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The Most Important Challenges to the Public’s Health in The 21st Century.
Poverty is the most important challenge to the public’s health in the 21st Century, especially in the developing world. Poverty forces people to make poor choices, such as live in places that harm their health, without decent shelter, clean water or adequate sanitation. It creates hunger, which leaves people vulnerable to disease. It also denies people quality healthcare and much needed medicines. The poor often have no access to health insurance and mostly bear the brunt of out-of-pocket payments. The illness of a breadwinner can spell doom for an entire family: a sick person who relies on daily income cannot work, thus creating a spiral of even more vicious deprivation. Poverty is also responsible for much of the world’s illiteracy, which makes people less informed about health risks and harmful behavior. It is important to remember that the World Health Organization (WHO) defines health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.”
Another important challenge to public health is non-communicable diseases (NCDs) which include cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Often ignored because they are less dramatic than their infectious counterparts, NCDs account for a large proportion of the world’s morbidity and mortality. According to the World Health Organization (WHO), NCDs kill 40 million people yearly, that is 70% of all deaths globally. Fifteen million of those deaths are of people aged between 30 and 69 years, and over 80% of those deaths occur in low and middle income countries. Yet most deaths caused by NCDs are preventable. The WHO estimates that cardiovascular diseases account for most NCD deaths (17.7 million people annually), followed by cancer (8.8 million), respiratory diseases (3.9 million), and diabetes (1.6 million). These four groups of diseases are responsible for over 80% of all premature NCD deaths. Because they tend to be of long duration, NCDs (also known as chronic diseases) exert considerable strain on the global economy.
Substance abuse is yet another major threat to global health in the 21st Century. It inflicts considerable harm on public health and safety, and also threatens the peaceful functioning of societies. Substance abuse is not limited to illicit use of illegal psychoactive substances like cocaine, marijuana or heroine; but also involves regular substances like alcohol, and drugs prescribed for legitimate medical uses. However, it is instructive to note that widely and easily accessible substances like tobacco and alcohol cause more deaths through sickness and accidents than all illicit drugs combined. Many abused substances may induce temporary feelings of euphoria or elation, but they also tend to impair judgement and lead to people making choices they would ordinarily reject, such as engaging in risky sex. Substance abuse has also been linked to violent behavior.
An estimated 10.3% of adults in the United States develop substance use disorders of an illicit drug at some point in their lives, with about 7.7% developing a drug abuse disorder and 2.5% developing a drug dependence disorder (Compton et al., 2005). In Nigeria, people have been known to sniff pit latrines when their preferred substance of abuse is unavailable. Crime committed under the influence of drugs is also a major problem worldwide. Addiction or dependence can have very telling effects on individuals and usually also have fallout on family members. As abusive drug use continues, problems mount. Users devote considerable resources to drugs. Many have been known to sell family heirlooms and jewelry for a fraction of their value after depleting family finances. The cost to society comes in form of reduced productivity; increased morbidity; cost of prevention, treatment and rehabilitation; drug-related driving accidents; cost of incarceration; and premature mortality.
As a future public health professional, my role in solving these identified challenges consists in influencing evidence-based policy formulation and implementation; as well as influencing behavioral change on a large scale. Prevention is not only better than cure, it is cheaper. I will seek to increase awareness on prevention strategies that address the major NCDs and their risk factors. I will encourage cross-sectoral collaboration in tackling poverty and disease. Thankfully, the Sustainable Development Goals (SDGs) contains targets, strategies and indicators that address these issues. Governments around the world have committed to eradicating extreme poverty and hunger, reducing inequalities, providing clean water and sanitation, as well as promoting good health and wellbeing. I will work to ensure governments meet these commitments.

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