Letter from the President-Elect: International Health: Being Interconnected Across Borders

Preventive medicine physicians have always known that diseases do not respect borders! 

With the ongoing COVID-19 pandemic and the emerging monkeypox outbreak, the world has begun to take notice and better understand that borders offer little ongoing protection against diseases. The World Health Organization recently declared the monkeypox outbreak to be a global health emergency, with cases being found in more than 75 countries. So, we clearly live in a world where the health and well-being of all are interconnected.

As I write this column, I am in Guyana, in South America, working with both private and governmental groups, while doing a 5-week sabbatical with the Guyanese Diaspora Charity. This is the country of my birth and prior to becoming an oil producing country in December 2019, Guyana had been one of the poorest countries in the Western Hemisphere. A new government was sworn in just two years ago, and while working diligently to alleviate the myriad problems facing Guyana, it is a country dealing with abject poverty across the nation, primarily in the rural areas. This is in addition to having to address the ongoing racial divisions that remain as a result of the former British colonial legacy of “divide and rule”, which still causes ongoing tensions between the Indo-Guyanese & Afro-Guyanese segments of the population.

From a health perspective, there is a tremendous amount of unmet medical need, primarily as it relates to chronic diseases. Hypertension, diabetes, coronary artery disease, chronic kidney disease, and obesity are highly prevalent and are all diseases that can be specifically addressed by preventive medicine and lifestyle medicine interventions. Moreover, Guyana has the second highest suicide rate in the world and it disproportionately affects the Indo-Guyanese community, with 80% of completed suicides occurring in that population group, even as they only comprise slightly less than 50% of the population. The many factors that contribute to that sad statistic include poverty, alcohol and drug abuse, domestic violence, hopelessness, and easy access to lethal organophosphate poisons.

What, you may be asking yourself, is the relevance of all of this to you as a member of the American College of Preventive Medicine? Well, almost a century ago, Dr. Francis Peabody said that, “The secret of the care of the patient is in caring for the patient.”¹ Also, for those of you not familiar with the work of Dr. Paul Farmer, who sadly passed away a few months ago, it might be instructive to read a recent piece on him in the NEJM, which describes him “…spending his life upending our ‘socialization for scarcity’ — our willingness to accept that lesser care for impoverished patients was inevitable.” ²

Living in America, we should recognize that we are amongst the most fortunate people in the history of the world. If we cannot be our brother’s keeper, then of what use is the largesse we already possess?

Given that, the ACPM will soon be launching a Special Interest Group in International Health, as this is one of the areas of focus that I will have when I become the President in March 2023. We will seek to find ways to contribute on the international level - our time, our resources, and our preventive medicine expertise! The idea will be to help our brothers and sisters around the world tackle the critical issues that they face with respect to chronic diseases, infectious disease outbreaks, and suicide, while rejecting the socialization for scarcity, by asserting our belief that lesser care is in no way acceptable for impoverished people, communities, and nations.

We truly are interconnected!