Take HEED--if not now, when?

As never before in history, humans can dramatically change the world and do it quickly. No more is there the need for millennia and the trials of natural selection of the cumulative effects of human-related alteration of the environment; we have genetic engineering on one hand, and industrial pollution and deforestation on the other, occurring at an unprecedented speed and time scale. On the political side, things can change even faster. An election, for example, is often quickly felt within weeks, and the changes following the events in New York and Washington, DC, on 11 September 2001 were effected in not more than a blink of the eye. Although these may appear to be disparate themes, they are all related to the environment, including the physical, the social, and the political. In addition, they all impact in one way or another on the huge and growing global disparity in the health of people in the rich nations versus the poor ones, which is attributable in large part to environmental degradation, social disruption, and political dysfunction. To make matters worse, these disparities are magnified by a growing knowledge divide on the ways to improve health through new approaches to a sale environment and strategies to develop and deliver drugs, vaccines, and medical care; social organization; and political mobilization of resources.

In recent years, an important theme and a new paradigm has been emerging. It begins with the dual recognition that riches without health impoverishes the quality of life, and the fact that the impoverished cannot buy good health; in fact, ill health directly contributes to poverty. In turn, poverty traps and ill health lead to economic instability and may sow the seeds of political instability. Like it or not, the world, its environment, and its people ore interconnected, even when separated by geography, socioeconomic gaps, of political systems. SARS (severe acute respiratory syndrome) and bird influenza are but two recent examples of the consequences of viral admixture arising in Asia within uncontrolled and crowded populations of fowl, mammals, and humans. The ripples of both emerging infections have been rapidly felt in distant and well-sanitized comers of the earth--just ask the economists, public health professionals, and the people of Toronto, Canada. Yet, humans can just as easily apply knowledge toward solutions for common problems, if there is a will to do so. Science advances allowed the identification of the SARS coronavirus within weeks of its emergence, an unprecedented tour de force. This has set the stage for rapidly scaled-up public health control efforts, vaccine development, and a search for effective drugs. Global mobilization can also work to limit the spread and impact of bird influenza. This global science is, importantly, no longer colonial in nature; it is conducted by the well educated and privileged in all countries, developed and developing, on behalf of the undereducated and underprivileged. In reality, to be effective, contemporary science must include scientists of all nations in order to identify problems quickly and to work on solutions in timely fashion.

The National Institutes of Health (NIH) and its Fogarty International Center (FIC) have played an increasingly important role in globalizing science to developing countries. In the field of environmental health, the National Institute of Environmental Health Sciences (NIEHS) together with the FIC has supported critical and collaborative research as well as long-term investments in the career development of the needed environmental health scientists in developing countries. Together, the FIC and the NIEHS have promoted an ecologic research approach toward emerging infections, have supported prospective multidisciplinary studies on the relationship between improved health and economic performance, have helped to train ethicists who can ensure that research conducted in developing countries is both ethical and culturally consistent with global standards, and are investing together in the improvement of medical journals in Africa and medical journalism for the public. Some may be surprised that a high-level national biomedical research agency such as the NIH would have such a global perspective, but it is entirely consistent with the NIH mission to conduct research to improve the health of people everywhere. In this context, science is no longer alone in the ivory tower, separated from the real world, or conducted for the sake of exploration alone. Although creativity, ingenuity, and invention continue to be the guiding light of excellent science, this is not enough to address the problems. It has long been said that science without dissemination is not good science. Today, the thought must be extended to the concept that science without application is also not good science. Biomedical and health-related social science, however fundamental and "upstream," must maintain a goal orientation toward ultimate application to improve human health; to this mantra, we must also add the word "everywhere."

The Health, Environment, and Economic Development (HEED) program, codeveloped by the FIC and the NIEHS and described in this issue of EHP, is an example of bringing creative scientists together to address broad interdisciplinary problems. HEED was created to focus science on the concept of sustainable development--specifically to encourage research on the human health consequences of development investments and their environmental consequences. It complements an existing FIC program, International Studies in Health and Economic Development (also cofunded by the NIEHS), which studies the impact of improving human health on productivity and economic development. HEED represents the reverse intent--to better understand the impact of development-related environmental alterations on health, Together, the two programs will generate new information of considerable relevance to the future of the human race and the earth, as well as all of the species that coinhabit the planet with us.

There has never been a time when the availability of resources, trained people, new approaches, and global awareness coincide as they do today. Given the continued abuse of our physical, social, and health environments; the magnitude of global environmental problems; and the potential to develop solutions, we must ask if not now, when? To those who say we in this country cannot afford to pay attention to the rest of the world, it can be countered that we actually cannot afford not to.

Gerald T. Keusch

Boston University Medical Campus 

Boston, Massachusetts,

E-mail: [e-mail]

Gerald T. Keusch is a physician-scientist involved in basic and applied research on global health problems in developing countries. Before assuming his current positions earlier this year as Provost and Dean for Global Health at Boston University Medical Center, he was Associate Director, International Research, and Director of the Fogarty International Center, National Institutes of Health.