This area of assessment is one that needs further work and is currently a knowledge gap. It has been identified as an area of concern through consultation with partners in Public Health Wales.
Emerging threats to health and well-being which are of specific concern are:
developing resistance to antibiotics and other drugs and medicines.
the potential for the rapid spread of infectious diseases in an increasingly interdependent and interconnected world (pandemics).
the potential impact of climate change and extreme weather events on public health.
the impact of Covid-19 on emotional and mental health (restrictions, changed response and anxiety associated with infection, and loss of social support structure for individuals).
In 2016, The World Health Organisation stated that:
“Today’s highly mobile, interdependent and interconnected world provides myriad opportunities for the rapid spread of infectious diseases, and radio-nuclear and toxic threats … Infectious diseases are now spreading geographically much faster than at any time in history. It is estimated that 2.1 billion airline passengers travelled in 2006; an outbreak or epidemic in any one part of the world is only a few hours away from becoming an imminent threat somewhere else …”
Some of these diseases are prone to becoming epidemic or pandemic, and would pose a risk to future generations. In the response to infectious diseases, both old ones and new emerging ones, one crucial aspect is having effective anti-microbial treatments, such as antibiotics and anti-viral medicines. The Welsh Antimicrobial Resistance Delivery Plan (April 2016) states that: “Antimicrobial resistance (AMR) is one of the greatest health threats to humans and animals. The problem has been building over decades so that today many common and life-threatening infections are becoming difficult – or even impossible – to treat”
Although these threats are likely to originate elsewhere, the response to an epidemic or pandemic relies on rapid assessment and response to limit local spread. Multi agency emergency response systems are in place and regularly tested and updated by all organisations likely to be involved. However, in a serious epidemic or pandemic situation, all organisations should have plans in place for business continuity when many of their staff and service users are likely to be affected. A failure to develop and test plans could lead to a greater mortality and distress, and have a wide ranging impact on many other vital services on which people depend.
Clearly, in 2020, these predictions became a reality with the global Covid-19 pandemic. This did lead to a stop in global travel, and travel all together – for periods of time – in Wales. In its 2021 global risks report, the World Health Organisation raises the challenges posed by trends that have been exacerbated by our experience of Covid-19; inequality, fast-paced technological change, and “environmental degradation”.
“Most critically, if environmental considerations—the top long-term risks once again—are not confronted in the short term, environmental degradation will intersect with societal fragmentation to bring about dramatic consequences. If managed poorly, these disruptions will hamper the ability of policy-makers and other leaders to act on different areas of risk.”
In recent times, misinformation, or ‘fake news’, and social media have presented serious challenges to governments, businesses and people themselves. Examples include anti-vax campaigns, electoral tampering, ‘Covid is a hoax’ campaigns. Fake news is designed to undermine trust and confidence in democracy and public institutions. The World Health Organisation has started to refer to this as an ‘infodemic’, where there is “too much information including false or misleading information in digital and physical environments during a disease outbreak.” In relation to the Covid-19 pandemic, the WHO has developed guidelines to ensure successful ‘infodemic management’, which involves ensuring consistent and factual information is disseminated appropriately. We do not currently have evidence to fully understand to what extent misinformation is causing people anxiety, or affecting Covid-19 vaccine uptake for example (see our ‘technology‘ topic for further information).
Since the 1970s, newly emerging diseases have been identified at the unprecedented rate of one or more per year. There are now nearly 40 diseases that were unknown a generation ago.
As we are still living with the COvid-19 pandemic, we can already see how behaviour and support structures and how those enable freedom of travel, participation in activities, and physical closeness has changed.
Pre-pandemic mask wearing, keeping 2m distance and washing/gelling hands was not the norm; infections were transmitted easily and freely. Basic handwashing was not common practice causing infections to spread.
The World Health Organisation has worked with many experts to identify potential shocks that are less well known but would have huge impacts if manifested. These are:
An inter-state skirmish escalates to war as governments fail to control action in the absence of accurate information. Weakened multilateralism leads to failure to contain.
