One world. One civilization

This the December, 1999 issue of Cardiovascular Research brings closure to the Cardiovascular Conundra Series. The thoughtful contributions of scientists who contributed minireviews on topics of the day are gratefully acknowledged. It has been a privilege to serve as Series Editor.

In this the Series finale, editor Michiel Janse has granted me the opportunity to share personal reflections for the coming millennium. Opinions expressed herein are not necessarily those of the editor, his editorial team or those of the publisher.

Closure of this millennium naturally draws one to revisit achievements in biomedical science and to look to the future, hopefully with wise vision – wisdom gained. We have witnessed a deciphering of structural and chemical bases of disease. Recent decades have seen this body of knowledge enriched with technologies of molecular and cellular biology that will bring the genetic basis of disease into closer perspective. The 20th century spawned the evolution of disciplines within the basic sciences. In medicine it gave birth to an age of specialization that served to enrich cognitive assessment and accommodate technologically driven diagnosis and management of organ-based diseases. Such specialization created identity and proved useful for political agendas and postdoctoral training. However distinctions between disciplines, oftentimes artificial, promoted chauvinism at the expense of interdisciplinary communication. The time is at hand for a culture of cooperation – to seek common ground in our understanding of disease pathophysiology and pathogenesis.

An even broader perspective and common purpose is possible – to address international health. The world's population reached 1 billion in 1804; 100 years later it was 2 billion. Current estimates suggest it will exceed 6 billion in 2004 and 8 billion in 2025. Our world's population will live longer in the 21st century. Global life expectancy, currently 66 years, will continue to increase to age 73 in 2025. In all countries, it will exceed 50 years. The improvement in world health is due to many factors: economic development; water management, including sanitation facilities; improved health services, such as control of infectious diseases in children, immunizations; and more effective therapies, particularly the management of cardiovascular diseases and such complications as myocardial infarction.

With more older people the world over, disease patterns are likely to change. Diseases affecting the heart and vasculature and those featuring neoplastic cell growth will become more prevalent worldwide and more common in countries where infectious diseases were once dominant and determined life expectancy.

As people continue to live longer, will they live healthier? We should not simply presume this the case. We should ensure it is so. As scientists and clinicians and in our role as members of various professional organizations, we must broaden our perspective. We must continue to advance biomedical science while promoting global health. In so doing we foster international cooperation and education. We should subscribe to global citizenship shedding the mantle of colonialism and its mandate of exclusivity. In fostering goodwill, peace and understanding between peoples of the world, we position ourselves as dedicated to the progress of mankind. As an asset to humanity and in the spirit of altruism, we would not expect to receive, but to give.

By transcending divergencies of opinions, interests inherent to political convictions and religious beliefs, racial prejudice, social elitism and conflict, we overcome activities destructive to the common good. We must seek the high road – the welfare of society – through research, shared knowledge and assistance of one another while mindful of differences in culture, religion, political and social structure. We should work toward a common effort to meet common problems of health and well being. We should build relationships that recognize and promote social value of collaboration in a spirit of international understanding.

What could each of us do to promote world health? We might consider: contributing to the implementation of programs that focus on world health through prevention and treatment; integrating discoveries between bench and bedside thereby contributing to the progress and development of one global society; creating bridge-building strategies between basic, clinical and population-based sciences for the purpose of world health promotion and education; and developing collaborations with industry and governments that advance global health. Let us dare to dream more than others think practical; care more than others think wise. Choices might involve a well-worn road, but doing it better than others thought possible. Alternatively, a less well traveled path, risking more than others considered safe. In either case, success brings a better world to live in.

And as we celebrate the new millennium, let us raise our glasses – to the world, one civilization.