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.