Young activists, fed up with corruption, inequality and suffering, mobilize against elites. AI-powered social media is exploited to spread disinformation, fomenting social chaos.
Brain-machine interface exploited
Companies, governments or individuals utilize burgeoning “mind-reading” technology to extract data from individuals for commercial or repressive purposes.
Collapse of an established democracy
A democracy turns authoritarian through the progressive hollowing out of the body of law. A legal rather than a violent coup erodes the system, with knock-on effects on other democratic systems.
A rapid reversal of the Earth’s geomagnetic poles generates destabilizing consequences for the biosphere and human activity.
Gene editing for human enhancement
Governments begin classified genetic engineering programmes. A class of people is born with genetic capabilities better suited for space, Arctic, or deep-sea survival, setting off a genetic arms race between geopolitical rivals with undetermined ethical consequences.
Malicious use of pharmaceutical neurochemicals aims to control adversaries. Governments begin to use these drugs for non-lethal law enforcement.
Permafrost melt releases ancient microorganisms
A warming planet leads to permafrost melt in the Arctic. An ancient virus, unknown in modern science, is released into the air, soil, and water systems.
Deployment of small-scale nuclear weapons
New technology allows for proliferation of low-yield warheads, blurring deterrence frameworks and leading to global nuclear war.
As a result of Covid-19, it is likely that the medical system has gone digital with remote technology for good. A teleconference medical appointment will be the norm. People will continue with rapid Covid-19 tests beyond 2021 to feel safe. Vaccination coverage globally will increase but we will encounter big challenges along the way. Big hospitals will rethink their operation because of the economic crises they have suffered because of Covid-19. Also, it is possible that people will get sick less from viruses, bacteria and food-borne illnesses due to recurring cleanliness of the average individual.
The impact of the behavioural changes and restrictions will have impacted on individual’s coping skills and anxiety about infection and hygiene. CAMHS services have seen an increase in acuity of distress and risk taking associated with the loss of the social support structures, eg school, youth clubs, social workers, extended family and friends.
New parents experienced restrictions in attending for appointments, delivery and admissions to wards and the neonatal unit which will have impacted on bonding and that early start in life for social language and relationship building. New parents also had restricted contact with their midwives and health visitors, this coupled with the loss of a social support structure will have impacted on emotional health of parents. Babies and young children have had a very different experience of play and social interaction which may impact on development.
As a result of Covid-19, we have learnt a great deal about the demand and capacity shortfall in our hospitals and wider health and care services. There is a clear need to have sustainable services that can respond to increases in demand for care and referrals into the health and care system. This must be done in a way that supports people to access the right level of services, which may be different from those that have been offered traditionally in the past. We have learnt that we can do things differently and we must build on the innovation and change that has benefitted us during the pandemic.
There is also wider learning associated with the changes that responses to Covid-19 brought about. For example, changes in support for homeless people, a pivot to online working etc.
Currently no content. There are surveys that have been undertaken with young people through the children’s commissioner and mental health voluntary sector organisations that need to be considered here.
More work is required to understand the impact of the long term impact of the Covid-19 pandemic. This should be explored as part of adverse childhood experiences research (see our ‘Giving every child a best start‘ topic for further information).
The role and influence of misinformation (fake news) and its impact on our ability to fulfil our wider public health and civic objectives, is not yet clear.
Clearly, our experience of health care and use of health services over the period, during the Covid-19 pandemic – has changed dramatically. We had seen a growth in online health consultations, more so in North West Wales, prior to the social distancing measures imposed during the Covid-19 pandemic. These increased exponentially during the lockdowns, and still continue to be in place for many health services, particularly in primary care. However, there is a growing concern and wish for face to face consultations. We are not sure currently how we can balance opportunities posed by online services, which can remove travel barriers for instance and produce cost savings for services, with the challenges around the quality of the service from the user’s perspective. How big an issue is this?
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