Public health challenges are global now

Thursday July 24, 2014

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Public health challenges are no longer just local, national or regional. They are global. They are no longer just within the domain of public health specialists. They are among the key challenges to our societies. They are political and cross-sectoral. They are intimately linked to environment and development. They are key to national, regional and global security. This was reflected when World Health Organisation (WHO) recommended that travel restrictions be placed onPakistan, Cameroon and Syria for being the only three countries that are currently exporting wild poliovirus.

According to WHO, 60% of polio cases were the result of the international spread of wild poliovirus and that there was increasing evidence that adult travelers had contributed to this spread. Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Nigeria were named as countries that are infected with wild poliovirus but not currently exporting it to other countries. WHO also said that these states pose an ongoing risk for new wild poliovirus exportations in 2014. During the low transmission season of the poliovirus, which is from January to April, there had already been international spread of wild poliovirus from three of the 10 infected countries, one of which is Pakistan.

According to the WHO statement, Pakistan, Cameroon and Syria should officially declare the interruption of poliovirus transmission a national public health emergency if they have not already done so. The countries should also ensure that all residents and long-term visitors (anyone staying in the country for more than 4 weeks) receive a dose of OPV or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months prior to all international travel. The WHO also recommended that the country ensure that individuals undertaking urgent travel (i.e. within 4 weeks), who have not received a dose of OPV or IPV in the previous 4 weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers. The three countries also have to ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the International Health Regulations (2005) to record their polio vaccination and serve as proof of vaccination. According to the WHO statement, once the country has met the criteria to be assessed as no longer exporting wild poliovirus, it will continue to be considered infected until the time it has met the criteria to be removed from that category. This is the ripe moment to have deeper introspection and look forward towards sustainable solutions.

Health is determined not only by medical care but also by determinants outside the medical sector. Public health approach is to deal with all these determinants of health which requires multi sectoral collaboration and inter-disciplinary coordination. Although there have been major improvements in public health in almost all the developing countries yet they are passing through demographic and environmental transition which is adding to burden of diseases. There is triple burden of diseases, viz. communicable, non-communicable and emerging infectious diseases. This high burden of disease, disability and death can only be addressed through an effective public health system and constant debate on the subject.

There is visibly and understandably very low public expenditure on health, very few public health institutes in Pakistan and inadequate national standards for public health education. Recent years have seen efforts towards strengthening public health issues in the provinces after the devolution of the subject to the provinces. In Punjab and KPK the two provincial governments took some crucial steps to improve the service delivery.

Historically, disease in other places was seen as an impediment to exploration, and a challenge to winning a war. Cholera and other diseases killed at least three times more soldiers in the Crimean War than the actual conflict. Malaria, measles, mumps, smallpox and typhoid felled more combatants than did bullets in the American civil war.

In an interconnected and inter-dependent world, bacteria and viruses travel almost as fast as e-mail messages and money flows. There are no health sanctuaries. No impregnable walls between the world that is healthy, well fed, and well off, and another world, which is sick, malnourished and impoverished. Globalization has shrunk distances, broken down old barriers, and linked people together. It has also made problems half way around the world everyone’s problem. And we know that, like a stone thrown on the waters, a difficult social or economic situation in one community can ripple and resonate around the world.

Now, there are solutions for those diseases, which plagued the explorers, soldiers and colonialists of historical times. We know how to prevent and treat malaria. There are vaccines for yellow fever.

There are treatments for TB. The striking feature is: while we diligently take antimalarials and top up our vaccinations when we travel to developing countries?the people living there, those threatened most by these diseases?–?don’t have this access. 3,000 Children in Africa die each day from malaria. They die of vaccine preventable diseases?–?like measles, by the hundreds of thousands.

And, people are dying, by the millions every year, of HIV/AIDS.

A world where a billion people are deprived, insecure and vulnerable is an unsafe world. The separation between domestic and international health problems is losing its usefulness as people and goods travel across continents. More than two million people cross international borders every single day, about a tenth of humanity each year. And of these, more than a million people travel from developing to industrialized countries each week. The world has really become a global village and it requires global solutions.

It is pertinent to have fresh perspective on our diet, lifestyles and policy formulation. People and parliamentarians are now fully alerted.

Initiatives are being taken. My personal experience is that strategies developed in collaboration, have a considerable impact. In today’s world we need a shift in awareness towards the idea of building global public goods that can help us reap the huge potential benefits of globalization while at the same time containing the risks and vulnerabilities that comes with it. The main question is one of taking responsibility, of using our democratic potential to promote change.

Investing in health is an obvious choice. It saves lives, millions of lives. But it will also boost our national economy. It is time to move ahead.

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