- Email: [email protected]
Sneeze and you could miss it
Public Health (2006) 120, 93–94
EDITORIAL
Sneeze and you could miss it In November 2004 there was a meeting in Costa Rica. The meeting, which brought together representatives from WHO in Geneva and all six WHO regions worldwide, reflected upon the progress made in delivering the health components of the United Nation’s Millennium Development Goals (MDG) and the challenges that must be overcome if they are to be achieved. A report based on these discussions was published in 20051 and a resolution was passed by the World Health Assembly in May 2005 seeking to build on existing progress in meeting the millennium—and other healthrelated—development goals by 2015.2 The health targets within the MDG are all focussed on delivering change in areas essential to promoting health and reducing health inequality worldwide. For example, it is highly unlikely that anyone associated with public health policy and practice would disagree with taking action to reduce childhood mortality and improve maternal health. Nor would they see reversing the incidence of diseases such a HIV/AIDS, TB or malaria, or the provision of safe and secure water supplies and effective sanitation, especially in rural areas, as anything other than of the utmost importance. A review of the targeted areas shows that whilst there has been progress against the 1990 baseline, there is much still to do.1 The report also highlighted that to achieve these goals; the global community must meet five challenges that are central to delivering effective, sustainable change. These are: 1. the need to strengthen health systems so that they are efficient and operate on a equitable basis; 2. the need to prioritise health actions within overall development and economic policies—especially in developing countries and those that have fragile
infrastructures or are emerging from past conflicts; 3. the need to develop and implement health strategies that reflect the diverse and changing health problems being experienced—especially as a consequence of the globalisation of health threats; 4. the need to mobilise resources—both in terms of financial aid and local capacity—more efficiently and equitably; and 5. the need to develop health data to allow effective monitoring of change. Again, these challenges will come as no surprise to anyone working in the field of public health. Indeed, several of our previous editorials in Public Health have drawn specific attention to these issues; whether for effective health planning in the immediate aftermath of conflict3 or the requirement for effective data systems that can monitor health status against a complex and evolving pattern of health needs.4 However, we believe that a further, sixth challenge—that of the need to maintain focus—is also critical. If the last few years have taught us anything, they have highlighted the importance of having the capacity to deal with the unexpected5 or, indeed, the expected. To put this challenge another way; what would the impact of a further outbreak of SARS, or the expected influenza pandemic, be on the delivery of the MDG? In this issue of Public Health, we are publishing a short paper on health care and public health in south Asia.6 How would such systems cope? The WHO report that in the ten years between 1995 and 2004, over 95% of the population in south-east Asia were being cared for by fewer than 15 doctors and 20 nurses and midwives per 10,000 population.1 By comparison, less than 10% of the European population were being cared for by fewer than 15
0033-3506/$ - see front matter Q 2005 Published by Elsevier Ltd on behalf of The Royal Institute of Public Health. doi:10.1016/j.puhe.2005.11.001
94
Editorial
doctors per 10,000 population and less than 30% cared for by fewer than 20 nurses and midwives per 10,000 population. So if a form of avian ‘flu were to become transmissible between humans in south-east Asia— which is not an unlikely scenario—we can assume that, as in the case of other disasters, much of the existing health care capacity will become directed towards dealing with the epidemic in an attempt to interrupt—or avert—a potential pandemic. Dealing with such a situation will impact heavily on the health care services in south-east Asian countries some of whom will undoubtedly have the capacity to cope and recover more quickly than others. Similarly, we can only guess what the impact would be on delivering the MDG. For some countries, the impact may be marginal, for others substantial. The WHO group meeting in Costa Rica were clear that existing development assistance (often in the form of economic aid) was already failing to bridge the gap between what poorer countries could afford to spend on health and the cost of meeting the MGD. As the G8 indicated at its meeting in July 2005 in Scotland, reducing the indebtedness of developing and fragile countries is one component of the solution.7 Better use of resources is critical. Yet there appears to be a remaining need for more money in the system.1 Developing global funding programmes to address global health issues is clearly a WHA priority.2 However, in the short-term it is highly appropriate that national governments focus on the needs of their own populations in response to a pandemic.8 At the same time, we are sure that thought has already been given to how best to support and develop the health care systems in those developing and fragile countries that could be the on front-line9 in the event of a pandemic. We can be less certain, however, that a global focus will be maintained on meeting the structural
challenges that impede the development of robust, locally responsive, sustainable and equitable health care systems, that are, at the same time, sufficiently flexible to meet new health threats.
