Impact of public health emergencies on modern disaster taxonomy, planning, and response

Current disaster taxonomy describes diversity, distinguishing characteristics, and common relations in disaster event classifications. The impact of compromised public health infrastructure and systems on health consequences defines and greatly influences the manner in which disasters are observed, planned for, and managed, especially those that are geographically widespread, population dense, and prolonged. What may first result in direct injuries and death may rapidly change to excess indirect illness and subsequent death as essential public health resources are destroyed, deteriorate, or are systematically denied to vulnerable populations. Public health and public health infrastructure and systems in developed and developing countries must be seen as strategic and security issues that deserve international public health resource monitoring attention from disaster managers, urban planners, the global humanitarian community, World Health Organization authorities, and participating parties to war and conflict. We posit here that disaster frameworks be reformed to emphasize and clarify the relation of public health emergencies and modern disasters.     

The World Bank's perspective on global health

Over the next 25 years, as populations age and tobacco consumption increases, most developing regions will likely see noncommunicable diseases become the leading causes of disability and premature mortality. The already existing problems of malnutrition and infectious diseases will remain. In this context, the World Bank is examining its role and contribution to global health. From a small start approximately 25 years ago, the Bank has greatly expanded its role in international health, population, and nutrition to become the largest single external financier of health activities in low- and middle-income countries. Many other Bank-supported activities affect health, including poverty reduction, housing, water and sanitation, and the education of girls. The Bank is also increasingly active in health policy debates, publishing numerous studies annually. Most of these studies focus upon specific countries, but some address key issues of concern to many developing countries. This article explains why the Bank continues to expand its resources devoted to health and the rationale for the changing emphasis of its activities in the field.     

Ethics and governance of global health inequalities

BACKGROUND: A world divided by health inequalities poses ethical challenges for global health. International and national responses to health disparities must be rooted in ethical values about health and its distribution; this is because ethical claims have the power to motivate, delineate principles, duties and responsibilities, and hold global and national actors morally responsible for achieving common goals. Theories of justice are necessary to define duties and obligations of institutions and actors in reducing inequalities. The problem is the lack of a moral framework for solving problems of global health justice. AIM: To study why global health inequalities are morally troubling, why efforts to reduce them are morally justified, how they should be measured and evaluated; how much priority disadvantaged groups should receive; and to delineate roles and responsibilities of national and international actors and institutions. DISCUSSION AND CONCLUSIONS: Duties and obligations of international and state actors in reducing global health inequalities are outlined. The ethical principles endorsed include the intrinsic value of health to well-being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups. This approach does not seek to find ways in which global and national actors address global health inequalities by virtue of their self-interest, national interest, collective security or humanitarian assistance. It endorses the more robust concept of "human flourishing" and the desire to live in a world where all people have the capability to be healthy. Unlike cosmopolitan theory, this approach places the role of the nation-state in the forefront with primary, though not sole, moral responsibility. Rather shared health governance is essential for delivering health equity on a global scale.     

Quebec's approach to population health: an overview of policy content and organization

While Canada's international leadership in the area of health promotion has been widely acknowledged in the past, Quebec's approach could be better known. Canada's second largest province has indeed developed a comprehensive public health infrastructure and adopted a population health approach which features an integrated set of legislative, organizational and programmatic policy instruments. These instruments not only ensure the core functions of public health, but also foster public intervention on the social determinants of health. In addition, Quebec's policy is supported by a solid research infrastructure, networked expertise and a mobilized workforce among health professionals. In spite of the interest it represents for the larger public health community in Canada and elsewhere, this largely French-speaking province's approach remains little known because of language and cultural barriers between Quebec and Anglo-Saxon countries, and it has yet to be systematically discussed in the English-language literature. This article provides an overview of policies and administrative structures in Quebec to support public health and address socially determined inequalities in health. It analyzes the development of these policies over the past decade and offers insight to their core content.     

Taming the tools of violence

This article summarizes why firearms are the most lethal tools of violence, and some pertinent issues public health professionals face when working to ameliorate the effects of gun violence. It surveys large gaps in data and understanding regarding the African context--most research has hitherto been conducted in developed countries. And it reviews international agreements that could be used to mobilize support for public health approaches. Although none focus explicitly on public health, some agreements offer commitments that can be used by people working to improve public health.     

