[Note that this blog is a work in progress, and that this and following posts are not final and set in stone. I may revise them later as I find out new facts or just think more deeply about the topic.]

Health – in our current life it has become almost a national obsession. Daily we are deluged with media reports about health, how to achieve or maintain it, what the latest research says about X, what to eat or not eat…. And yet there are more questions left unasked, let alone answered. Why, for example, do more people die of heart disease now than tuberculosis (which killed my aunt in 1920)? Why do people in northern climates get multiple sclerosis at a rate many times that of people in the tropics? Why is pellagra, once a scourge of the American South and parts of Europe – virtually unknown there today? Why is death by gun so much more common in the US? Why are people so panicked by Ebola virus in the Congo when other diseases such as measles and pneumonia kill many more people there? Our fates as individuals are bound up in the fate of the groups we belong to, and when and where we live. Just what does that mean in practical terms?

Perhaps we can turn some of these questions around, and ask them in reversed form, a form that gets overlooked in the clamor of why this or that pathology waxes or wanes. And so we can ask one of those “invisible” questions – what do people in a particular area need as a group to be healthy?

Let’s explore a few of these elements, which we’ll investigate in further detail in the next few posts on this blog.

The first obvious element that we need is air. We have to breathe, on average 15 times a minute. And that air needs to be reasonably pure, so that it doesn’t poison us along with giving us the oxygen we need. Air pollution is such a major topic that it will be handled in a separate post, a bit down the line, so on to the next element.

The second element, and one that we take for granted (unless we live in Flint, Michigan) is clean water. You just turn on the faucet and drinkable water comes out. But what if that isn’t the case? What if all the water you have to drink is polluted with microbes or chemicals or just plain dirt? Well, first of all, you’ll almost certainly get sick just from drinking the stuff. The number of diseases carried by contaminated water is staggering – legendary killers like cholera and typhoid down to the “runs” that plague tourists drinking water filled with unfamiliar bugs. And if the water is impure, how do you wash with it, or keep your dishes or your clothes clean? Hand washing with soap and water is one of the most effective disease prevention strategies known (as you no doubt heard last flu season). But what if the water itself is contaminated? And what if just wading in your local rice paddy or irrigation ditch can give you schistosomiasis or liver flukes?

And not only is clean water crucial for health, it’s also becoming more and more a scarce resource. The major use of water isn’t drinking – it’s agriculture, irrigating thirsty crops for food and profit. Industry uses another major share (and usually pollutes what it uses in the process). Competition for usable water is becoming a growing source of tension all over the world – even in the US, where the clash between California’s cities and agriculture over water from the Colorado River basis is becoming a major issue.

We can only survive a few days without water, but beyond that crucial need, the next most obvious is food. In contrast to clean water, which we take for granted, what we eat is a subject of endless fascination for Americans. What, how much, when, how to eat are endlessly discussed in the media and socially. For most of the world (and actually us, under the hype), there are four basic questions. Is the food enough? Does it have the necessary components? Is it safe? Can I be sure that I’ll have enough today, tomorrow, and in the future?

How much is enough? Speaking in simple terms of calories, the average adult needs around 2000 a day. People can survive on much less, but their immune systems don’t function well, and they are in danger of coming down with diseases that better-nourished people would fight off easily, and of course they have much less energy for work, school or any other task. The necessary components we all recognize as protein, carbohydrate, fats, and the various vitamins and minerals. A deficiency of any of these leads to specific diseases, especially the vitamins like vitamin C (scurvy) and pellagra (vitamin B3). Before the discovery of vitamins in the early 20th century, some of these seemed mysterious indeed. For instance, pellagra was thought to be a contagious disease.

Food safety is something that we are becoming more aware of. It almost seems that every month there’s a different recall for some food that’s been contaminated with E. Coli or Salmonella. But there are other dangers lurking in the refrigerator, for instance, poisoning by some metals. In the 1950’s people in Minamata, Japan, began developing strange and terrible neurological problems – paralysis, dementia and birth defects. Eventually the cause was traced to a chemical factory located on the same ocean bay as Minamata. Mercury from the plant was discharged in wastewater into the bay, where it was taken up by fish and shellfish that formed a major part of Minamatans’ diet. And you may have noticed advisories cautioning pregnant women about not eating too much fish, because it’s contaminated with mercury.

So we have three major elements here – the needs for breathable air, enough clean water, and enough of the right kind of food, all of which have been protected from various kinds of threats. But there are other things that determine how healthy we are, and our next post will take up a few of them.