I feel outraged and sad about the death and harm suffered on 9/11 and in the consequent acts of violence around the world. Death and suffering of such magnitude, intentionally and predictably arising from policies created by human beings and having effects for generations, are matters of great concern to public health workers. But in all other respects 9/11 was immaterial for public health.
Public health workers worldwide spend most of their time tackling the relatively well understood personal, environmental and social risk factors for chronic and infectious diseases. But there are three ‘meta-issues’ that desperately require more public health attention if we are to promote wellbeing globally and avoid the extinction of humankind: poverty, fundamentalism and environmental destruction.
Poverty causes increased disease and premature death. It is largely hereditary and remains extremely common; it is increasing in sub-Saharan Africa. Poverty is not inevitable but poor people and poor nations cannot eradicate it. Its doppelgangers are exploitation, inequity and powerlessness. However, poor people are not so disconnected and powerless as they were and they are unlikely to remain as passive as they have been. Letting poverty continue will almost certainly lead to an unstable, more violent world.
Fundamentalism involves the belief that there is a single truth that believers have a responsibility to propagate. Fundamentalism is most commonly used to refer to religious fundamentalism (particularly, and misleadingly in the West, Islamic fundamentalism). However, fundamentalism is also applicable to economic, political and nationalistic beliefs, where it also precipitates intolerance and violence. If the global community cannot find ways of living peacefully with our differences we will destroy each other, with resources that could be used more productively. [I am conscious that pluralism (believing that there is no single truth) may logically be viewed as a fundamentalist belief in its own right.]
The environment has been changing naturally for billions of years and life has evolved concurrently by trial and error. Human life has evolved to prosper in the environmental conditions of the last two million years. Over the past 200 years, humans have been actively changing those conditions in ways that threaten our own, and other species’, health. In the next 100–200 years we may create an environment that is incompatible with human life.
These three ‘meta-issues’ are the products of human action, are interlinked and individually and collectively have potentially disastrous consequences for public health. To solve the problems created by any one we must tackle all three. Have the events of 9/11 affected our understanding of, or our responses to, any of these public health issues? No. Have the events of 9/11 affected our responses to chronic or infectious diseases? No. Do western governments now behave more ethically or as better global citizens? No: they continue to torture, profit from the international arms trade, support corrupt undemocratic governments, bully less powerful countries into unfair trade agreements. And the resources directed to the ‘war on terrorism’ would never have come to public health anyway. 9/11 was mostly irrelevant for public health.