesity rates are nudging 50%.
Yet a columnist in the Washington Post this week called on WHO to protect the world, read America, from infections and refocus its distracted yet truly minimal interest in obesity and car crashes.
Troubling as these patterns are in developing countries, they are but the first rumbles of the storm. The worldwide shift of working people from rural to city living parallels rising levels of prosperity, but also brings pressures to consume more food. City food is cheap and carries a heavy freight of fats, salt and sugars.
In Abu Dhabi children playing on their home computers without moving from their screens can order up fast food which is freely delivered by motor cycle within minutes. The car supplants the bicycle and the foot.
A worldwide epidemic of overweight and obesity, even where under nutrition persists in poorer quarters, presages high levels of diabetes, heart disease and stroke ahead. Meanwhile tobacco consumption is increasing in the developing world. There are no pro-Ebola or pro-SARS lobbies, but a tidal wave of commercial greed pushes tobacco consumption forward, causing five million deaths each year.
And each time a virus twitches, we see the finger of the gods writing in the sand of society and run, panicking, for cover.
In North America, Australia, New Zealand and parts of Europe, the death toll from heart disease and stroke has tumbled by more than 60% since the 1960’s; only 10% of those deaths now occur among those aged less than 65. Compare this with Brazil, where 28% of heart attack and stroke victims are young.
The World Health Organization has shown commendable leadership in relation to global tobacco control and now has its sights set on nutrition and exercise. These strategies, while global, can assist individual countries to strengthen their local efforts.
But the greed and self obsession that has led the developed world to the brink of financial and environmental disaster is alive and well: we want WHO to focus on our worry about the influence of the spirits, and longer term global disasters can go hang.
To wait until heart disease and stroke decimate workforces before we take seriously the global epidemic of heart disease and stroke would be both a health and economic tragedy. Heart disease and stroke are already propelling families into poverty in developing countries as young breadwinners and mothers die. Economically these breadwinners are also the most productive members of the workforce and their efforts determine future prosperity and investment.
Mrs Thatcher was said to have encouraged Ronald Reagan not to wobble. Whatever her faults, irresolution was not one of them.
We need un-wobbling globally, beginning with our political leaders not to regard the current threat from flu — however big or small it turns out to be, however deep our belief that we deserve divine punishment — as the main game.