Old map of the Malabar coastline.
When black gold arrived in the ports of Arabia demonstrating powerful medicinal cleansing of phlegm from the body, the Malabar coast became the center of healthcare. Compatriots of Mohammed met the Chera king in 642 CE, who had become enamored with the peace of the people of Mecca, bonding relationships through marriage and religious conversion to ensure access. These black kernels, known today as black peppercorns, earned space as a required component of diets worldwide.
Over the next thousand years, waves of conquerors visited the shores of the Chera kingdom on the Eastern Ocean, now known as the Indian Ocean, attempting dominion over lands from which they could secure good health, and the power and wealth that are only then possible. Traded for twice its weight in metallic gold due to its healing, culinary and chemical properties, black pepper fueled wars between Europeans and Malabar and Travancore warriors, as desperation for healing substances swept over regions of the world devastated by pestilence, pox, and plague. The wisest traders from the Western (Mediterranean) Sea and the Eastern (China) Sea quietly secured trading rights, respectfully also learning traditional medical wisdom to ensure a steady supply of black pepper, as much a necessity as a luxury. It was the beginning of international cooperation on health, the trade of medicines and the know-how of providing healthcare successfully to one’s own people.
Emissaries of health have dotted history, bringing cures and wisdom for the treatment of disease across unknown lands, transcending boundaries to discuss the ways and means of helping secure the greatest asset of any nation - the health of its people.
Recently, the nations of Africa were declared officially free of wild polio, heralding a great feat of cooperation in the elimination of disease. Through abundant supply of vaccine shared globally through support of the WHO, the challenges of required cold chain were met to keep the weakened virus alive in a vial traveling through deep sweltering heat. Coordination and communication allowed global and local workers to rid rural and urban bastions of contagion. Never mind that hard data quietly reveal that we are not tracking all polio cases, especially those caused by the vaccine, known as VDPV, vaccine-derived polio virus. Clearly, this investment in polio eradication must today help attain the goal of confidence in the current structure of global cooperation on healthcare. We all want to believe so that we do not have to overhaul the foundations of the current global healthcare system.
Suddenly however, the coronavirus crisis has demanded vastly altered requirements for cooperation, as no concerted vaccine, accurate testing kit or algorithm of pharmaceutical treatment has been able to treat Covid-19 cases or contagion. Modern scientists will readily admit they cannot connect the dots from molecule to clinical efficacy. They might witness healers around the world treat incurable diseases. Yet they desperately deny them legitimacy for joining the platform of global cooperation of healthcare because it discomforts understanding of mainstream science. Indeed, what do we do with the hard clinical data that are true, that have no scientific explanation?
This medical authority, symbolized by groups like the WHO, FDA, NIH, CDC, and Ministries of Health around the world, tries to persuade the world that sophisticated solutions using knowledge patched from different disciplines of biomedical science for clinical testing is a demonstration of cooperation. They want us to swallow the pill that convinces that illness is just a deficiency of the favorite pharmaceutical of the current crusade. In fact, the only global cooperation on healthcare today is non-transparent agreements between profitmakers using other stakeholders of health - all of us - as pawns. To gain momentum, they raise their hands in frustration over the global crises in healthcare and ask for more funding to help achieve great results, clinging to the successes of molecules in drugs and vaccines.
The sharp border between the striped waves of capitalism and the starred fields of socialism is a quiet barb-wired ravine known as corporate profit, expanding in the past century into the grand avenue named healthcare. It plays on the reality of our survival-of-the-fittest mentality which inspires competition, and validates creativity and ingenuity, but capitalist healthcare also crowds out the weak, meek and unable. Socialist values ask us to have compassion and responsibility for the less able. The reality of our fragile states as humans with our transient states in robust health during life reminds us that even the most invincible Superman may tumble in a blink of time into a piteous invalid.
The elusive goal of global cooperation toward healthcare for all, claimed as the spirit of the mission of the WHO, requires three shifts: clear prioritization of health over profit through transformed key economic decisions and parameters supporting health outcomes that measure wellness; health freedom and choice for all peoples — even those who define healing differently than the medical dynasty; and enforcement of health as a human right that is accountable and supported by actions of justice.
Currently, national and international policies advocate for companies making huge profits supplying products and services that treat disease. Price caps need to be disruptively set for pharmaceutical medicines, which use public resources of water, land, and chemical raw materials of our earth, and which can not belong to private corporations. Proprietary knowledge of medicine-making needs to be altered. Key economic decisions need to eliminate higher-than-production-cost prices and private-public partnerships that pretend to educate the public about health while using public resources to pocket private funds using inflated pricing. Because corporate inner board rooms of public companies are legally required to take decisions that prioritize profit and market share, we must curtail their play on the healthcare market, remembering they will transcend any directive to take health of the public as their onus. Ethics aside, that onus belongs to governing bodies assigned health as their charge.
