July 11, 2012

National Security And Global Public Health

By Melvin J. Howard

Global public health security covers a wide range of complex issues, including the health consequences of human behavior, climate change, weather-related events and infectious diseases, as well as natural catastrophes and man-made disasters. Many people don’t think of national security when it comes to health care. But lets go back in history Europeans brought the first diseases against which the Native Americans had no immunity. Chicken pox and measles, though common and rarely fatal among Europeans, often proved fatal to Native Americans, and more dangerous diseases such as smallpox were especially deadly to Native American populations. It is difficult to estimate the total percentage of the Native American population killed by these diseases. Epidemics often immediately followed European exploration, sometimes destroying entire villages. Some historians estimate that up to 80% of some Native populations may have died due to European diseases. In addition to the diseases brought over by the first wave of immigrants to Hawaii, leprosy, whose origin is not known and for which there has never been a cure, had a profound effect on the public health of native Hawaiians. Because of the social stigma attached to the diseases (it was mistakenly thought to be a venereal disease) as well as its extreme contagiousness, lepers were isolated on the island of Molokai beginning in 1886. For 16 years, a Belgian priest named Demian Joseph de Veuster provided medical care for these patients, whom the medical community refused to treat, before succumbing to the illness himself in 1889.

Compared to Hawaiians of European and Asian ancestry, native Hawaiians have continued to bear the brunt of the archipelago's health problems. Whereas Hawaii as a whole boasts the longest average life span of any state (males live an average 75.37 years, females, 80.92 years), the death rates of native Hawaiians at all ages are above average. The infant mortality rate for native Hawaiians is 6.5 per 1,000 live births. In addition, native Hawaiians experience high rates of diabetes and hypertension. Health workers consider poor diet a major factor, and economic problems undoubtedly contribute to this situation.

Then there was the dreaded Black Plague or Black Death, the most severe epidemic in human history, ravaged Europe from 1347-1351. It is thought that as many as 25 million people (one third of Europe's population at the time) were killed during this short period,. Thousands of people died each week. This plague killed entire families at a time and destroyed at least 1,000 villages. Once a family member had contracted the disease, the entire household was doomed to die. Parents abandoned their children, and parent-less children roamed the streets in search for food. If the people weren't dead they ran away in vain attempts to save themselves. Victims, delirious with pain, often lost their sanity. Life was in total chaos. The Black Death struck the European people with very little warning. They did not understand the causes of infectious disease, or how they spread. They did not have the ability to understand where this sudden cruel death had come from. And they did not know whether it would ever go away. The Plague was a disaster without a parallel, causing dramatic changes in medieval Europe, contributing to what is called the Crisis of the Fourteenth Century.

National Security 

The Obama's administration National Security Strategy, is a 52 page document intended to guide U.S. military and diplomatic policy for years, is to eliminate the need for the U.S. to strike first or take unilateral military action," the policy puts "heavy emphasis on the value of global cooperation, developing wider security partnerships and helping other nations defend themselves." The strategy also outlined the importance of improving the U.S. economy for national security "through better education, national debt reduction, a stronger U.S. clean energy industry, greater scientific research and a revamped health care system. In the strategy President Obama writes that the U.S. Armed Forces "will always be a cornerstone of our security, but they must be complemented." Obama adds, "Our security depends on diplomats who can act in every corner of the world ... development experts who can strengthen governance and support human dignity. Part of the document focuses on promoting national security through global health and related efforts. "The freedom that America stands for includes freedom from want. Basic human rights cannot thrive in places where human beings do not have access to enough food, or clean water, or the medicine they need to survive," the document states, noting the U.S. role in assisting with efforts to achieve the U.N. Millennium Development Goals.

The strategy cites examples of how the U.S. aims to "promote dignity ... through development efforts." They include, the Global Health Initiative (GHI), U.S. food security programs and leadership in humanitarian crises. The U.S. "has a moral and strategic interest in promoting global health. When a child dies of a preventable disease, it offends our conscience; when a disease goes unchecked, it can endanger our own health; when children are sick, development is stalled," according to a section of the document that focuses on the GHI. On food security, the document states that instead of simply providing aid for developing countries, we are focusing on new methods and technologies for agricultural development. This is consistent with an approach in which aid is not an end in itself – the purpose of our foreign assistance will be to create the conditions where it is no longer needed. We are promoting child and maternal health. We are combating human trafficking, especially in women and girls, through domestic and international law enforcement. And we are supporting education, employment, and micro-finance to empower women globally. Global public health security depends on actions to prevent and respond to threats that endanger the collective health of the global population. Those threats have an impact on economic or political stability, trade, tourism, access to goods and services and, if they occur repeatedly, on demographic stability.

Environmental threats to global health security

Non-occupational human exposure to arsenic in the environment is primarily through the ingestion of food and water. Of these, food is generally the principal contributor to the daily intake of total arsenic. In some areas arsenic in drinking water is a significant source of exposure to inorganic arsenic. In these cases, arsenic in drinking water often constitutes the principal contributor to the daily arsenic intake. Contaminated soils such as mine tailings are also a potential source of arsenic exposure. Inorganic arsenic levels in fish and shellfish are low. Foodstuffs such as meat, poultry, dairy products and cereals have higher levels of inorganic arsenic. Pulmonary exposure contributes to smokers and non-smoker alike, and more in polluted areas. The concentration of metabolites of inorganic arsenic in urine (inorganic arsenic, MMA and DMA) reflects the absorbed dose of inorganic arsenic on an individual level. Exposure of the general population to arsenic occurs mainly through food and water and in most areas, food is the main source. Arsenic in food is mainly in the form of organic arsenic, which is generally thought to pose less health problems than inorganic arsenic. About one-quarter of the arsenic present in the diet is inorganic arsenic, mainly from foods such as meat, poultry, dairy products and cereals. Fish and shellfish contain the highest concentrations of arsenic, but the proportion of inorganic arsenic in fish is very low, below 1%. In some areas, where levels of arsenic in groundwater are high, drinking water may be the main source of intake. In drinking water, arsenic is present in the more toxic, inorganic form. Contaminated soils such as mine tailings are also a potential source of arsenic exposure.

Urbanization, increasing international trade and travel has contributed to the rapid spread of viruses and insects that carry them. For instance, dengue caused an unprecedented pandemic in 1998, with 1.2 million cases reported to the WHO World Health Organization in 56 countries. Since then, dengue epidemics have continued and have affected millions of people from Latin America to South-East Asia. Globally, the average annual number of cases reported to WHO has nearly doubled in each of the last four decades. Surveillance is crucial for public health security and without it, it is impossible to detect and respond to emerging health threats. For instance, HIV and AIDS had perhaps been occurring for many years in Africa and Haiti but had not been detected due to inadequate surveillance and health systems in these developing countries. This new disease was only brought to international attention when the first few cases appeared in the United States. Even then, the disease was not detected by surveillance systems but by chance, when epidemiologists noticed an unusual number of orders for drugs to treat a rare infection that is common in AIDS cases.

The behavior of individuals at all levels – political leaders, policy-makers, military commanders, public health specialists and the general population – can have major health consequences, both negative and positive. Threats to public health security such as natural disasters, epidemics of infectious diseases, chemical and radioactive emergencies or other health events, can have one or more causes. The causes may be natural or man-made, environmental or industrial, accidental or deliberate, and in many cases related to human behaviour. Public health is undermined not only by human action but also by the lack thereof. Complacency and a false sense of security can tempt governments to reduce spending on public health and to scale down prevention programmes with potentially disastrous consequences for collective global health.