Public health is a diverse concept. When we look at the overall ‘health’ of a society we must also look at what are the different causes of ‘premature’ death. Everybody eventually dies so it is not just why people die that is important but rather what brings on an early or preventable death. There are all the preventable diseases and ‘conditions’ that lead to early death. The list starts from the time of human conception through childbirth, childhood and onwards into adulthood. I have addressed many of these in previous articles.

What I want to talk of today are the ‘accidents’ that cause deaths in otherwise healthy people. Accidents can be divided into two broad categories, natural accidents and disasters and then those that are results of human error, and human acts of commission and omission. Of course the human toll in many natural disasters can be ameliorated with proper planning and timely intervention. The most frequent natural disaster we confront to some degree almost every year is the flooding in our rivers.

Once a natural disaster of any sort occurs, be it floods or earthquakes, it then also becomes a problem for the medical community to treat the victims and to prevent different forms of diseases that are often prevalent among people that are displaced and live in unhygienic and unsanitary conditions.

So it would seem that physicians have an important role in, at least, treating these victims of disasters. However, as physicians we have little if any capability when it comes to preventing natural disasters. That, of course, does not mean that physicians should not participate in planning for how disasters should be handled once they occur.

We now come to all other ‘accidents’ that kill more people in a day that can be attributed to other forms of ‘violence’ directed against ordinary people. These are of course motor vehicular accidents (MVAs) especially in the ‘private’ road transports. Some of these are obviously due to ‘human error’ and as such cannot be prevented. But many more are due to crimes of omission. Most of our public transports are poorly supervised, drivers are often not well-trained and the vehicles involved are not properly maintained.

An overloaded public transport bus with poor brakes, imbalanced wheels and worn out tires, driven by a badly trained driver forced to keep a schedule to get paid is a recipe for disaster. The second one and perhaps as frequent are physical and ‘gun violence’ directed by individuals against others. As far as either of these problems is concerned, physicians can only do what most other concerned citizens can do. However, there is one area where physicians do have an important role to play. That is planning, building, equipping and manning ‘trauma centres’.

It could be worthwhile to see where most MVAs occur and then determine district hospitals in the vicinity that can serve as trauma centres. The trauma centres do not have to be ‘state of the art’ but must be equipped with basic facilities as well as staffed by experienced physicians. This can, of course, cut down on the initial mortality of many of the victims of these accidents. Early access to adequate medical care after major injury is the single most important factor in saving lives.

Besides providing localised care there are other important benefits of regional trauma centres. In most of the world trauma victims that survive accidents but end up by being brain dead are one of the major source of ‘organ donation’. If some of these unfortunate victims can be kept ‘alive’ long enough they can become donors for liver, kidneys and the heart. At this point in time most of our kidney transplants are from related donors while liver transplants are virtually unheard of. Considering the diabetes and hepatitis epidemics sweeping the country at this time, the need for kidney donors and liver donors far exceeds the limited supply of these organs. And this need is expected to increase with time.

One of the most interesting public health ventures was initiated more than 30 years ago at the height of the ‘cold war’. Doctors from the United States and the former Union of Soviet Socialist Republics (USSR) started an organisation called the International Physicians for Prevention of Nuclear War (IPPNW). Over time IPPNW had affiliates in more than 60 countries. Besides providing information to policy makers and the public about the horrors of nuclear war, this organisation also kept open contacts between the US and the USSR.

The guiding principle of the IPPNW was that ‘doctors have to prevent what they cannot treat’. The IPPNW received the Nobel Prize for Peace in 1985. After the fall of the USSR, this organisation lost its major reason for existence. Here it seems to me that perhaps doctors in India and Pakistan need to embark on a similar venture. After all, a ‘nuclear’ exchange between India and Pakistan will be equally devastating for both the countries. If I remember correctly, a couple of decades ago, IPPNW affiliates in India and Pakistan were involved in this movement but unfortunately it went by the wayside.

If we take the idea that doctors must try and prevent what they cannot treat then that includes almost all the preventable causes of death especially in a poor country like Pakistan. Of course, as I have said above, in many things physicians cannot play a role beyond that of ‘concerned citizens’. But even so considering the fact that physicians are much more aware of the dangers of MVAs, gunshot wounds and many other public health problems including pollution, lack of clean drinking water, and other such problems, in my opinion physicians must take the lead in mobilising public opinion.

There is another issue that I have often addressed in the past and that is of medical ethics being taught in our medical colleges. There should be formal lectures on questions relating to ethics and this includes inculcating in our medical students a need for taking a lead when it comes to the sort of public health issues I have mentioned above. Unless we ‘seduce’ our young people into working for such goals, they will never consider it a priority in their medical careers.

I have always believed that it is perfectly acceptable for physicians to make a decent living and perhaps even a bit beyond it. But I also believe that these physicians, once they have done well in life, should also devote some time, money and energy to help the environment we live in. It is quite commendable that many successful physicians do indeed take care of some poor patients without charging them for medical services. But that is not enough.

That brings me to something I saw in the US. Many of my medical colleagues and friends in the business world believed that once they had made enough money to live on they should then devote some time to public service. More importantly, many young men and women take time off after college and before starting their professional education and work in projects like the ‘Peace Corps’. Sadly, something like that is unlikely in Pakistan.