The supply-demand curve must be reduced from disease measures toward health. The curve of competition and reward for ingenuity must admonish maximizing profits from illness toward competition for rewards and profits for the best techniques for restoring long-term health, especially as WHO predicts that 22% of living people in 2050 will be over 60. Pushing the already-growing wellness industry into the forefront, entrepreneurs might be encouraged to enterprise products and services that reward people successfully maintaining their own and their community’s health.
The general public must be drawn toward health promotion and health maintenance, two of the stated WHO goals. Currently health programs reflect a World Disease Organization. Policy shifts must require the International Classification of Diseases (ICD) to include paradigms that emphasize returning people successfully toward health.
With less incentives and financial rewards for keeping patients ill, those requiring disease-care can be the beneficiaries of national health systems which do not commodify humans to maximize their own growth but rather provide essential services. Suppliers and decision-makers profiting from extravagant disease interventions and others’ illnesses will be curbed.
The shift toward global cooperation also requires attention to the growing population in both developed and undeveloped countries who reject pharmaceutical medicines riddled with side effects, ridiculous prices, and associated medical errors. They await health leaders who embrace deeper constructs of total well-being such as the Sustainable Development Goals (SDG). Even in the best studies, lack of adherence to global disease initiatives persists among a steady portion of participants. Usually blamed on ignorance and non-literacy, the echo of non-acceptance is often attributed to tribal beliefs, religious bias, or inability to accept science. Global initiatives will fail as long as they deny human rights to choice by those who define healing differently than the medical hegemony.
The global health freedom movement is demonstrated by legal stands such as the presence of TCM (traditional chinese medicine) in Chinese hospitals. In the USA, 12 “health freedom states” legally allow the public to choose non-licensed practitioners of healing modalities provided the healer does not claim to be a pharmaceutic physician. In Canada, practitioners of naturopathy and TCM are registered as Doctors of Natural Medicine. South American nations use traditional herbals as a mainstay of their cultures alongside PAHO, in whose echo WHO was made for the northern hemisphere. Most African nations have programs in traditional medicines too, and repay post-colonial debts created by imperialists by allowing WHO, missionaries, and NGOs to work among their healers. In India, the Ministry of AYUSH is now separate from the misnamed Ministry of “Health” & Family Welfare devoted to pharmaceutical initiatives and provides legal protection from the medical dominion by embracing the people’s right to practice ancient wisdom as it continues to sprinkle black pepper around the world.
Health freedom allows other medical systems to co-exist while people choose whether to participate in a global movement ostensibly developing a common language on health. These people reject measuring well-being in dollars. Whichever language we choose, health must be enforced as a human right, to be practiced by individuals as an essential element of freedom, and supported by robust legal pillars that acknowledge our right to choose our own paths to health.
Most traditional medical systems are relentlessly unified by a deep connection with ecosystems. Alongside them, Ayurveda points to ancient science seamlessly connecting philosophy and practice, bridging concepts of health and well-being, botany and agriculture, nutrition and culinary science, architecture and vaastu, with medicine. Ayurveda whispers that when our ecosystems are imbalanced by chronically disrespecting Nature, then contagious illnesses erupt to put things back into balance. The keys to achieving rebalance are cleaning the ecosystem, focusing on the land, the water, the air, and awareness of time, which for humans is counted by trees, as trees are one of the only living beings around us that live longer than we do.
For global cooperation in healthcare today however, we do not only need a quiet whisper from docile nature-loving pacifists. We need jagged disruption of the misunderstood and co-opted term “health,” prying it away from the current paternalistic form of disease+management, misnamed health+care. We need to shift to true science that is patient-centered, not profit-based. We need initiatives that reward people for healthy behavior. We need health maintenance to promote person-centered choices, support health literacy using parameters of wellness. We need patients to learn responsible self-care and accountability for their own well-being. In the meantime, black pepper continues to be the most popular spice sold today, used both knowingly and unknowingly for its medicinal effects globally.
(Bhaswati Bhattacharya is a Fulbright Specialist in Public Health and Clinical Assistant Professor of Family Medicine at Weill Cornell Medical College. She studied at the Kennedy School of Government at Harvard during her MPH studies.)