With a little time on the afternoon of New Year's Eve, I'm looking at what we might see in the coming year for some of the health issues this blog deals with. Full disclosure: Coming from a science-fiction writer, these forecasts are almost certainly wrong, and where accurate are likely to be much too conservative.
Haiti is likely to be a persistent and discouraging concern, and for several reasons. The Ministry of Public Health and Population (MSPP) tells us that in the 50 weeks of 2012 between January 1 and December 17, it recorded 107,808 cholera cases (2,156/week). Of those, 65,233 were serious enough to require hospitalization (1,304/week). Eighty hundred and twenty-six Haitians (16.5/week) died of the disease. I doubt that cholera will get much better, or much worse, so another 100,000 cases in 2013 seems likely—and another 800 to 1,000 deaths. The real economic and social burden will be in the nonfatal cases, which will continue to stress Haiti's rudimentary healthcare system.
Haiti can also expect less publicized health issues to persist: HIV, malnutrition, and all the opportunistic infections that exploit them. The destruction of so much food production by Sandy means Haiti will need even more food aid—which, if past experience holds true, will arrive too late to prevent starvation and just in time to depress prices for next year's locally grown crops.
Climate: Storms and drought caused a lot of health problems around the world this year. Right across sub-Saharan Africa, climate is causing warfare between herders and farmers, with massive dislocation of people into camps where diseases spread easily. Pakistan is dealing with the aftermath of new floods, including malnutrition and waterborne diseases. So are many parts of the Philippines.
The self-proclaimed "advanced" nations will take little note except when climate change affects them directly—by killing people in heat waves, for example, or when a hurricane hits, or when distant forest fires create local smog. (Vancouver had some bad days last summer thanks to such fires in Siberia.)
Violence: We have managed to forget that until very recently, disease killed more soldiers than their enemies did. Armies have imaginatively shifted the burdens of both disease and violence onto civilian populations, while giving their own troops the benefits of socialized health care. Meanwhile, warfare has (for example) driven Ebola and Marburg out of the forests of the Democratic Republic of Congo into Uganda. Refugee camps from Darfur to Turkey to Afghanistan to Thailand are full of cold, underfed children with diarrhea.
The awful gangrape case in Delhi has alerted a billion people (or at least half a billion females) to the public health impact of sexual violence, but I am pessimistic about a rapid improvement in that situation. Too many males simply blank out when presented with an opportunity to get laid. Similarly, the kind of necrotizing male ego that results in both individual and mass shootings will continue to cause thousands of American deaths thanks to the availability of firearms.
H5N1—the original inspiration for this blog—seems likely to me to remain very much in the background. Those who contract it will be a tiny, very unlucky minority. WHO's tally of cases and deaths since 2003 shows a steady decline from a very low peak in 2006 of 115 cases to just 32 in 2012. But the high case fatality rate (59 percent worldwide, and 83 percent in Indonesia) makes it still a disease to watch. And as a threat to poultry, H5N1 is also a genuine threat to the nutrition and economic wellbeing of billions of people from Egypt to Indonesia.
Everything else will continue as well: tuberculosis, malaria, dengue, HIV, encephalitis, antibiotic resistance, and all the ills of poverty and inequality.
Those are the obvious key issues, but I keenly recall being completely blindsided by H1N1 in the spring of 2009: The wrong flu strain, turning up on the wrong side of the Pacific. No doubt we'll be surprised by still other viruses and bacteria in the coming year. And no doubt our public health services will do brilliantly at coping with them. But they will also know that they could have done better—might even have prevented the outbreak altogether—if only they had been better funded and resourced long before.
Whatever turns up, I'll do my best to cover it and to support the healthcare workers and other professionals who work to keep us well. I wish you all—but especially them—a very happy, prosperous, and healthy 2013.