A Triage Approach To Humanity

And Why Mental Health Matters

What happens when we look at all the threats to humanity collectively, and rank them according to their severity? The recent Covid-19 pandemic revealed our vulnerability, and it also displayed how disorganized we —a bureaucratic, capitalistic society — are to collective challenges.

The collective-body

Let’s, for a moment, entertain the idea that humanity is represented in a single human body. Lets also say this “collective-body” is sick, really sick — with lots of diseases, open wounds, and a bad migraine. Additionally, some latent, and not so latent mental health issues.

To make it personal, let’s say this sick person is you, for hypothetical purposes. And now, you, with your full range of maladies, are administered to the hospital. What approach do you wish the doctors to take? Which injuries and illnesses should they treat first? And what is the long-term rehabilitation plan?

Triage

/ˈtriːɑːʒ/ noun

1. (in medical use) the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment.
2. Origin: From the French trier, meaning to separate, or break into three.

Yes, Triage. It’s such a cool word it’s hard to believe it exists. It is used when there are mass casualties and doctors need to know which injuries require immediate attention (Orange)— constricted airways and massive blood loss, intermediate attention (Yellow)—open wounds and broken bones, and “we’ll get to you at the end” (Green)— bruises and scratches.

There is one more category (Red), when a patient is so badly wounded, they are unlikely to survive even if treated. Therefor, doctors skip over them to treat the next in line — those with a more probable survival rate. Let’s hope humanity is not in this group.

Where to start?

So, what are your injuries (threats to humanity), and what is their associated risk (probability for most amount of casualties)?

We can break the threats into two categories: direct (the actual cause of death) and indirect (stressors that magnify direct causes). For example, heart disease (direct) is the leading cause of death in humanity per year, and it is magnified by poor diet, inactive lifestyle, aging, stress, and loneliness (indirect).

Direct threats (as stated by WHO)

OK, so below are some interesting numbers — the causes of death to humans per year (figure 1). Before looking, what is your guess at the top five?

One feature of this list is that it is broken into three main categories — Communicable, non-communicable, and injuries (this category includes war-deaths).

All these direct threats have allocated funding at multiple levels. There is a war on cancer, a war on AIDS, and a heart specialist for every neighbourhood. There are lots of dollars for each disease — because they are tangible, actionable, and profitable.

Take your time to go through the numbers. One day, you will be on this list, but where?

Figure 1: Causes of death annually to human beings (2017). *Note: Cardiovascular disease in front at 31.5% of all deaths (17 million per year). Number two on the list — Neoplasms — short for cancer (specifically tumours). Also note, violence and self harm at 2.32% (this includes war). One important note: most deaths are non-communicable.

COVID-19

Another thing to note is where COVID-19 stacks-up in the above table (which is from 2017). COVID-19 is a communicable disease and we should keep in mind two things: 1) Most people who died from COVID-19 had “underlying conditions”; and 2) the average age of those who died from COVID-19 is above 75. This number becomes important when we begin to factor in some of the indirect causes of death below — like the effects of aging itself, as well as the compounding effects air pollution, climate, the environment, and yes, mental health.

Indirect Threats

How are we doing with our triage-approach towards humanity’s illnesses? We just spend money and resources in proportion to the percentage of deaths for each cause. Right? But what if there are other factors? And what about mitigation. We don’t want to continue merely treating these causes, we want to prevent them — to get the roots. So, what causes the causes?

1. Malnutrition. “70% of childhood deaths (age 0–4) are reportedly due to diarrheal illness, acute respiratory infection, malaria and immunizable disease. However 56% of these childhood deaths can be attributed to the effects of malnutrition as an underlying cause”
2. Obesity. If you are obese, you are more likely to have: just about every non-communicable cause of death on the list. Also you are much more likely to have severe mental health issues.
3. Air pollution. According to the WHO, there are 7 million (8% of total) deaths per year due to air pollution.
4. Temperature and climate. Around 5 million deaths per year due to extreme temperatures (mostly heat waves).
5. Aging.
6. Mental health.
7. Environmental degradation

The last three, we don’t have numbers for, so we’ll have to do a bit of speculation. For example, cardiovascular disease and cancer become the leading causes of death for people over 50 years old. And “unintentional injury, suicide, and homicide” are number 1,2, and 3 for humans between 15 and 34 years of age. So as we age, the most likely causes for death change.

