In 2017, American epidemiologist  Anthony Fauci said there was, quote,   “no doubt” that the country would be confronted  by an infectious disease outbreak within the   next three years.

And in June 2019, Fauci  described public health’s biggest nightmare   as quote “a respiratory-borne illness,  that spreads rapidly, that's new." Less than a year later, Fauci’s greatest  nightmare was realized with COVID-19, a new,   rapidly spreading, respiratory virus that resulted  in the deadliest pandemic in U. S. history.

How did experts see this coming? And what  could we have done differently to prepare for it? The answer, it turns out, isn’t in a  crystal ball.

It has to do with infrastructure,   surveillance, technology, and  pretty much our entire planet. Hi, I’m Vanessa Hill, and this is Crash Course  Public Health! And in our last episode, we’re going to take a journey into the future.

INTRO One of the somewhat obvious problems with  talking about the future is that we don’t  know what we don’t know. Like, if I walked up  to someone in the mid-18th century and said,   “I was scrolling on my iPhone and I found  a great Groupon for a dermatologist on Facebook,” that person would probably be  like…what language are you speaking? So, sure: we don’t know what the next  big scientific breakthrough is going   to be or what futuristic diseases we’ll  encounter.

But when it comes to our health,   we actually have a pretty good idea of what  could be next. And we also have some ideas   about what we need to do today to prepare. It’s true that in a lot of ways, the future of   public health is as unknowable to us as the  iPhone was to people in 1850…and also for   people in the year 2000, for that matter.  But there are also a lot of ways in which   public health is somewhat foreseeable.

Like, consider COVID-19. Experts didn’t   necessarily see COVID-19 coming. Instead,  they recognized that disease outbreaks like   COVID-19 had always been a part of human  history.

And they also recognized that   the current global health care system wasn't  equipped to deal with this kind of virus. That’s one reason we hear so much about  infrastructure. Infrastructure includes   all of the structures that society  needs to operate.

Traditionally,   we think of physical things like buildings,  roads, and power plants. But it also involves   less tangible things like telecommunication and  education systems–and a workforce to operate   those systems. In public health terms,  infrastructure means creating a   health system that can handle any issue we throw at it,  from mental illness to a global pandemic.

One major piece of public health infrastructure  that we hear about is disease surveillance.   This basically consists of the systems that hospitals,  health agencies, and entire countries use to track   and analyze disease emergence, levels, and spread  in a population. Like a meteorologist predicting   the weather days in advance, health experts  use disease surveillance to forecast things   like the upcoming flu season or a new virus. One of the first recorded instances of disease   surveillance actually occurred as early as the  mid-1600s, when an amateur scientist in London   by the name of John Graunt began analyzing  and surveying the London Bills of Mortality,   a weekly report on disease and death  released by the city.

Graunt published his   findings in a book titled “Natural and Political  Observations Mentioned in the Following Index,   and Made upon the Bills of Mortality”--which  people usually just called “Observations.” In his book, Graunt analyzed publicly available  death records with a population-approach,   which allowed him to notice larger patterns  in disease and mortality. For instance,   Graunt noted that while rates of  chronic diseases were pretty stable,   contagious diseases tended to surge or fall  depending on neighborhood or time of year. Today, disease surveillance looks at more than  just germs–like crowd-sourced traffic data,   Google searches, airline travel history, and in  the case of COVID-19, even sewage–literally your poop!

At a time when people and information are  traveling faster and more often than ever before,   health experts are learning how to use  all these data points to forecast emerging   disease outbreaks and trends before they  come knocking on civilization’s door. When they’re working effectively, these  surveillance systems create a global   network of understanding and communication.  However, when there are gaps in these systems   due to a shorthanded workforce, outdated  systems, or lack of financial support,   health experts lack the best tools and  resources to keep people healthy and safe. While disease surveillance remains an important  public health tool, public health experts are   also going beyond monitoring disease spread to  understand how human systems can unwittingly cause   or worsen illness.

This is where some experts  have proposed a planetary approach to health.   If public health is the recognition that health  is shared between all people, then a   planetary approach to health is the recognition that the  health of the entire planet is connected, from marine biologists working on the Great Barrier  Reef, to the levels of CO2 in the atmosphere,   to the shrinking of the Amazon rainforest, to  all the animals that live in that forest.   And science has shown that a planetary  approach to health isn’t just possible– it might be necessary. Let’s go to the Thought Bubble. Consider our food supply.

As it is, we already  use about half of the planet's livable surface to   feed ourselves with agriculture and livestock. As  climate change leads to more droughts and floods,   experts project that there will be less food  available. This will likely drive up the price   of food, meaning that even more people will  go hungry or rely on nutritionally-deficient foods.

