Presentation on theme: "Global Public Health Thomas E. Novotny, M.D., M.P.H."— Presentation transcript:
1Global Public Health Thomas E. Novotny, M.D., M.P.H. University of California, San FranciscoPublic Policy and Biological ThreatsIGCC/AAAS Wye River Biosecurity WorkshopAugust 15, 20061
2DefinitionsPublic Health: “the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort”Institute of Medicine, The Future of Public HealthCore Function No. 1: Prevent epidemics and the spread of disease
3Unique Features of Public Health Basis in social justice conceptsInherently political natureDynamic, ever-expanding agendaGrounding in the sciencesPrevention is prime strategyLink with governance—national or multi-national
4Historical Perspective Conflicting value systems of public health and wider community;Often takes outbreak, disaster, or other tragedy to implement public health strategies;Little attention paid to financing core public health functions (pure public goods).
5Essential Public Health Practices Monitor health status to identify community health problems;Diagnose and investigate health problems and health hazards in the community;Inform, educate, and empower people about health issues;Mobilize community partnerships to identify and solve health problems;Develop policies and plans that support individual and community health efforts;
6Essential Public Health Practices, continued Enforce laws and regulations that protect health and ensure safety;Link people with needed health services and assure the provision of care;Assure a competent health workforce;Evaluate effectiveness, access, and quality of health services;Research for new insights and solutions to health problems.
7Global vs. International Health Global Health: problems, issues, and concerns that transcend national boundaries and may best be addressed by cooperative actions.International health:bilateral foreign aid activities, specific disease control projects in developing countries, and direct medical assistance.
8Globalization and Public Health National governance challenged by globalizationGlobal trade expansion opens markets to all legal productsTransnational approaches needed on global health issuesBoth temporal and spatial dimensions
9Global Public Health Problems Tobacco UseObesityEmerging infectious diseasesPersistent OrganicPollutants, Climate ChangeHazardous andNuclear WasteBioweapons
10What are emerging infectious diseases? Diseases whose incidence in humans has increased in last 20 years or threatens to increase in future, usually due to demographic or environmental factorsInstitute of Medicine, 1992
11Examples of emerging and reemerging infectious diseases Ebola virusHIVHepatitis CSin Nombre Virus (hantavirus)Influenza A(H5N1 and H7N7)SARS coronavirusLegionella pneumophilaEscherichia coli O157:H7Cyclospora cayetensisBorrelia burgdorferiVibrio cholerae O139 CholeraDengue feverDiphtheriaMeningococcal meningitisMonkeypoxRift Valley feverYellow fever
12Why are they emerging? Global travel Globalization of food supply and central processing of foodPopulation growth, increased urbanization, and crowdingPopulation movements due to civil wars, famines, and other man-made or natural disastersIrrigation, deforestation, and reforestation projects that alter the habitats of disease-carrying insects and animals
13Why are they emerging?Human behaviors, such as intravenous drug use and risky sexual behaviorIncreased use of antimicrobial agents and pesticides, hastening the development of resistanceIncreased human contact with tropical rain forests and other wilderness habitats that are reservoirs for insects and animals that harbor unknown infectious agents
14World Population Growth Global Travel andWorld Population GrowthWorldPpuatinbs()Days to circumnavigate globeYe18543296543215
15Antimicrobial resistance Worldwide problemDramatic increase in antimicrobial-resistant community-acquired and nosocomial pathogensMajor risk factors:Antimicrobial use (misuse - human and vet)Infection control practices (noncompliance)
16Current International Efforts at Infectious Disease Control Improve surveillance efforts;Develop international standards and guidelines for disease reporting and control;Strengthen international research;Disproportional concern with techno fixEncourage national governments to improve public health systems.Source: World Health Assembly. Communicable diseases prevention and control: new,emerging, and re-emerging infectious diseases. WHO Doc. WHA 48.13, May 12, 1995.
17International Health Regulations Established under WHO in 1951: ‘Sanitary and quarantine requirements and other procedures designed to prevent the international spread of disease;’Lack of compliance almost universal;Revisions (1995): Surveillance, response, increased number of diseases covered.
18International Health Regulations Intended to protect industrialized world commercial investments and armiesGlobal infectious disease spread through mobility, war, etcMajor effort to protect economies through control of Infectious Diseases and subsequent bad publicity.
19Poverty and Global Health Poverty and its consequences, including poor nutrition and sanitation, is the major factor reducing years of healthy life in the world
20The biggest killers of the poor Source: WHO, 2002
21Non-Communicable Diseases “Chronic diseases are the largest cause of death in the world. In 2002, the leading chronic diseases – cardiovascular disease, cancer, chronic respiratory disease, and diabetes – caused 29 million deaths worldwide.”Yach et al, JAMA 2004
23(Yach, Hawkes et al. 2004)High BMITobaccoPhysical inactivity
24The Issues in Non-communicable Diseases A chronic disease pandemic, growing rapidly in developing countries (cancer, DM, obesity, CVD)Insufficient public health focus or fundingComplex set of interrelated factorsRisk factors and diseases can be reducedNeeds innovative solutionsRequires multiple stakeholder involvementNeeds a catalyst for global actionAlready lots of evidence for effective interventions
25Tobacco Use is a Great Example of a Public Health Problem HostGovernmentand Young PeopleAgentAdvertisingMovies and MediaPolitical InfluenceEnvironmentGlobal MarketsCognitive GlobalizationInformation Asymmetry
26Framework Convention on Tobacco Control First health treaty to be negotiated under auspices of World Health Organization;Agreement by consensus at 2003 World Heath Assembly (190 countries);So far, 168 have signed, 137 ratified;Depends on ratification and developing national policies in accordance with obligations;Advertising ban, warning labels, misleading information on labels, taxation, clean-indoor air policy, liability, smuggling controls, etc.
27Global Public Health Infrastructure Development Political commitmentFinancing of public health infrastructureSurveillanceScientific investigationCommunicationsTherapeutics (policy and development)Critical evaluation of interventions
28Shaping Global Health: Civil Society, the State, and Academia Highly credible scientific evidence (especially surveillance);Public health advocacy;Enforceable and enforced sensible public health laws and governance;Health diplomacy.
29ReferencesInstitute of Medicine. The Future of Public Health. Washington DC: National Academy Press, 1988.Fidler DP. International Law and Infectious Diseases. New York: Oxfod University Press, 1999.Grad FP. The Public Health Law Manual, 2nd Edition. Washington DC: American Public Health Association, 1990.Hong Kong Department of Health. A Briefing on SARS in Hong Kong, 16 April 2003.Isaacs SL, Schroeder SA. Where the public good prevailed—lessons from success stories in health. The American Prospect, June 4, 2001.Turnock BJ. Public Health: What It is and How It Works. Gaithersburg, Maryland: Aspen Publishers, Inc., 2001.World Bank. Public Health In Eastern Europe and Central Asia—A Decade of Experience In Transition. (In Press), April 15, 2003