Public Health Ecology: Challenges for Clinical Practice in Rural Bangladesh

To improve health in populations addressing the United Nations Sustainable Development (SD) target goal 3.4 of reducing premature mortality from noncommunicable diseases by one third by 2030, discussions have centered on accessibility and quality of care. However, the increasingly commercial missions and centralized organization of health systems are not well aligned with public health goals for universal access. Additionally, quality-of-care conversations are focused on efficacy, often of modest levels, to the exclusion of major attention to efficiency, patient-centeredness, and equity. The promises of synthetic biology and precision medicine ignore the cost challenges of opulation applications. In these broad contexts, there is an emerging paradigm for health that inflammation is a common biological pathway for multiple and interacting health conditions. This insight commands attention to the identification of the breadth of causes and stressors producing chronic inflammation and suggests that public health ecological activities may be significantly health-creating for populations. The ubiquitous causes of concern range from chemical, psychosocial, environmental, nutritional, and viral, to poor oral health. To illustrate the significant relevance of this long-overdue broader framework and new model for population health activities worldwide, this communication will consider, for one general rural Bangladeshi population, the depth of data implicating several factors in its health, and measures to decrease these adverse stressors. Public health ecological deep medicine offers a potentially impactful and contrasting approach to population health from current business-dominated models which focus on isolated medical conditions.