A tribute to Mateusz Zatonski

Contribution presented at the 3rd Calisia Conference on Family Health, Kalisz, Poland, 18-20 June 2023
Mateusz Zatonski was one of the most talented public health researchers of his generation. As co-supervisor of his PhD, I was enormously privileged to know him and to learn from him.
In this short paper, based on a talk I gave when we commemorated his life, I offer some personal reflections on the state of public health today. This is a major challenge. So much has happened in the past few years. We have had a global pandemic that has killed millions of people prematurely. The impact of climate change is becoming ever more obvious, with worrying signs that we may soon be reaching a tipping point from which there is no going back. As the people of Poland are especially aware, we have a major war in Europe. Those of us outside Poland applaud this country’s support for the Ukrainian people in their struggle against the illegal Russian invasion of their country.
Three years ago, I was invited to join the Pan European Commission on Health and Sustainable Development, established by Hasn Kluge, the World Health Organisation’s Regional Director for Europe. This was an unusual group to talk about health. Most came from other areas, with three former presidents, two former prime ministers, and others from the financial sector, agriculture, and development banks, among others. I was privileged to chair its scientific advisory board and to write the evidence review that informed the work of the Commission [1].
Our task was to make recommendations that would ensure that Europe would be better prepared for the next crisis, given the many threats that existed. Our first task was to learn from the experience of the pandemic. This included the conditions that allowed SARS-CoV-2 to jump species and spread among humans. This took us into the area that we call OneHealth, the complex set of relationships that link humans, animals, and the natural environment, as well as the microorganisms that are constantly ready to exploit any opportunity that we give them. But, of course, the threats to public health go beyond infections. We devoted an entire chapter to the many risks that we face. Some, such as asteroid impacts, are existential threats to our species that are beyond our control. Seen from space, we are just one among many small and relatively insignificant rocks in a large and complex universe. But there are other existential threats that we can do something about. I have already mentioned climate change. Although most of my research, over almost four decades, has been in Europe, I also work in Africa. There, and especially in the Sahel, we are seeing a lethal combination of the expansion of deserts, extreme weather events, conflict driven by the quest to possess minerals, and rapid demographic change, together making life unliveable for many and driving migrations, with consequences that go far beyond that region.
But it is not just the direct threats to health. Our evidence review looked at the many factors that either strengthen or weaken the ability of our societies to respond to these threats. This takes us to the concept of resilience. And this demands that we look in depth at the wider political context. Here, I cannot help but note how the insights that Mateusz demonstrated in his work would have been so important to help us understand these issues. The one thing we learned from the experience of countries such as the United Kingdom and the USA is that you can have world-beating scientific capacity in universities and research institutes packed with expertise yet still fail to tackle a pandemic. Political leadership, or the lack of it, matters.
Another thing that we learnt was the importance of community. Governments did things during the pandemic that were previously unimaginable. They locked down entire countries, bringing economic activity almost to a halt. They closed schools and factories. And they paid people to stay at home. Yet, while these measures were clearly very effective in interrupting the transmission of this new virus, there were consequences. One of the things that we learned was the importance of strong social safety nets. In too many countries, those safety nets were full of holes that people fell through [2].
And, of course, we also learnt the importance of investing in public health. The global financial crisis of the late 2000s had been an opportunity to make deep cuts in our public health infrastructure [3]. Tragically, when we needed strong public health capacity, it was often lacking.
In some ways, making a diagnosis was easy. The countries that had done well in the pandemic were those that had invested in their infrastructure, in science, healthcare, and social welfare. They were also those that had informed and engaged political leaders [4]. But how do we get to this situation? That is much more difficult. And this is where we in the public health community need to recognise what we now call the political determinants of health. This is something that Mateusz understood. His experience of growing up in central Europe, and his detailed understanding of the history of that region gave him an exceptionally valuable perspective.
This was where we were so lucky to have people who had held senior political positions among our commissioners. They reminded us of the importance of being in, to borrow the words of the musical Hamilton, “the room where it happens”. Too often, we in the public health community simply talk to ourselves. We were extremely fortunate in having, as our chair, Mario Monti, a former Italian Prime Minister and European Commissioner. This meant that we could engage directly with the G20, the forum that brings together the world’s leading eco­nomies. And it meant that several of our proposals, such as those for a forum where health and finance ministers can talk together, would be taken forward.
They also reminded us of the need to frame our arguments in ways that appealed to those who might be sceptical. We in the health community, believe that health is a value in itself. However, we need to do more than that. We need to make the case for health as a driver of economic growth. And we also need to point to the evidence that those whose health is suffering because of policies that exclude them from the economic growth that is benefiting the few become fertile ground for populist and antidemocratic politicians. In these ways, better health is essential for societal well-being.
And we need to step back and look at the world in which we live and the creatures with which we share it. We cannot go on as we have in the past. We have one planet. There is nowhere else to go.
I am reaching the end of my career. The task of responding to these challenges is one for a new gene­ration. And the one thing that gives me hope is that there are so many amazing young people who are taking up this challenge, such as Ola, Mateusz’s wife, who has done so much to maintain his legacy. The tragedy for us all is that we have lost another who could have contributed so much. Mateusz’s death has robbed his friends and family of an inspirational individual. But it has also robbed our planet of someone who, while he already had achieved much, had so much more to give.

DISCLOSURE

The author reports no conflict of interest. References

References