To add more into this spiderweb. A lot has to do with where you are born— are you “developed or developing?” In developing countries, HIV and AIDS are the number one cause of death… And what if your a persecuted minority? Or of a certain caste? Man or women? born with a disability?

Yes, It’s hard to do a risk assessment for each cause, and carve up all the threats-to-humanity in nice-little-percentages. But, I promise you, we are getting somewhere with all this.

Mental health

This is the elephant in the room and the crux of our future. Our physical health, mortality-probability, and wellbeing is effected by our mental health. Many of the above sicknesses, are accompanied by, and the predecessor of: stress. Namely anxiety, depression, regret, guilt, anger, jealousy, etc. These emotions are associated with hormone imbalances, which lead to issues with sleep, diet, and maintaining healthy relationships. These effects can be subtle or severe, and are cumulative over time — trauma compounds itself.

How can we quantify the impact of poor or positive mental health on humanity? And, what can we do to improve the mental health of humanity? This is the question of our time.

Note: the one place where we directly see poor mental health as a cause of death is “suicides and interpersonal violence” (2.3% of all deaths each year — about 1.3 million humans).

The environment and ecosystem services

What creates stress in your day-to-day life? When walking through an urban area filled with loud noises, fast cars, pollution, and few trees, how do you feel? Relaxed and at ease?

Humans are less stressed and have a better immune systems when surrounded by nature.

Additionally, healthy ecosystems: 1) sink carbon; 2) prevent erosion; 3) regulate floods; 4) pollinate crops (this is a biggie); and 5) supply us with a bounty of goods.

Often the destruction of ecosystems is considered an externality in the eyes of capitalism and development. Basically, no one pays for the habitat replaced by skyscrapers. And everyone pays for how that lack of nature effects our health. What if we valued nature as a healthcare provider?

Full circle

Why don’t we view indirect threats to humanity as though they are a healthcare issue? Why don’t we mobilize with the same urgency as we do against cancer and COVID-19? Why is Climate Change, our “mental health pandemic”, obesity, malnutrition, environmental degradation, and air pollution such a slow-motion solution?

The answer: It’s not profitable or powerful to fix them. That’s it. We live in a capitalist society; what did you expect? Sorry.

Humanity responded to COVID-19 with a lot of resources: numerous lockdowns, an unparalleled vaccine program, and international cooperation. COVID-19 posed a direct and tangible threat. It was something we could go to war against, to profit on, and create control from. It was also relatively short-term, something where results happen in years, not decades.

When we went into lockdown, global emissions fell rapidly. But it wasn’t Climate Change we were after. But what if it was? Could we not do fossil-fuel-lockdowns!? What if we treated Climate Change, mental health, obesity, and malnutrition with that same ferocity and top-down control that we did with COVID-19? Is the risk not even greater?

What if we treated Climate Change like it was cancer, inside your own body. What would you do? Wait for another IPCC report?

Triage

Triage, ranks the severity of each malady, and deals with them according to practicality and priority. Lets do that — come up with a metric, and run the models for the big indirect threats to humanity. Then, we act as though we really care.

Or perhaps, we just let things run their course. Everyone works on their own individual-process as well as the collective one, as best they can. Maybe we stop trying to fix-the-earth, and realize humans are an evolving species — with a future hard to predict and judge.

Populations in the wild often go through major up-downs (just like previous human civilizations). So, maybe we ride the up-down, best we can.

Big love,

D