Hi Michael, Andre and Ian,

Many thanks for the articulate reponses. There is certainly nothing that I would challenge here myself. Certainly, diabetes and its related 'metabolic syndrome' are high on the list - and fast climbing. Infectious diseases are always well represented. I had a thesis student recently, who did a very good study around associated antibiotic resistance, biofilms and persisters - and some view the abuse and over-prescription of antibiotics as a global epidemic - especially from the damage that it does to the environment - which is not something that I had considered previously.

Yes - increasing intolerance to environmental exposures and increasing rates of asthma certainly has a place.

I hadn't considered sleep - but it makes perfect sense - especially related to increasing accidents, depressive states etc.

A further area that I have researched previously is around osteoporosis. It, and it's pre-curser of osteopenia are often described as a 'silent' epidemic - but rates are rapidly increasing and healthcare costs burgeoning.

In non-communicable diseases, diabetes is probably the 'ticking time bomb' (copyright Any Newspaper Headlline Ever)

See http://www.idf.org/sites/default/files/The_Global_Burden.pdf for one example of future predictions.

In infection-related stuff, hepatitis C may become a far higher burden disease than it is now. Plus pandemic threats of flu always around the corner (coronavirus e.g. SARS, MERS, less likely to cause global pandemic in my opinion, though potentially serious as an emerging threat)

I think we might experience different epidemics in different places. In the developed countries (and those that are trying their best to develop) we can be sure that lifestyle factors will kill many people. Being sedentary and eating too much is a common health threat and I can't see that this will change soon. Well, many people (including me) working on it. But making people active and less careless about their diet is a hard battle against those who benefit from a couch potatoe lifestyle of millions.

Well, on another note I could also imagine that allergies do play a central role in future health care. With development comes less exposure to certain environmental threats (I mean like germs etc). Hence, we cant cope once we are exposed to e.g. cat hair. I have been observing this for quite a while. Coming from a developed country I do not know many people without an allergy. But, since I am working and studying in Malaysia (and have therefore been around Asia) I know very few people who have any allergies. Yes, it is not too clean here, but thats why people are not so vulnerable.

Looking at developing countries infectious diseases will probably take the lead. However, as I pointed out with every step towards development NCDs will be more prevalent.

Andre

Sleep(lessness) seems a likely prospect to me. We've already seen drug companies trying to treat it (Gaboxadol), we have behavioural treatments for it, and it's associated with poorer mental and physical outcomes. It will be called an epidemic at some point.

Hi Michael, Andre and Ian,

Many thanks for the articulate reponses. There is certainly nothing that I would challenge here myself. Certainly, diabetes and its related 'metabolic syndrome' are high on the list - and fast climbing. Infectious diseases are always well represented. I had a thesis student recently, who did a very good study around associated antibiotic resistance, biofilms and persisters - and some view the abuse and over-prescription of antibiotics as a global epidemic - especially from the damage that it does to the environment - which is not something that I had considered previously.

Yes - increasing intolerance to environmental exposures and increasing rates of asthma certainly has a place.

I hadn't considered sleep - but it makes perfect sense - especially related to increasing accidents, depressive states etc.

A further area that I have researched previously is around osteoporosis. It, and it's pre-curser of osteopenia are often described as a 'silent' epidemic - but rates are rapidly increasing and healthcare costs burgeoning.

Hi Dean,

certainly true. Demographic change will plays its role, without a doubt. Osteoporosis, Sarcopenia and then frailty will be a challenge for generations to come. The "silver tsunami" will hit hard.

However, I believe it is a whole big picture of factors that will bring us the next epidemic. Old age is associated with many health conditions, but if people also living a careless life things get worse. I have read numerous papers making exactly this connection. Lifestyle changes are important and can be implemented for relatively low costs. Yet, I acknowledge that this is a difficult undertaking...

Hence, it is important to have such debates so that we are able to identify threats but also opportunities.