The relevance of the public–private partnership paradigm to the prevention of diet-associated non-communicable diseases in wealthy countries

The public–private partnership (PPP) paradigm emerged as a form of global health governance in the mid-1990s to overcome state and market failures constraining access to essential medicines among populations with limited purchasing power in low- and middle-income countries. PPPs are now ubiquitous across the development spectrum. Yet while the narrative that the private sector must be engaged if complex health challenges are to be overcome is now dominant in development discourse, it does not yet appear to be shaping government approaches to addressing health inequalities within high-income welfare states such as Canada. This is significant as both the actions and inactions of firms factor heavily into why low-income Canadians face a disproportionate risk of developing diet-associated chronic diseases, such as type II diabetes. In the same ways PPPs have been an effective policy tool for strengthening public health in poor countries, this paper illuminates how the PPP model may have utility for mitigating poverty-associated food insecurity giving rise to diet-associated non-communicable diseases within the context of wealthy states.     

Report of the commission on health research for development and the countries of the south.

Of late, governments of affluent countries have become more brazen in using United Nations organizations and other global commissions as tools to serve their political and economic interests. WHO and UNICEF have been used by these governments to impose technocentric and dependence-promoting programs on countries of the South. The report of the Commission on Health Research for Development is yet another effort in that direction. It advocates international cooperation in health research. It merely adds to the bulk of documents on international health research. It is ahistorical. It does not analyze why WHO and UNICEF and the governments of affluent countries imposed global programs on immunization and diarrheal and respiratory diseases without bothering to gather even the most elementary data about them. There is a method in the brashness. Worse still, it ignores the rich heritage of health research of the past half a century in countries such as India, Indonesia, and Thailand. It is yet another effort to obscure the message of self-reliance contained in the Alma-Ata Declaration on Primary Health Care.     

The development of international health policies--accountability intact?

International health governance as it exists today is facing major structural challenges in view of globalization, the increased transfer of international health risks and the mounting challenge of health inequalities worldwide. As a consequence the capacity of nation states to ensure population health and to address major health determinants has been weakened. This paper explores health as an exemplary field to illustrate that we have entered a new era of public policy which is defined by increasing overlaps between domestic and foreign policy, multilateral and bilateral strategies and national and international interest. Cross border spill overs and externalities of national actions need to move into the core of public policy at the national and global level within a new rules based system. A new perspective on global health governance is further necessitated through the increased number of players in the global health arena. The organizational form that is emerging is based on networks and is characterized by shifting alliances and blurred lines of responsibility. The paper explores the emerging paradox of state sovereignty and makes a set of proposals to pool state sovereignty on health and structure the myriad of networks. Particular attention is given to the role of the World Health Organization within this process of change and adjustment. In using a framework from international relations analysis the paper explores how nation states are socialized into accepting new norms, values and perceptions of interest with regard to national and international health and what challenges emerge for the WHO in "inventing" global health policy.     

Soziale Ungleichheit und Gesundheit

Social differences in morbidity and mortality have always been a central topic in public health research. In recent years, there has been a growing research interest that has clearly resonated with the general public and the political arena as well. This article describes the development and establishment of social epidemiology in Germany and presents the current status of research. In addition, it describes different models for explaining health inequalities. On this basis, selected challenges and prospects of socio-epidemiological research are demonstrated. The reason why the analysis of social differences in morbidity and mortality will continue to be a key task of public health research in the national and international context in the future is also explained.     

Historical advances in health inequality research]

The socioeconomic inequalities in health have recently become an important public health concern in South Korea, and the issue has gained increasing attention from many South Korean researchers due to the increasing income inequality and widening social polarization following its economic crisis in the late 1990s. However, despite the mounting literature on health inequalities published in recent years, the history of research on health inequality in South Korea is premature in comparison to the long histories in several Western countries. Understanding the historical background underlying the issue of health inequality research may aid in establishing and accumulating scientifically solid evidence in South Korea. It may also direct the South Korean research community to develop research agendas that are more politically and academically appropriate for South Korean society. This paper describes the historical development of health inequality research in the West and introduces several important issues contributing to the advancement of health inequality research. Specifically, the major studies conducted before and after the UK Black Report are presented. In addition, the history and current status of health inequality research in South Korea are documented and evaluated. Finally, several research agendas for the quantitative and qualitative improvement of health inequality research in South Korea are proposed.     

Social justice,epidemiology and health inequalities

A lifetime spent studying how social determinants of health lead to health inequalities has clarified many issues. First is that social stratification is an appropriate topic of study for epidemiologists. To ignore it would be to ignore a major source of variation in health in society. Not only is the social gradient in health appropriate to study but we have made progress both in understanding its causes and what can be done to address them. Post-modern ‘critical theory’ raises questions about the social construction of science. Given the attack on science by politicians of bad faith, it is important to recognise that epidemiology and public health have a crucial role to play in providing evidence to improve health of society and reduce inequalities. Evidence gives grounds for optimism that progress can be made both in improving the health of the worst-off in society and narrowing health inequalities. Theoretical debates about ‘inequality of what’ have been helpful in clarifying theories that drive further gathering of evidence. While it is important to consider alternative explanations of the social gradient in health—principal among them reverse causation—evidence strongly supports social causation. Social action is by its nature political. It is, though, a vital function to provide the evidence that underpins action.     

