Day Three Morning: Wednesday, 24 March 2004

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Plenary Session: Global diseases & global institutions

Biological warfare and epidemics are as old as the recorded history of man. If the story of the Exodus of the Israelites from Egypt were to be written today, the locusts and frogs and blood of the Passover story would be easily replaced with Aids, Ebola, West Nile Virus, SARS, Hanta Virus, Anthrax, Tuberculosis, and other agents yet to be discovered. As in ancient days, it remains a chilling prospect and thought that such agents could be unleashed at any time.

It has been extremely gratifying to note that the recent scare of SARS was handled so well, and that political shenanigans only briefly impeded an appropriate worldwide response to the threat. Just as the World Health Organization played the major positive role in the elimination of Small Pox, so it did also in controlling the spread of SARS. This was accomplished by treating the disease as a medical problem rather than as a political one.

Unfortunately, this has not been the universal experience with other viral diseases in which political correctness took precedence over public health exigencies. Control of SARS was achieved through the most ancient of modalities: isolation of infected individuals. Also, numerous other organizations, such as the CDC in Atlanta, mobilized their considerable resources to stop the disease from becoming a true epidemic. Cooperation must be the byword for all involved and there is nothing proprietary about an epidemic.

But will the current positive trend in the containment of global diseases continue?

Round Table 1: How does society achieve behavior modification?

Many studies have demonstrated that the leading causes of hospitalization are behavioral and include smoking, alcoholism, drug addiction, obesity, and failure to follow physician orders. It is tautological to say that the best way to stay healthy is by not being sick. A corollary proposition is then that if one is not sick, money will not be spent on healthcare, and the healthcare bill will decline.

How can society fairly, humanely, and democratically enforce behavior modification that will improve the general well-being of its citizens? Is it fair that resources are denied to a man or woman who has worked all his or her life and paid into a welfare system to suddenly discover that the most advanced therapy for a cancer will not be available because of the irresponsible behavior of his cohorts?

Should certain lifestyle free will choices that are intrinsically dangerous be allowed to suck up huge portions of a healthcare budget? Who will decide what those choices are?

Round Table 2: Who is responsible for controlling the diabetes pandemic?

Type 2 diabetes mellitus is one of the leading causes of morbidity and mortality in both developed and less developed countries. Its incidence in the Western world is approximately 8% of the adult population and in the United States may, with its complications, account for the expenditure of upwards of $200 billion per year. In some societies, such as the Eastern Arabian Gulf, the incidence may approach one quarter of the adult population.

The causes of this explosive outbreak are numerous and are related to obesity, change in lifestyle, urbanization, lack of physical exercise and perhaps genetics. Whose responsibility is it now to control each of these causes?

Round Table 3: The employers’ dilemma of rising healthcare costs

Labor unions have often sought and obtained from employers lifetime healthcare benefits which in some instances have come to accrue a value in excess of the assets of the corporation, thereby driving it into bankruptcy. At the time the contracts were written, it was impossible for either party to anticipate the monetary value of such contracts.

At a time when there is an enormous disparity in income between management and worker it has become difficult to justify increasing employee contributions to health plans. For high corporate productivity it is necessary for the workers to be healthy and content and for management to equitably balance benefits and social responsibility for all.

How can multinational companies leverage their knowledge about best practices in healthcare to attain all of the above goals?