Sometimes it really helps to stop messing around with all the minutiae of daily work, to lift up one’s head and take a look at The Bigger Picture. This year’s Nobel Week Dialogue in Stockholm, Sweden was entitled “The Future Of Health”, with the panelists comprising four Nobel Prize Laureates: Charles Rice (awarded in 2020), Michael Rosbash (2017) and Drew Weissman (2023), all receiving the Nobel Prize for Medicine or Physiology, and Olga Tokarczuk, awarded the 2018 Nobel Prize in Literature. The combination was indeed an inspired one, steering the dialogue away from the esoteric detail of science (those are presented elsewhere by this year’s Nobel laureates), and towards an overview of the major health challenges that the world – that we, the people that live on this precious planet – must prepare to address.
“Let’s look the monsters straight in the eye, call them out by name, and beat them up with strong science.”
I’m fascinated by SpaceX rockets. But the idea of the rich blasting themselves off from an environmentally tortured world to begin life elsewhere not only seems like a sci-fi comic book solution to the problem and an infinitesimally slim hope of saving us all, but also one that is morally bankrupt - both with regard to Mother Earth as well as to human values. If our fate is determined by ‘survival of the richest’, it might just concentrate the attribute of selfishness on another planet, perhaps where they merrily carry on exploiting each other. Mars ain’t the kind of place to raise your kids, Elton sings. In fact, it’s cold as hell. I agree.
I much prefer the attitude expressed at the Nobel Week Dialogue: Let’s look the monsters that we have created straight in the eye, call them out by name, and beat them using strong, evidence-based science. The message of the entire conference was that our connections to each other, as well as to our environment, is the fabric of our health and it is crucial to deal with it at a global level.That our world and our shared challenges – climate change, antibiotic resistance, pandemic preparedness, mental health, food insecurity, amongst many others – will affect us all, regardless of where we live. It’s impossible to create safe havens. In this matter, we are protected neither by wealth nor by the country we live in.
Ola Rosling, co-founder of Gapminder, gave a high-speed factfulness check, showing that our very prejudiced assumptions would lead us in all the wrong directions. That child mortality may indeed be higher in low-income countries, but that child mortality deviates widely within all countries, correlating with the poorest of its citizens. In other words, health inequity is a consequence of economic imbalance, not of the country itself. And in many rich countries, there are millions of people living in poverty. So to achieve health equity, we must raise people out of poverty – wherever they live. It’s as simple as that.
“Keep in mind this one thing: a fair society leads to healthy lives. We have known this for years, and we have all the evidence we need.”
Our focus should first be on the social determinants of health, agrees Jeremy Farrar, the chief scientist of the World Health Organization (WHO). Governmental policymaking and redistribution ability are vital to health equity. Science can contribute by providing sound evidence of the effect of socioeconomic status on health, adds Carl Skau, Deputy Executive Director and Chief Operating Officer at the World Food Programme (WFP). But there are severely urgent problems that must be addressed now: 3.45 million people are living in acute food insecurity and their relief from the ongoing catastrophes in Gaza, Sudan, South Sudan, Haiti and Mali are urgent. Preventing and ending conflicts leading to these catastrophes is a matter of great urgency.
Climate change has major consequences for health. Climate change correlates with loss of biodiversity and the rise of infectious diseases (Pfenning-Butterworth, 2023). For example, the dengue fever virus is now moving into new regions due to climate change. Our health and well-being are intimately connected to the global climate and ecosystem in countless ways.
Currently, we have a weak basis of fact on mental health treatment. Science should focus on better understanding the effects of community that can guide policymaking for more effective mental health treatment, care and prevention. Reconnecting vulnerable people back into their societies is thought to be crucial.
Antibiotics have been a lifesaver since their discovery in the 1940s, but overuse of antibiotics inevitably leads to antibiotic resistance. No new classes of antibiotics have been invented in decades, and there is scant interest from pharmaceutical companies to discover and develop new ones. Better antibiotic stewardship is therefore essential.
Vaccine hesitancy undermines the proven principle of mass vaccination as the most effective strategy to prevent infectious diseases at scale. Interestingly, however, the noise from anti-vaccine protesters is disproportionate to their countries’ demand for vaccines, according to Sania Nishtar, chief executive officer at Gavi, the Vaccine Alliance. Social media amplifies their outrage and protests out of proportion. Vaccines are increasingly accepted by the majority as the most important form of prevention of the spread of infectious disease.
Despite the noise from naysayers and deniers, the world has much to celebrate. In fact, we ought to counteract negativity by transmitting positive news. The School Meals Coalition is making significant strides in their goal to provide every child in the world with a healthy, nutritious meal in school by 2030. The effects are manifold: getting more girls into school, promoting healthy body growth, brain development and good habits from an early age, and putting health equity at the centre of policymaking.
In October 2024, the incoming Indonesian president Prabowo Subianto promised to supply meals to 83 million children and pregnant women nationwide. This is a major step forward for health equity, and a significant success that reconnects policymakers with science advisors, where the evidence informs policy decisions. Good news travels slower; we need to track progress and tell the world about it, not least for the reason of applying a little friendly pressure on Subianto to turn his promise into reality.
If I were to ask you to keep in mind just one thing from all of this, it is this: a fair society leads to healthy lives. ‘Trickle down’ economic policies do not lift the most vulnerable people to health. We have known this for years, and we have all the evidence we need.
The Nobel laureates agree: alternative facts suck hard. It is the duty of all of us who believe in the ability of science to provide facts, proven by evidence, to speak out. Try a few of these:
As advocates of science, we have a duty: to remind everyone that science is the single most important contributor to human health, happiness and longevity.