Agreed Andre,

It's a complex picture - especially for aging societies and 'consumer-based' societies. For instance, factor in the current 'poly-pill' debates. If people feel that they can take a pill to offset poor life-style choices - then you can 'bet your bottom dollar' that they will take it!!

Exactly...thats why we are currently looking at poly-pharmacy in this age group. We launched a huge research project in Malaysia and one of our goals is to find out how many pills and stuff other people take. I have conducted already a number of these interviews and the lists of pills etc. are long. However, this is not solving any problem.

Poly-pharmacy might then also be called an epidemic....

Andre - perfectly correct. Whatever is seen as the next solution - is often the next problem.

Hello Everyone,

Dean, if you refer to a simmering public health problem with potential worldwide health consequences - one that might catch us unawares in the near future - you might consider declining worldwide fertility as a candidate. This location

http://www.rickety.us/2009/10/world-total-fertility-rate-declines/ reports that the world Total Fertility Rate has declined from 4.9 in 1950 to 2.6 in 2010, without associated significant decreases in death rates. I guess we are all happy that the fertility rate is declining - less population always considered a good thing - but consider Russia, where birth/death rates in 1950 were 28/9 persons compared to 10/15 persons in 2010. What this means is that Russia, like so many countries (many of them "modern" Western nations) is facing a sociodemographic crisis due to a decline in fertility, which will be realized increasingly in the near future. So if we consider a true "simmering" public health problem, we might consider declining fertility in view of all it's potential sociomedical ramifications as one.

Re the point about antimicrobial resistance, yes that's prob one of the most serious problems across healthcare (certainly in infection at any rate). Various high-level groups and agencies have been pressing this issue in recent months. See links below for example -

Threat report from the US CDC http://www.cdc.gov/drugresistance/threat-report-2013/

Chief Medical Officer in the UK, report specifically devoted to the subject https://www.gov.uk/government/publications/chief-medical-officer-annual-report-volume-2

And if you're particularly bored, my paper last year highlighting and quantifying the overall lack of research in this area :-)

http://jac.oxfordjournals.org/content/early/2013/09/13/jac.dkt349.full

Hi Alan and Michael,

An illuminating response Alan. It's not one that many people would 'guess' I would assume - but very relevant. That is a dramatic drop over half a century and, no doubt, due to many factors that underpin other public health issues.

Yes Michael - it's a rapidly growing dilemma. The only silver lining is that the issue seems to be at the fore in many countries - and that might equate to quicker solutions. I wasn't bored - but looked at your paper anyway. Nothing wrong with it!!

Dean

With cholera, case numbers starting to stabilise

http://www.who.int/gho/epidemic_diseases/cholera/cases_text/en/

I think that as most countries affected increase access to clean water, sanitation etc, I think this will (slowly) decrease over time. So as far as the opening question of 'next health epidemic' goes, I would describe cholera as a current public health problem rather than something that will expand into the next big thing.

Mental health issues is an interesting one though. Not my field of expertise at all, but I would not be surprised to see the media throwing around the term 'depression epidemic'.

Alan,

I have checked the chart and think its an interesting development. I know from many European countries that this trend is pretty much the same (like Russia). I am just trying to connect this to health (well, depending on what we want to understand under the term health). I can imagine that many countries are then trying to get people from other countries and regions in (this happens already). With this, exposure to different germs etc. of citizens in the "host country" might cause trouble...probably more impacts on health (but I can't connect the dots yet).

Yes, Jennifer..Agreed. Just last year they adopted the FIRST comprehensive mental health action plan (World Health Assembly, 2013). WHO defines health also in terms of mental health. However, we have long neglected the issue. It was (and still is in most developing countries) simply something that is not recognized. At home (Germany) I have a number of friends with mental health conditions and it slowly becomes something that is considered as a real disease. However, here (Malaysia) I do not know of a single person who has a diagnosed mental disease (even though I expect there are many people). Same goes for Korea where I have worked for a year. We are again at a point where development, culture and so forth play a role. Lets say gay people, refugees, older adults and other groups are marginalised in many societies. They have usually higher rates of mental disorders. Since, these disorders are not treated as "real" things get worse.