The development and application of a public health skills assessment tool for use in primary care organisations

The public health skills assessment instrument described in this paper was developed to provide a key group of UK primary care practitioners (health visitors) with a personal development planning tool and researchers with a robust assessment tool for use in evaluations of innovative local public health programmes. Pilot testing with over 120 practitioners has provided evidence of its reliability and validity as a research instrument as well as yielding useful insights for public health educators, practitioners and policy-makers. Factor analysis confirms 10 core competency domains for health visitors which are remarkably consistent with those recently identified for UK public health specialists, interpreted here as grounds for optimism in the greater co-ordination between strategic and front-line approaches to public health work in primary care. However, results also confirm earlier findings indicating low levels of skill amongst health visitors in tackling health inequalities through interventions such as community development, raising questions about their capability to work effectively in new roles proposed by the Department of Health.     

“融入”而非“隔离”:英国现代精神卫生政策的范式转换

长期以来,精神疾病是困扰人类社会的重要难题.在英国,政府借助于公共政策,介入于精神卫生问题的历史由来已久.纵观英国精神卫生政策的发展历程,"融入"而非"隔离"的理念逐渐成为该领域的主导哲学,并由此引发传统的精神卫生政策向现代精神卫生政策的范式转换.     

The introduction of new vaccines into developing countries. III. The role of intellectual property

The development of new vaccines that address the particular needs of developing countries has been proceeding slowly. A number of new public sector vaccine research and development initiatives have been launched to address this problem. These new initiatives find that they often wish to collaborate with the private sector and, in collaborating with the private sector, they must address issues of intellectual property (IP) management. It has not been well understood why IP management is important and how such management by public sector groups can best be conducted. IP management has become very important because vaccine research and development is driven by the regulatory process. The regulatory process has increased the cost of vaccine development to very high levels especially for the highly sophisticated new vaccines currently under development. Thus, investors seek IP protection for the required large investments. Conversely, we assert this concept as a new insight, IP rights are essential for mobilizing the significant funds necessary to meet regulatory requirements. Thus, IP rights are of value not only for investors but also for the public at large. In the absence of public sector mechanisms to carry out the functions that the private sector currently conducts, the public sector needs to increase its sophistication in IP management and needs to identify and implement strategies that will help the public sector to achieve its public health goals, especially for the poor and, among these individuals, the poor in developing countries. This paper suggests some strategies that might be used by the public sector to help achieve its public health goals, especially for the poor.     

Alcohol control and urban livelihoods in developing countries: can public health aspirations and development goals be reconciled?

This commentary explores how household economic necessity and the public health aspirations set out in the WHO’s global strategy to reduce the harmful use of alcohol might be reconciled in the context of alcohol control in developing countries. The ‘ambiguity’ of alcohol’s role in social and economic development is clear, but, as yet, little progress has been made on how best to integrate alcohol control within development policies in low- and middle-income countries. Without this holistic thinking, alcohol control efforts are likely to be thwarted by liquor’s allure as an accessible micro-enterprise opportunity. Similarly, developmental efforts will be undermined by the severity of alcohol-related harms that now disproportionately affect middle-income countries. Drawing on the example of South Africa, this short commentary explores the complexities of controlling the supply of alcohol when its sale represents a major livelihood strategy amid conditions of high unemployment and constrained access to formal employment markets. The policy preference for closing illegal bars or shebeens in South Africa does not address the ‘causes of the causes’ of why people drink, and therefore why its sale continues to be an attractive livelihood choice. It also does little to provide alternative leisure or employment opportunities, which ultimately threatens the longer term sustainability of policy. We need to better appreciate why selling alcohol is a seductive business opportunity and the potential consequences of this for realising public health aspirations.     

Can Poor Countries Surmount High Maternal Mortality?

Does poverty bind developing countries to high levels of maternal death in childbirth? Or, as safe‐motherhood advocates claim, do public health and social policy interventions have the potential to accelerate maternal mortality transitions? Globally, almost one in 200 live births leads to the death of the mother, making maternal mortality an issue of critical international import. This article presents an analysis of the determinants of national maternal mortality levels with a view to shedding light on these questions. A cross‐national regression of 64 countries shows that wealth indicators explain only a portion of the variance in national maternal mortality levels. Other determinants, including women's educational levels and the proportion of deliveries attended by trained health personnel, are more clearly associated with national maternal mortality levels than are measures of wealth. The results offer grounds for optimism concerning the potential for global safe‐motherhood efforts to induce maternal mortality transitions.     

