Population health issues relevant to neuroscience in Nepal

Bezruchka, S. (2004). Population health issues relevant to neuroscience in
Nepal. J Neuroscience 1(1): 4-9.
http://www.neuroscienceforum.org.np/

Neuroscience provides understanding of the mechanisms through which the
determinants of population health act. After basic needs are met, a
population with a smaller hierarchy will have better health than one with
a bigger gap. Neuroendocrine aspects of the hypophyseal-pituitary-adrenal
axis in which the hippocampus plays a key inhibitory feedback role are the
mechanisms at work. In Nepal, basic needs, such as food and clean water
are lacking for a substantial portion of the population. Remedying this is
the first priority of the population health doctor. Thereafter, decreasing
the hierarchy is necessary for Nepal to achieve good health.
Neuroscientists can play a critical role by not promoting extensive
clinical interventions, but using their understanding of the mechanisms of
action of population determinants to advocate for social justice.

Key Words: Hierarchy, Hippocampus, Kerala, Population health, Social
justice, Sri Lanka, Structural adjustment

Neuroscience is intimately connected with issues of the health of
populations, whether specific to Nepal or more broadly throughout the
world. In fact, discoveries in neuroscience over the last several decades
have shown that this biomedical subject helps explain the mechanisms
through which the determinants of health of populations act. It has been
observed for several millennia and more often during the last several
centuries and especially for the last several decades, that poor people
have poor health. The ancient Greek and Roman civilizations understood
this and also gave us some of the earliest documented population health
statistics. The Roman data showed life expectancies for Rome around 21-22
years, except for the slaves for whom it was around 17 years. In fact, for
much of civilized life, the average length of life ranged from a high of
about 35 years to a low around of 20. In the Paleolithic, before the
advent of tools, when we lived a forager-hunter lifestyle, and hadn't
domesticated plants and animals, life expectancies have been estimated to
be in the 30 to 50 year range. What is evident, then, is that with the
progress of the development of agriculture, human health declined. This
counter-intuitive finding is not disputed by any scientist who has studied
this aspect of human demographic history. 9, 18

Over the last century, health of some populations has improved and
surpassed that of peoples of the Stone Age, the Paleolithic. However, a
large proportion of humans on the planet still have health statistics
little different from the average over much of human history. In other
words, many Sub-Saharan countries of Africa, such as Sierra Leone, Zambia,
Zim use would emphasize teaching lowtech clinical examinations, extolling
the value of extensive discussions with friends and family of patients
about how to care for them, and fostering minimal use of various
pharmaceutical nostrums. My personal clinical motto is "Don't just do
something, stand there." Meaning that I avoid clinical interventions just
for the sake of doing something -- the old adage of "don't just stand
there, do something," unless they have significant benefit and are not
extravagant.

Another way is to model good primary care of neurological conditions
themselves, not just in teaching others, but in everyday practice.22, 23
That way, you can tell your students that they can treat a patient just as
well as you can or perhaps even better.

Another way is to support the development of primary care facilities
staffed by local mid-level practitioners throughout the country.

But all these methods will have limited effect on improving health in
Nepal. What might really make a difference is to understand the importance
of neuroscience physiologic and pathophysiologic mechanisms, which impact
the determinants of health of populations that depend on the gap or range
of hierarchy. Since neuroscientists are the ones who stand a better chance
to look at how chronic stress in populations affects health, they can
teach this to others, both clinical people and the ordinary public. These
ideas can get into public and private school curricula. I have been doing
this in grades 7 through 10 in Seattle public schools and find great
student interest. You can write articles for the mainstream press, have
discussions on various radio and TV venues. The strength of your expertise
will convey the ideas powerfully to ordinary people** . (** Population
Health Forum's website:  http://depts.wwashington.edu/eqhlth)

So the role of neurosciences in Nepal in producing health must be an
activist position. You should enter the political arena to structure
policies that decrease the gap as a population health doctor. You should
recognize your tendency would be to advocate for increasing the economic
gap through promoting the desire for using expensive technology,
procedures and pharmaceuticals that are of little value for improving
population health. Neuroscientists in Nepal could be world leaders in this
aspect of population health. It would not be out of line for a country
within which sits Sagarmatha (Mount Everest), the churning stick of the
ocean of existence.

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Stephen Bezruchka, MD, MPH Department of Health Services School of Public
Health and Community Medicine University of Washington Box 357660 Seattle,
 Washington 98195-3576 USA Email: [log in to unmask]

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