Bottom line: The physical disease is still considered to be a real disease, whereas many Western countries are already alarmed. Depression etc. can therefore become on of our great health challenges..Just one number: Depression alone accounts for 4.3% of the global burden of disease and is among the largest single causes of disability worldwide (World Health Assembly, 2013).

More very useful recent posts. Communicable diseases will 'come and go' - especially depending on geographical location, GDP etc. The current or next epidemic may, in this sense, be short lived depending on interventions. Alternatively, the next epidemic may be a 'recycled' issue. For instance, here in New Zealand, cases of rheumatic fever seem to be on the increase. When everyone thought that polio had virtually been eradicated - it keeps cropping up here and there.

The mental health (depression) issue is highly complex. A future epidemic of it may not necessarily indicate a rise in rates. It could equate to better services, better access, better screening, better assessment, less stigmatisation, more classifications etc. Agreed though, the rates of prevalence and incidence will vary dramatically depending on where you live in the world.

Thank you Dean - your comments are thought-provoking. Perhaps I interpreted your question a bit differently than some - what issue(s) are lurking out there that, while not yet considered "health" problems, may of a sudden loom as a huge problem for us - something or things so insidious perhaps that we do not realize they pose health problems at all until we are on the verge of being overwhelmed? Thus I find myself "thinking outside the [health] box" so to speak... What types of things might well inundate us with health ramifications before we even realize the potential threat of them? A good example might be the proliferation of fast food chains that while representing economic growth and fast access to relatively cheap calories, ultimately pose a huge threat to health through their contributions to obesity and diabetes? Anyway, I find this question immensely stimulating of thought, and I thank you!

Dear colleagues''

Department of ''Burden of Diseases'' would solve these future interests through researches in preventive medicine/epidemiology e.g. prostate and colon cancers, RTA are projecting, worldwide (due to civilization & increased life age times).

Adel AL-Harbie MD, MSc TMIH (LSHTM-UCL), PhD Infec Dis (Edin)

Alan - no I thanks you for your insightful responses. Thinking outside the box helps us all. Your example, to me, is reminiscent of the recent state of affairs related to obesity - and it not been considered an epidemic - but more a naturally-occuring consumerist choice. The fast food issue is indeed right up there - alongside its globalisation. It seems every few weeks - the 'first' MacDonald's is opening up in some country. Then there are the ecological repercussions of such globalisation. Might we view epidemics in the future more related to ecological models and perspectives?

Holy crap Dean - if that ebola gets loose, you've got your answer !

Epidemic ''syndrome'' worldwide is illiteracy.

The ebola outbreak has a case fatality rate of 64%. If that gets loose, there might not be too many folks left to view the epidemics in relation to ecological models and perspectives :-)

Tangent - Peter Piot's memoirs called 'No time to lose' are excellent for his recounting of the early days of discovering the ebola virus. They bought what turned out to be ebola samples back on a passenger plane in the overhead locker, then played around with it in the lab where their protective gear amounted to rubber gloves and an apron.

Hi Alan - good to know I've found the answer - although I doubt it. So - ebola is now on the list, which adds to the rich mix. Michael - I don't mind the idea that we can forget about ecological models etc - it will save me a bit of time. Adel - an interesting spin. Obviously, illiteracy is not a medical epidemic - but perhaps we can think outside the box. Those that do not have education/literacy are those that are most likely to 'go first' and lead in terms of numbers when it comes to pandemics/epidemics i.e the ones most likely to be least resistant, have less access health care and medication, have poorer health etc. On the other hand, they are often less mobile to transfer disease i.e. do not have the resources for international travel etc.

