Ian Gust ~ Full interview

Professorial Fellow in the Department of Microbiology and Immunology at the University of Melbourne

1.  What are in your view the most urgent problems in the field of health?

Number one is controlling population growth. We have a plague of people on the planet. It is likely to take 20 to 30 years before we get into equilibrium. The number of people we have now causes enormous health problems because the growth is occurring most rapidly in countries that are least able to provide any reasonable level of health care.

Secondly the consequences of climate change which are a complicated group of issues. I think there are a whole range of consequences. In most places the major changes will be on the agricultural potential of land, either because there is too much rain or too little rain or erosion. And that has a tremendous impact on nutrition. People will be more susceptible to diseases and the death rate will increase. There will be changes in the distribution of diseases. Some insect-born diseases which are currently relatively uncommon will become more common in more populous areas where rainfall actually increases.

Third is implementing effective approaches and making optimal use of products that we already have, but which we have not utilised to their greatest effect. For example, there are many areas in which inappropriate diet or use of alcohol or smoking or lack of access to immunisation cause enormous health implications which are relatively easily addressed with simple technologies or approaches that are readily available, but have not yet been adequately implemented.

The fourth big challenge is reducing inequality for people around the globe. We have an enormous range of access of existing, successful means for prevention and treatment of diseases. This leads to inequalities in health outcomes. For example, in my own country the differences between health, infant mortality, life expectancy between aboriginal people and non-aboriginal people are as great as between any two populations on the planet.

2.  What solutions do you see for these problems?

Some of these problems are intractable, unless we are able to function better as a global community. At the very core I think most of the problems are political and economic. As we have seen so often in the last 100 years the countries that are desperately poor suffer enormously from ill-health. As economic conditions improve, so does the health of the population and the birth rate falls. Without any particular campaigns from the government, when the people find out they do not need 8 or 10 children in order to replace themselves or get cared for, they choose to have less children so that they can participate in the economy and have greater personal benefits. Trying to resolve some of the underlying political issues that enable a country to move forward economically is what is at the heart of improved health of the population. There is always a downside of great prosperity that leads to certain diseases. But in general these diseases are less devastating than diseases of poverty.

3.  And when you have to invest in medical solutions, what solution would that be?

The medical solutions hang of the political solution. They are very much the effect rather than the cause. I don’t think that our fantastic transforming medical advances will suddenly cure political and economic problems. For instance in the West we have had the benefits of immunisation for the last 50 years, but it is only in recent times where we have seen economic and political reform in a number of countries that enable these benefits to be realized. In developing countries donors are able to provide certain benefits, but unless this is accompanied by political will, adequate physical infrastructure and an adequate number of trained health care workers, these benefits cannot be sustained.

4.  Do you have specific solutions for the consequences of climate change?

First some problems will probably have to become worse before people in some very important countries take them seriously. In my country, where it is very dry, the changes are so dramatic that the population is willing to make major sacrifices. Some very polluting and rapidly industrializing countries do not react strongly enough, because the benefits of industrialization are so obvious and the downsides, by comparison, so distant. I fear things have to become worse to get the global commitment for major changes in living and for government expenditure. I think we are moving from a century of plenty to a century of scarcity of many materials that the developed world has taken for granted. Perhaps the most important way of instituting major change is for resources, like water, to be given a realistic economic price. This will change the behaviour of people.

5.  What in your view are the necessary conditions for successful solutions?

In democracies for the majority of the population the belief that they are essential for their own wellbeing. And in countries that are not democracies for the rulers to believe that it is in their best interest to implement these kinds of policies.

And in the US which is the worlds biggest user of energy and biggest polluter things have probably got to get worse before the population will recognize that something seriously has to be done. And probably in China and India things will have to get worse before people take it very seriously and make major adjustments.

6.  Do you think there are any biotechnological solutions for the problems we just discussed?

Technology will provide a component of the solution. And there are a lot of technologies or biotechnologies which will be very important in the future for providing for example alternative forms of energy and more efficient crops. But I think they are enabling rather than transforming. And we need transforming solutions for the politics and the economics.

7.  Can you give some examples of how biotechnology can do that?

Capture carbon dioxide from the atmosphere. Possible in creation of biofuels and so on. In the field of health the potential of biotechnology is almost unlimited in terms of producing new approaches of prevention or treatment of diseases and even for identification of personalised medicines as well. Those are all advances that we see happening and we can predict many more of the same.

8.  And do you think that biotechnology should be placed higher on the agenda?

I think biotechnology has an appropriate place on the agenda. I don’t see it as a magical solution. Biotechnology will be tremendously important in producing a whole range of approaches for the problems I have mentioned. But they do not need more attention or funding. There is Darwinian process going on that will select those approaches that are the most useful. They get funding from government, venture capital and industry. Some policies are able to direct the flows of this money so that they can go more into the energy or more into the health field.

9.  Do you think there are any solutions that will lead to public debate?

Yes. There is public concern about anything that involves organisms that are genetically modified and you see that particularly in Europe. There is a real fear, some is rational, some is irrational, about any process that involved genetic modification. There is rational fear about reducing diversity in the environment and about access to certain seeds been via a limited number of for profit companies. The irrational concerns are about the process of genetic modification which ignores the constant selective breeding that is done by nature.

10.  How should we deal with this debate

I think it is a matter of gaining people’s confidence by systematically introducing the technology and demonstrating its safety. Addressing the real concerns takes time. We can do this systematically and collaboratively around the world so we can learn from each others experience.

11.  And do you see any differences between developed and developing countries?

The are huge differences. Some developing countries will be able to rapidly make the transition from developing to emerging to developed as we are seeing in Brazil and India. But in a lot of other, smaller countries that do not have the resources, I think that unless the international community can assist them greatly, the gap will continue to get wider. We should keep doing what we are doing, but more effectively, learning from some of the mistakes that are made in the past.

12.  And what would the field of health look like in 20 years time?

In terms of the really big issues we will see that the global population is just at its peak or just declining and that will be a tremendously important milestone. I think we will see continued evidence of significant climate change so that the countries that are the most doubting will be convinced that major changes need to be made. I think that we will start to see scarcity of resources like water that we have taken for granted. And there will be a health effect from that. In the developed world we will see even though the government is spending a larger proportion of the GNP on health the outcomes will be minimal. Because fundamental changes to lifestyle will not have been tackled seriously. AIDS will stay a very big, international health problem especially effecting the poorest countries.

13.  Something to say that I have not asked

No. I think that the comments I have made are based on what we know at the moment and do not take into account any catastrophes or major changes that might occur in the coming future, like an epidemic of influenza. That could have devastating consequences that you just cannot predict at the moment.