This is already happening in many  nations, leading to the migration of people   to places where food is more available, which  leads to international tensions flaring up as   countries attempt to control these resources. Meanwhile, we’re turning diverse ecosystems into   places for cows to hang out, or for the production  of cash crops. And as corporations hack away   at these once-vibrant ecosystems–like forests  in Central and South America–we’re destroying   the habitats of animals with unknown viruses  and bacteria, all of which could potentially   jump to humans.

The more contact we have,  the higher the risk of this happening… Reports have shown that from 1980 to 2020, the  number of disease outbreaks around the world   each year has more than tripled. A growing  reason for this is that human interference   in nature results in more contact between humans  and disease-carrying animals. And 6 out of every 10 infectious diseases in people come from an animal!

West Nile virus came from birds and is transmitted to humans by mosquitoes. HIV is  thought to have come from chimpanzees infected   with simian immunodeficiency virus, or SIV, which  was likely transmitted to humans when they came   into contact with the blood of infected animals  while handling their meat. And according to one study, rodents on their own are carriers of as  many as 68 diseases that can affect humans.

So what feels like a food problem turns out  to be kind of an…everything problem. Thanks, Thought Bubble. It’s also pretty  hard to discuss the future without talking about technology.

Some experts say we’re in the  information age, a time that began around the 1970s, when developments in computer technology  and human connectivity made more information   accessible to more people than ever. One of the biggest culprits for this sudden   information explosion is the Internet. Ah, the  Internet–that pristine fountain of information   from which all truth, objectivity, and mutual  respect flows forth…said no one ever.

The Internet is probably most famous for being  both really awesome and also a verifiable mess.   It’s a jungle of memes, chat rooms, Wikipedia  rabbit holes, articles, more articles explaining   why those other articles are wrong, and then  more articles explaining why those articles   are wrong and…yeah, you get the point. And this wild west where everyone has access   to bottomless information feeds has posed some  big challenges for public health. In fact, one of the most difficult battles that public health  experts are fighting isn’t even a health battle,   per se.

It’s an information battle. Or, more  accurately, a misinformation battle. In a world and a marketplace that values clicks,  views, and “smashing that subscribe button” (don’t forget!), a video with a title like “Could  onion juice be the cure for cancer?”  will always be more popular than an article or YouTube  video explaining that onions are not in fact full   of cancer-curing properties.

This may be due  to the fact that many platforms are designed   to promote engagement with novel information  that inspires emotions like surprise or disgust,   which even when false, is more likely to  be shared than the plain old truth. The fact is that while the Internet is very  good at providing access to information,   it’s very bad at prioritizing which of that  information is, you know, correct. This is a problem for public health experts, who can  have trouble competing with cancer-curing-onion   headlines to get out their slightly less  eye-catching message around, say, the importance of getting vaccinated or regular check-ups.

And sure, this is an Internet-y problem. But it’s  also the responsibility of health experts  to build trust with the public – an ongoing,   never-ending task. This involves listening to  people and community leaders and addressing   their concerns about public health measures.

It also involves working with communities to   spread public health messages, and engaging  at the local level in a trusted way so that   people in the community understand and trust  experts when a crisis rolls around. And it also means communicating with the public in a  way that’s clear, concise, and relevant. Okay, so there’s obviously a lot of work to  do if we want to build a future where everyone   has the opportunity to live their healthiest  life.

And public health experts have given us   lots of models, strategies, and plans for how  we can start building that world today. When public health is working, it can feel  invisible. Over the course of this series,   we’ve created a lens that you  can use to see public health   in action literally everywhere.  And when we have this lens handy,   we can also begin to see places where  public health needs to do better.

That’s where health equity comes in.  Because public health is only really   doing its life-improving job when it’s doing  that job for everyone. And when we understand   the stories and people that led to the public  health systems of today, we can see  who those stories left out–and why our systems need to do  a much better job of including them now. In the end, the things that make public  health work for everyone are going to be   the same things that have made every worthwhile  human endeavor successful.

Collaboration that fosters innovation. Empathy that’s reflected in our policies and in where we invest our resources.   Curiosity and the endless pursuit of “what  if”s that lead to discovery. But it also means   building systems that turn these awesome parts of  being human into real drivers for change.

Thanks for watching this episode  of Crash Course Public Health,   which was produced by Complexly in partnership  with the American Public Health Association. If you want to learn even more about Public  Health, head over to APHA’s YouTube channel   to watch “That’s Public Health” a series  created by APHA and Complexly. Crash Course was filmed in the Castle  Geraghty studio in Indianapolis, IN, and   made with the help of all these fun people.

If you'd like to help keep Crash Course free for  everyone forever please consider joining  our community of supporters on Patreon.