Health and foreign policy: influences of migration and population mobility

International interest in the relationship between globalization and health is growing, and this relationship is increasingly figuring in foreign policy discussions. Although many globalizing processes are known to affect health, migration stands out as an integral part of globalization, and links between migration and health are well documented. Numerous historical interconnections exist between population mobility and global public health, but since the 1990s new attention to emerging and re-emerging infectious diseases has promoted discussion of this topic. The containment of global disease threats is a major concern, and significant international efforts have received funding to fight infectious diseases such as malaria, tuberculosis and HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome). Migration and population mobility play a role in each of these public health challenges. The growing interest in population mobility's health-related influences is giving rise to new foreign policy initiatives to address the international determinants of health within the context of migration. As a result, meeting health challenges through international cooperation and collaboration has now become an important foreign policy component in many countries. However, although some national and regional projects address health and migration, an integrated and globally focused approach is lacking. As migration and population mobility are increasingly important determinants of health, these issues will require greater policy attention at the multilateral level.     

The global financial crisis: whither women's health?

The global integration of trade and financial markets that has been the hallmark of the past 30 years of neoliberal globalization means that local economies can be shaped by economic events seemingly unrelated to the scale or geography where women's empowerment projects unfold. These global–local interactions raise questions so far largely absent in public discussions of the 2008 crisis precipitated by the US sub-prime loan scandal: what are the gendered effects of global financial crises; specifically, how do these crises affect women? And how do these market crises intersect with the non-market activities that are key to understanding gendered health issues in developing countries. This article addresses these questions by reviewing the literature on gendered health impacts of financial crises over the past two decades. We find that the manner in which national governments and the broader international community react to crises can either magnify (as illustrated through the impacts of structural adjustment programmes on women's health) or mitigate (as illustrated through the policies pursued following the loss of support from the collapsed Soviet Union on Cuban women's health) gendered health-negative effects. Lack of attention to gender-specific consequences of past crises or health-positive interventions into such crises has weakened the ability to advance policy advice on protecting women's health during the present crisis. The article concludes with a gender-focused critique of the dominant policy responses to the 2008 financial crisis and a call to undertake real-time investigation of gendered health risks and opportunities arising from the present crisis.     

Australian public health: some history lessons from South Africa

OBJECTIVE: To draw historical parallels between inequalities in South Africa and Australia and their implications for public health, and especially Aboriginal health, in the latter. METHODS: To use the work of Terreblanche in South Africa and Houston in Australia to demonstrate the relevance of past inequalities to some of today's health problems. RESULTS: Economic structural issues remain crucial to the development of and the future health of these two countries. There are more grounds for hope for a more equal society in South Africa than there are in Australia. CONCLUSIONS: South Africa has made some attempt to face its past while Australia has not. Attempts to kill off Aboriginal culture continue. Aboriginal health will only improve when white Australia is prepared to face its 'black' past and move beyond the racism and indifference that surround Aboriginal affairs. The neo liberalism of both countries serves their disadvantaged populations ill.     

Communicable disease control: a 'Global Public Good' perspective

Despite the increasing 'globalization' of health, the responsibility for it remains primarily national, generating a potential mismatch between global health problems and current institutions and mechanisms to deal with them. The 'Global Public Good' (GPG) concept has been suggested as a framework to address this mismatch in different areas of public policy. This paper considers the application of the GPG concept as an organizing principle for communicable disease control (CDC), considering in particular its potential to improve the health and welfare of the developing world. The paper concludes that there are significant limitations to the GPG concept's effectiveness as an organizing principle for global health priorities, with respect to CDC. More specifically, there are few areas of CDC which qualify as GPG, and even among those that can be considered GPGs, it is not necessarily appropriate to provide everything which can be considered a GPG. It is therefore suggested that it may be more useful to focus instead on the failure of 'collective action', where the GPG concept may then: (1) provide a rationale to raise funds additional to aid from developed countries' domestic budgets; (2) promote investment by developed countries in the health systems of developing countries; (3) promote strategic partnerships between developed and developing countries to tackle major global communicable diseases; and (4) guide the political process of establishing, and mechanisms for providing and financing, global CDC programmes with GPG characteristics, and GPGs which have benefits for CDC. In short, the GPG concept is not without limitations and weaknesses as an organizing principle, but does provide, at least in some areas, guidance in improving collective action at the international level for the improvement of global CDC.