Smartphones were pressed intobacteriological growth media.

“We didn’t have to wait long…”

University of Surrey, 2014.

Supertyphoon Haiyan

08 November 2013196 mph at landfall11 million affected

27,400 injured1,700 missing

6,000 dead

Things Not Digital in Global Public Health

Demographics

As of 2007, we’re more urban than rural for the first time in human history.

About a billion of us live in slums like this.

IslamabadImage: National Geographic

95% of the increase in population by 2050 will be in the cities of the developing world.

UN Habitat-2010

~9.31 Billionin 2050

Image: CDKN.org

William Gibson’s “uneven distribution”Caracas, Venezuela

MegacityGrowth

Doubling time:

0.2% = 350 years

0.6% = 116 years

1.5% = 47 years

2.5% = 28 years

4.0% = 18 years

5.0% = 14 years

✔

✔✔✔

✔

✔✔

✔

✔✔

✔

✔

✔= developing world

Infant mortalityper 1,000 live births

Best Worst

For reference, The US infant mortality

rate is 5.20.We rank 47th, between

Greece and New Caledoniahttps://www.cia.gov/library/publications/the-world-factbook/

But efforts like the Millennium Development Goals have shown what’s possible with infant mortality:

> = mortality dropped by roughly half

>>>>>>

>

= war variance

In the United States,stunning achievements in public healthand civicresponsibility

Disasters: Fast and Slow

Just over the past 48 months…

• Sendai earthquake and tsunami

• Fukushima nuclear disaster

• Christchurch earthquake

• Supertyphoon Haiyan

• US tornado swarms

• Russian wheat fires

• Russian heat wave

• Queensland floods

• Hurricane Sandy

• Pakistan floods

Nine Planetary Boundaries

Planetary boundaries: Exploring the safe operating space for humanity. Ecology and Society 14(2):32, 2009

About 25% of global agriculture is grown in water-stressed areas

World Resources Institute – May 2014

http://www.wri.org/applications/maps/agriculturemap/#x=142.03&y=12.23&l=2&v=home&d=gmia

About 15.4 millionall-causerefugees globally.

Just in syndromic surveillance alone, ISDS predicts in 2030 we’ll be about 4 million healthcare workers short.

Not like you. Like her.

Not such good news elsewhere…

• HIV• SARS• West Nile• Hantavirus• H5N1 Avian• H1N1 Swine• MERS• Lassa fever• Nipah• Ebola and Marburg• Legionnaires• Hendra• Enterovirus 71• Cyclosporiasis• Human Monkeypox

• Malaria (DR)• Diphtheria• Dengue• Tuberculosis (MDR, XDR, TDR)• Chikungunya• Cholera• Plague• Rift Valley Fever• Typhoid Fever• Resistance…

– MRSA– VRSA– NDM-1

• Zoonoses (75%...)• Agricultural and Livestock pathogens

Seem to be new Very different / Don’t belong

24

Of more than 30 “new” infectious diseases since 1970, about 75% have been zoonotic

Turkana…refugees?Northern Kenya, 2012

• Language

• Culture

• Experience

• Cosmology

• Myth

Point of Care diagnostics?

26

Bad water, food, medical care…persistent struggle.

Image: Crystal Davis, WRI

27

Dhaka, Bangladesh:On any given day 1/3 of the population is sick.

Grameen Kalyan, 2013

Image: InSTEDD

28

Hard-working, ambitious, and eager to learn

Image: Eric Rasmussen

But without a functioning State…

Janjaweed raid, Darfur, 2009Photo: Reuters

30

Dadaab Refugee Camp, eastern Kenya, 2013

Natural disasters

Industrial disasters

Climate change

Conflict

Trafficking

Religious extremism

Economic recession

Post-colonial disintegration

Demographic migration

Poverty / Brain Drain

Emerging infections

Compound Crises

EnergySecurity

Ecosystem Services

Food Security

Humanitarian

Assistance and

Disaster Relief

National Recovery

and Reconstructi

on

WaterSecurity

Disaster Risk

Reduction

Political Stability

Infrastructure

Security

Hazard Preparedne

ss andResponse

Transportation Security

Job creation

Public Health

Communications

Security

CapacityBuilding

Emerging Disease

Detection

EconomicResilience

Human Security

32

Data for

Decisions

Crowd-sourced data – open and free, to pretty rigorous standards

WWHGD.org

Data Preparedness for

Human Security

Image: MindTelANTz – Village health resources

Human Security Taxonomy ANTz

UN effort

Big Data. Huge.

For knee-of-the-curve warning of:

• Emerging infections• Developing famine• Economic disruption• Social unrest

11 May 2014

Food and Water

Aquaponics10% of the water.

8x yield / unit area / time.

Water

Fresh water reclamationseems a desirable goal

Photos by Lorenzo MosciaNational Geographic

Puralytics.com

Puralytics Shield

• 500 gallons per day

• 24 inches high, and 60 pounds

• LED-driven photocatalytic reactions

• Nanomembrane flow system

• 570 watts

• Replaceable cartridge

• Zero water waste

• Routine maintenance annually

First water production in the field 11 May 2014

Things we can’t do well yet in low-resource environments…

• Communicate between languages and cultures• Analyze water• Clean water• Diagnose viral diseases• Provide diagnostic tools to CHWs• Evaluate medication legitimacy• Predict zoonotic transmission risk• Provide power• Determine medication delivery• Manage cold-chains• Educate women

• Human security is a desirable goal.

• Health is one security component, driven by foundational needs.

• Exploring those mathematically inarguable needs is good business.

• It’s a market full of science, engineering, art and design.

• It’s also a market of systems: interesting, profitable, and fair.

Take-Home messages:

Eric Rasmussen, MD, MDM, FACP

RasmussenE @ ihs-i.com

360-621-3592