I don’t know how many of you watch, or have even heard of, the show Torchwood – but it’s one of my favorites and I was finally able to catch up on the last season over the past few weeks. The premise – alien technology exists on this planet and there is a team of people out to save the world from it.1 The past few seasons have focused on season long story arcs and the one from this season was all about a public health crisis. The gist – one day, initially called Miracle Day, everyone in the world stops dying. While everyone stops dying, it doesn’t mean that all illnesses are cured or people stop aging – no, it simply removes death from the equation. The impacts on and questions that are (and can be) brought up about the health care system are fascinating (and sadly, at least for me, the show only spent about half an episode actually exploring the health system and the impact of this crisis.) How does a health system operate when every formerly deadly disease is now chronic? How does the system deal with patients who have no chance of recovery but yet won’t die? What happens to modern medicine when there are no more organ donors? How do different countries deal with the same major public health crisis?
The show focuses on the United States and The United Kingdom where the plan ends up being to classify all people into one of three health categories (A: healthy, B: ill but functioning, and C: non-functioning.) The line between categories B and C is quite blurry but yet quite important as people in category C are considered as good as dead and put in camps reminiscent of concentration camps. The worst of the category C cases then have their still living bodies burned in incinerators. For those in category B, an abundance of pharmaceuticals are used, including large amounts of pain medication, to prevent them from moving into category C.
Little to no mention is made of the impact of this crisis in developing nations but some of the readings from this week’s class really got me thinking about what different countries would be forced to do in this kind of crisis. Would developing nations with little access to the medication and resources needed to sustain those in category B be forced to split the population into only two categories and basically write off anyone who was ill at all? Would countries with high birth rates and low resources be forced to require pregnant women to have abortions as adding more people to the non-decreasing population would reduce the care that the current population was given? Given the framework in the paper by Murray and Frank2 and the discussion of cost effectiveness and equity in the paper by Mills, Rasheed and Tollman3 would we consider the health systems in those countries to be performing optimally in these cases?
Like all television, everything wraps up nicely in the season finale as order is returned to the universe and people start dying again. It is definitely interesting though, to think about how much healthcare and the systems built around it depend on people eventually dying and leaving the system and how much would need to change if death was taken off the table.
1. yes – there is a lot more to it including over 30 years’ worth of mythology from another show named Doctor Who, but I bore even myself talking about this sometimes.
2. Murray, Christopher and Julio Frenk. “A Framework for Assessing the Performance of Health Systems”. Bulletin of the World Health Organization. Vol 78, Issue 6. 2000. 717-729.
3. Mills, Annie, Rasheed Fawzia and Tollman, Stephen “Strengthening Health Systems.” Disease Control Priorities in Developing Countries. 87-100.