Friday, February 18, 2011

How Will Social Change in the Middle East Affect Health in America?

For those not moved by politics, fear not! I have an article on B vitamin supplementation and endurance sports, and another on fish oils in the pipeline. But for everyone else, read on…

I was moved to write again on this topic by reports from Bahrain stating that doctors and nurses have been beaten and are being prevented from tending to those peaceful protesters who have been wounded. There are reports of ambulances being prevented from reaching victims. There are reports of protesters being attacked and beaten at the hospital. As a doctor, there are not words strong enough to express my condemnation of these acts. Government interference with protest is reprehensible, but at least there’s precedent. Government interference with doctors tending to the wounded is inexcusable.

In a previous post, I stated that self-determination is a necessary requirement for optimal health, and that we Americans should encourage social change in the Middle East to promote health. Having appealed to your altruistic side, let me now appeal to your selfish side – even if you don’t care one bit about the people of the Middle East or their rights, your health will benefit if the Arab world wins its democracy, and the US changes its foreign policy in the region.

Let me first define terms. I’m suggesting that the US government decrease military funding of the region, decrease troop deployment in the region, and reinvest in human and social capital in the region (education, health, etc.). I believe that this is achievable, and that the US will still maintain if not increase national security by actively working to win the good will of the Arab world. The election of Barack Obama garnered the US favorable publicity in the Middle East, and that was accidental – it has decreased recently, but I believe we can regain this goodwill through deliberate action. Most importantly regarding health, I believe that winning good will is less expensive than military control, and that this policy will come with significant monetary savings, which can be reinvested in social services here in the US.

The first way that social change in the Middle East will improve American healthcare is therefore a matter of funding. As a clinician, I have seen patients struggle with the cost of healthcare, and find it deplorable that no programs exist to help these people. For example, I remember a patient of mine with Type II Diabetes who struggled to pay for her blood glucose test strips. This was a woman in her early 50’s, a parent and grandparent who had several people depending on her to make a living. When I first saw her, she was a stroke waiting to happen; she had the highest blood sugar and hemoglobin A1c I’ve ever seen, the highest total cholesterol I’ve ever seen, and the highest blood pressure I’ve ever seen. I’m still a young clinician, but believe me, when I say they were high, they were high. We were able to bring her back to a healthier state within a few months, but this state was tenuous, and compounded by the fact that she was struggling to make ends meet even without the added healthcare costs. Make no mistake, these were life-saving measures we were taking, and we were barely holding on. Were this woman to have a stroke and either die or be unable to work, the social cost would be enormous, as she and her dependents would have to rely on government assistance, not to mention have to pay for emergency medical services. Mind you, this could be prevented for less than $5 a day, accounting for test strips and her medication. Meanwhile, the US currently spends $3.5 million every day on military aid to Egypt. Using those potential savings to sponsor better healthcare programs here in the US could improve the health of American citizens, improve quality of life, and potentially save the US money in other areas.

The second way that these changes could benefit American health is environmental. Plain and simple, oil belongs underground, not in the air. While air quality has slowly been improving in the developed world, air pollution is implicated in respiratory diseases and other chronic conditions. Additionally, use of these hydrocarbon fuels contributes to global warming. How global warming will directly affect the health of individual humans in the long term is not yet known, though there is increasing concern about nations’ ability to feed their people due to climate change. A great portion of these fuels come from the Middle East, from countries ruled with iron-fisted strongmen, rulers against whom people across the Middle East are now revolting. We are now finally at a point where renewable energy sources are becoming real possibilities, not just castles in the air. A deliberate plan of political and military withdrawal from the region, coupled with investment in renewable energies, with the intended goal of reducing consumption of fossil fuels, would have a marked effect on human health.

I’m making grand plans here, I know, but this is not a time for timidity and business as usual. Far from being distant events affecting people ‘over there’, the changes happening in the Middle East have potentially great implications here. It has often been said that out of all crises arise opportunities. Some say that for every door that closes, another opens. That has never been truer than it is right now. By protesting peacefully for their rights, the people of the Arab world are trying to close the door on militarism, unsustainable economic policies, and environmental degradation. Rather than trying to keep our foot in the door, let us instead turn around and open the next.