Thanks for this stimulating discussion, Dean. It has caused me to "take a walk" on the net and see what others think. Clearly many have their own ideas although few are unique, but most are interesting for one reason or another. Doubtless some of this is old news to you: at http://www.greenandhealthy.info/nextglobalepidemic.html we find a discussion of Morgellon's Disease (fibers growing out of human lesions); at http://www.npr.org/blogs/health/2014/02/13/276489011/stopping-microbes-not-missiles-u-s-plans-for-next-global-threat a surveillance system designed to detect the next worldwide pandemic (hopefully before it occurs but likely, not) at

http://scribol.com/lifestyle/blame-global-warming-for-next-global-heath-epidemic a discussion of global warming effects on worldwide human health; at

http://www.newsmaxhealth.com/Health-News/high-blood-pressure-hypertension-global/2014/02/04/id/550875/ and http://www.selfgrowth.com/articles/diabesity-the-new-global-reversible-epedemic the authors contend that hypertension and diabetes, already global problems, will assume even greater status in the near future; and at

http://www.foreignaffairs.com/articles/60816/laurie-garrett/the-next-pandemic the authors hold that avian flue, H5N1, is certain to be the next global health problem.

Given all these opinions and the evidence they present (however tilted!), it is no wonder that our global lack of consensus on the issue may in fact be the major current threat to world health and in the foreseeable future.

Global co-operation (or lack thereof) is an interesting one. In the end, it has been relatively successful in addressing the HIV pandemic. The roles high-level political figures like Clinton and (in particular to smooth the path within Africa) Mandela played in getting assistance to high burden regions, as well as promoting investment in research and implementation of drugs etc, was absolutely crucial. See also Kofi Annan and thus the creation of UN AIDS.

I think within pandemic research and implementation, there is much greater co-operation than there was. I recently took part in a debate on antimicrobial resistance and this subject came up there as a major potential stumbling block to 'tackling' the problem.

And with non-comm diseases triggered by lifestyle choices, you have added problem of dealing with the unscrupulous machinery belonging to the tobacco industries, or those promoting fast-food, sugar etc etc. Money talks, global co-operation will often be a distant second. Formidable obstacles.

Anyway, this is an enjoyable thread!

Thank you Michael. So the seemingly straightforward question posed here ("What is the next health 'epidemic' ?) really encompasses multiple possible answers involving to name a few, surveillance, policy, cooperation, globalization of those, communicable and non-communicable disease, emerging diseases of all types, tangible and intangible threats, lifestyle choices... it makes one's head spin. And thinking of those as obstacles! Yes they are. So what IS the next health 'epidemic' ? I don't know.

The next health epidemic is...

*opens envelope in front of expectant audience*

Oh, it's a question mark.

I think there will be several epidemics across various areas of disease, as mentioned upthread. And each and every one of them will be about as multi-factorial as it gets. And the media will fail to aportion appropriate headlines to all of them.

Yes..very much..as in many debates lack of certainty is always certain. Although I enjoy the uncertainties generally, it terms of health epidemics it would be nice to get a more precise answer. I don't think this will happen since people from different backgrounds look at things differently. That brings the global cooperation into play. It is actually interesting that we can't really figure out what will come next..but..we do understand that everything is inter-related. Hence, I won't add to the debate with another option but would conclude for myself that there are indeed some indicators for epidemics that need to be looked at.

ILLITERACY in any life specialty/sub specialty is the main reason e.g. Health is uncontrolled/associated with CD, NCD & injuries (the highest morbidity/mortality/fatality) all over the world.

Many thanks for ll that material Alan - much appreciated . There's some weird and wonderful stuff out there that serves to muddy the water in a good fashion. I really like the idea that a lack of global consensus and global co-operation is a big problem; in fact, is globalism the next health epidemic? Was it all better when everyone lived in geographical silo's with distinct borders and boundaries.

"Was it all better when everyone lived in geographical silo's with distinct borders and boundaries."

