...with more bad news to come
Just in case you hadn't noticed, the headlines are full of the West Africa-originated Ebola crisis. Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention (CDC), observed just last week while speaking at the World Bank, that Ebola is now the biggest world health crisis since HIV/AIDS. According to the World Health Organization (WHO), the current deal toll from this year's outbreak alone stands at 4,447. International agencies and governments are fighting to contain the world's worst Ebola epidemic since the disease was identified in 1976; contain not only in West Africa but also to prevent the spread of the virus to the rest of the world, including the UK, Europe and North America. Despite these efforts (and hopefully the many more to come) the CDC estimates between 550,000 and 1.4 million people in West Africa may be infected with Ebola by January of next year. The first cases in the US are being reported as I type and there have already been deaths in Spain and Germany. Sadly, these horrific events shouldn't come as a complete surprise.
Ten days ago, I led a session for Conference Board's Strategic Risk Council in London. Assembled were 14 senior risk officers from the corporate world, representing industries as diverse as big pharma, insurance, banking, consumer goods, beverages and snacks, chemicals, shipping and agribusiness. Together we explored the key "mega-trends" and critical uncertainties that may shape the future of global markets over the next ten years. We applied a scenario framework, allowing us to discuss a divergent set of potential futures that may unfold, built around the key variables of the pace and nature of globalisation (how the world is run) and the impact of changing demographics on global economic growth (one billion new consumers versus the accelerating liabilities of an aging population with spiraling social care costs/ pension time bombs etc.).
A rich set of discussions ensued, exploring the impact of urbanisation, access to increasingly scarce resources (food, clean air and water, natural commodities etc.), a shift to the East in economic (and political) power, the rise of the Millennials as digital consumers, the ageing of developed economy populations, the imperative for innovation and scaled-based efficiency, the quest for talent and the role of seemingly omnipotent regulators. Towards the end of the day, having developed a set of compelling but divergent stories about the future, we stopped, stepped back and acknowledged we were in the present and actually didn't know exactly which of our scenarios would unfold (most likely none of course, not as exactly described). We then reviewed the key scenario-independent implications (and most especially risks) for our diverse organisations, irrespective of which future were to become true. What emerged as a pressing concern in every scenario, was the heightened threat of disease. Now I acknowledge that Ebola loomed large in the headlines ten days ago too and that present events have a horrible habit of shaping human perceptions of the future, but none-the-less, it was a striking conclusion.
As our globalised world continues to become ever more urban - we passed the 50% mark of the world's population living in cities back in 2010 and according to the UN, this "mega-trend" is well on the way to 70% by 2050. The majority of new "mega-cities" (populations of over 10MM+) will be in developing nations, however, half of the overall expected urban growth will actually come from small urban centres (pop.<500K) and the vast majority of this expansion will be in low-income geographies. While urbanisation in developed countries has led to an improvement in health, the concentration of population in poor urban centres, often in slums or shanty towns, has not. Unable to cope with the expanding population or offer appropriate healthcare, the urbanisation of low-income countries represents new healthcare challenges to the international community, including:
Unsanitary living conditions, no access to clean water or sanitation
Heterogeneity of urban dwellers
Overcrowding and increased frequency of contact
In combination, this has led to large urban populations becoming incubators for disease, where all the conditions to create a new outbreak occur. While disease may appear first in poor urban areas, they soon spread to wealthy neighbourhoods and tourist areas. Add to this increased global connectivity and such cities become gateways for the worldwide spread of infections.
So what to do?
While we didn't have time to discuss this in detail in our session (although I am sure the conversations have continued back at their respective HQs) there is no shortage of expert opinion on how to address, and in many instances, prevent these mega-trends precipitating and propagating devastating disease. A paper published in The Lancet back in February 2011, authored by Alirol et al, explored the correlation between urbanisation and disease. Concluding recommendations offered a range of measures from the combination of local, city-wide housing and sanitation programmes to comprehensive globally coordinated approaches to disease surveillance, control, and prevention. They go on to argue that conventional healthcare strategies simply won't cut it in a globalised world, greater cross-border collaboration of both urban development and healthcare is essential if we are to have a chance to limit and control the types of pandemic we are now witnessing.