PLANETARY HEALTH WEEKLY

By Dr. Stephen Bezruchka

January 20, 2022

David Zakus asked me if I would do a blog for the PHW.  I’ve known David from his days in Edmonton at the University of Alberta and follow the Weekly every Thursday.  Some background about me and what I hope to cover, this being my first blog.

I was born in Toronto and attended the University of Toronto in the 1960s studying mathematics and physics.  I went on to graduate school at Harvard University in mathematics but dropped out to go to medical school.  I spent the intervening gap year in Nepal, walking the trails and writing the first trekking guidebook.  This experience totally changed my direction from wanting to do mathematical modeling of cancer processes to wanting to provide appropriate medical care in Nepal and training local people to do this.  I was able to get a perspective on this at Stanford Medical School and subsequently at the Royal Victoria Hospital in Montreal.   I have spent over of ten years in Nepal.  Efforts have included setting up a community health project a week’s walk west of Pokhara in the 1970s and training locals there to deliver quite primitive care (e.g. cutting skin grafts with a razor blade).  In the 1980s, in a project sponsored by the University of Calgary I set up a district hospital as a teaching hospital for Nepali doctors and supervised them.  I also worked as an emergency physician in the U.S.  Now I teach population health at the University of Washington’s School of Public Health in Seattle.

Almost 30 years ago I went to public health school (Johns Hopkins) to better understand why the United States, by almost any measure of health, was behind all the other rich nations. My question was not answered but I came to appreciate the role of political and social forces in producing population health.  I now teach courses where the ‘patient’ is the country.  How do different countries achieve their levels of health?  The easiest diagnosis I could make in the emergency department was that someone was dead.  So my focus is on mortality.  Today some 50 nations have lower mortality rates than the United States.  To achieve this we spend more than twice as much per capita as any other nation on healthcare. 

What I have learned in these thirty years is that healthcare and personal behaviors are not as important in producing health as we are led to believe.  The longest lived country in the world, Japan, has more than twice as many men smoking per capita as does the U.S.  And when doctors go on strike, morticians have less work to do.

I hope to cover topics on what produces health in human societies and how that is affected by the planetary environment.  What needs to be done?

Please ask questions to guide me (sabez@@uw.edu). And stay with me every third Thursday of the month going forward. See you next on February 17.