Again, it's obviously complex with many ifs, buts and maybes, but for a straight yes/no answer, I'm going to say 'no'.

Reason being, the world generally is at it's healthiest than it's ever been (life expectancy, healthy years of life, child mortality etc all better now than 10,20 or 50 years ago). Globalism allows a greater awareness of low-income settings and thus an opportunity to invest and create interventions, such as irrigation, sanitation, bed nets, supply of medicines etc, for places and regions we in high-income settings were not aware of previously. International surveillance data is far better than just your own surveillance data.

There are the downsides we've discussed above. But overall, I think it's all for the better. As globalism/globalisation evolves, things probably improve overall but the challenges evolve too.

Yes - I agree Michael. Just mixing it up a bit. Globalization, if you take away some of itsfacets I.e corporate international fast-food chains, is generally for the better. It's good to compare and contrast health issues internationally.

I think cancers are next health epidemic.

We are drowing in chemical sub , bad habites , poor diet and exesive strees.

Alireza,

Good to hear from you - but I would argue they are 'not the next' health epidemic - but already well established and have been for some time. 

It is possible that infectious diseases will have resistance  to current  vaccines and they will no longer protect us.

That is true enough Joan - there is plenty of evidence out there to support anti-biotic resistance as a potential major global hazard but, so far, it's not emerged quite as some doom-sayers have suggested. It's still a major problem to keep a close eye on though. 

Nutrition and reduced micobiome diversity, glycophosate related diseases.

You have since the 50s animals being fed antibiotics as part of their feed due to observation that they got fat faster.  That is causing huge common pathogens to have much higher virulence.  I am not so sure we know what eating animals that get fat faster do to us, however, we do know that the farm lot animals have grossly out of whack omega 3:6 ratios and that is creating health problems.  I am not so sure that we know the difference in eating animals that have been able to graze on plants and or what if any benefits from a richness of a varied diet in passes on to us.  Do they concentrate unknown micro-nutrients in their fat, for example?  Are they deficient in nutrients from their grain feed diet?  Apparently cows are slaughtered at 6-7 months now and they are so sick, they likely wouldn't see a year.

Farming practices have really reduced soil quality and GMO has even done huge damage to microbiome that lives in the soil.  The nodules in the legumes that are responsible for nitrogen fixation are smaller and aren't doing their job as well as the microbes in the legumes seem to also be hurt by round-up.  And then, you put the feces of the antibiotic fed animals onto the soil as fertilizer and it doesn't have the diversity of nutrients because of the limited diet and it serves to increase antibiotic resistance as some of that is transferred to us through our food.

Clostridial species play a significant role in serotonin production.  Some are very dangerous, and some train our immune system and essential ones to our health that come from soil are being harmed.  Diversity of microbes in the soil is about half.

So, you have more poor quality corn being grown, in highly dense fields, and farming practices are such that food density from crops is up, but what about nutrition.  What about the mineral content of the food we eat today.  I've seen estimates that we only get 40% of the magnesium that we used to get, even if we eat by shopping the outside ring of a grocery store, and magnesium is involved in something like 3700 biochemical reactions in the body.

Our microbiome in our body has reduced diversity and with that comes reduced diversity for enzyme production.

So, by packing in on the food density per acre in farming, we've reduced mineral absorption and add to that we've increased the processing of food.

Processed grains have 90-100% of selenium removed, and selenium is essential for the liver to detoxify the body.  If you go through nutrients removed from processing, it is shocking how little nutrition is left.

You just don't have the same stores of what the body needs from nutrition available to the body to respond to flues and colds, and any other disease the body encounters.

"They" are going around saying that today's youth will be the first generation that does not exceed life expectancy of their parents and I say has anyone looked at the obituaries lately?  Seems like tons gone in their 50s, 60s and 70s already.  It takes at least 10 years for data that would actually measure declining life expectancy to catch up with what's may already happening.

I also think the reduced nutrition of food and increase virulence of pathogens will also potentially tap the hidden herv-k retroviruses in the genome to come out an play more often.  Something like 3/4 of C4 of complement have herv-k hidden away in that gene and so the more the body has to spend fighting disease and up-regulating the need for C4, the more potential issues with herv-k.  Apparently we have something like 30 copies of this retrovirus in our genome and I think where people have it in their genome and how or if it is expressed will play a larger role in disease because of reduced nutrition and increased fighting of other pathogens.  The body normally naturally takes care of herv-k, but I think it struggles more because of the huge changes we are creating from how we create food.

And then add to that the high fructose corn syrup.  Fructose is processed in the liver with the same mechanism as alcohol, so there's even another enormous stress that has been added to the body because of subsiding corn.  It isn't the cheapest sweetener without the subsidy, so ill health through corn is one of the largest agricultural subsidies.

And then start looking at what the glycophosates from round-up and GMO are doing to the gut, in an environment of reduced nutrition and increased virulence of pathogens.

just 10 days back, BBC reports Bill Gates saying that we are vulnerable to flu epidemic in next decade. Link added here.

http://www.bbc.co.uk/news/health-38330823

Hi Yogesh,

Let's wait and see - hey!! First it was avian flu - and recently Zika!! I'm not sure that Bill Gates is the leading medical authority. We can all have a 'guess'. 

Very interesting. A series of epidemics appeared gradually as Dr. Whitehead mentioned previously. So, it is reasonable to wait for another visitor soon. Wishing a good health for all.

Regards

SM Najim 

Actually more disease from vaccines, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404712/pdf/cis307.pdf, just one of a number of studies and very serious issues discussed in a documentary...

https://medicalxpress.com/news/2016-11-resistant-bacteria-air.html

"Polluted city air has now been identified as a possible means of transmission for resistant bacteria. Researchers in Gothenburg have shown that air samples from Beijing contain DNA from genes that make bacteria resistant to the most powerful antibiotics we have."

The possibility of an airborne resistant bacteria is chilling, - a recent episode of legionnaires in Hopkins Mn. was illustrative - tracking the source was quite difficult but the health department proved capable.  

An agressive microbe resistant to UV and resistant to present antibiotics could be devastating W/O killing a single person.....  Survival in a damaged state would provide little comfort.....

Throw biofilms on top of that.......

Read more at: https://medicalxpress.com/news/2016-11-resistant-bacteria-air.html#jCp

https://phys.org/news/2016-06-resistance-antibiotics-immune-interconnected-bacteria.html#nRlv

A current epidemic which is estimated to cost $850 billion/year is muscle and bone injuries - and the associated tendon injuries.  We may well have more and more labor saving appliances, but the ability to be self reliant and self mobile is the best method to keep health care spending to a reasonable level.

Problems associated with mobile phones and supporting towers. The problems are not necessarily physical illnesses but might social and mental.

I agree with Omran. Considering all the screen time together, including both watching TV and other electronic devices, it was estimated that U.S. youth spend > 7 h per school day on screens since 2009. The relations between elevated use of electronic devices and mental health issues have become a heated topic, but the findings are still controversial.

"Mental health" is going to be the next global health epidemic.

Surprisingly, epidemic will continue till it become endemic.[ The global pharmaceuticals market was worth $934.8 billion: https://blog.marketresearch.com/the-growing-pharmaceuticals-market-expert-forecasts-and-analysis ]

Epidemic and Endemic will continue till it become Pandemic. [like diabetes and cardio].

Next half of this century under go severe mental disorders and sleep related issues and electronic implicated nerve imbalance. [over all, a kind of Zombies like condition]

But sudden high impact epidemic going to be Infertility and birth defects.

But it is not too late to change our life style and social responsibility to overcome this.

Follow

Please check this link:

https://www.who.int/emergencies/ten-threats-to-global-health-in-2019