References 1. WHO. Health and the millennium health goals. Geneva: WHO; 2005. Available at: http://www.who.int/mdg/publications/ mdg_report/en/. 2. WHA. Resolution WHA58.30. Accelerating the achievement of the internationally agreed health-related development goals including those contained in the Millennieum Declaration. Available at: http://www.who.int/gb/ebwha/pdf_files/ WHA58-REC1/A58_2005_REC1-en.pdf. 3. Sim F, Mackie P. When the guns fall silent. Public Health 2003; 117:219–20, doi:10.1016/S0033-3506(03)00125-2. 4. Mackie P, Sim F. Counting counts. Public Health 2005;119: 457–8, doi:10.1016/j.puhe.2005.03.001. 5. Sim F, Mackie P. The Asian Tsunami remembered Public Health 2005;119:345–6, doi:10.1016/j.puhe.2005.02.001. 6. Shaikh BT, Kadir MM, Hatcher J. Health care and public health in South Asia. Public health, (this issue), doi:10.1016/ j.puhe.2005.08.018. 7. G8 Gleneagles 2005. Chairman’s Summary. Available at: http://www.g8.gov.uk/servlet/Front?pagename=Open Market/Xcelerate/ShowPage&c=Page&cid=1119518698846. 8. UK Dept. of Helath. Influenza pandemic contingency plan (Oct 2005). Available at: http://www.dh.gov.uk/Publica tionsAndStatistics/Publications/PublicationsPolicyAndGuid ance/PublicationsPolicyAndGuidanceArticle/fs/en? CONTENT_ID=4121735&chk=Z6kjQY. 9. WHO (2005). WHO global influenza preparedness plan. Available at: http://www.who.int/csr/resources/publica tions/influenza/WHO_CDS_CSR_GIP_2005_5/en/index.html.
Phil Mackie Fiona Sim Royal Institute of Public Health, 28 Portland Place, London W1B 1DE, UK E-mail address: [email protected] Tel.: C44 20 72918359; fax: C44 20 72918383 Available online 22 December 2005
In this Issue Evaluating the impact of health care is an essential tool for public health. In this issue we explore the impact of health care on avoidable mortality in Australia and western European countries. We also consider the effects of socioeconomic status on the consistency of self-reported health status of common risk factors of major disease. Three papers report on impact of injury and the potential for prevention with studies from South Africa, describing the epidemiology of burn injury, and the UK considering the causes of injury amongst higher education students. A third study, exploring injury in Nicaragua, continues to highlight the emergence of injury as a major threat to health and wellbeing in developing countries. In studies of communicable disease control we publish new data on factors affecting vaccination coverage in southern Anatolia and compliance with TB management standards in an English setting. Finally we publish papers considering participation amongst children with cerebral palsy, health and road transport in Pakistan and the increased incidence of fatty liver amongst non-obese children in Japan.
EDITORIAL
Sneeze and you could miss it In November 2004 there was a meeting in Costa Rica. The meeting, which brought together representatives from WHO in Geneva and all six WHO regions worldwide, reflected upon the progress made in delivering the health components of the United Nation’s Millennium Development Goals (MDG) and the challenges that must be overcome if they are to be achieved. A report based on these discussions was published in 20051 and a resolution was passed by the World Health Assembly in May 2005 seeking to build on existing progress in meeting the millennium—and other healthrelated—development goals by 2015.2 The health targets within the MDG are all focussed on delivering change in areas essential to promoting health and reducing health inequality worldwide. For example, it is highly unlikely that anyone associated with public health policy and practice would disagree with taking action to reduce childhood mortality and improve maternal health. Nor would they see reversing the incidence of diseases such a HIV/AIDS, TB or malaria, or the provision of safe and secure water supplies and effective sanitation, especially in rural areas, as anything other than of the utmost importance. A review of the targeted areas shows that whilst there has been progress against the 1990 baseline, there is much still to do.1 The report also highlighted that to achieve these goals; the global community must meet five challenges that are central to delivering effective, sustainable change. These are: 1. the need to strengthen health systems so that they are efficient and operate on a equitable basis; 2. the need to prioritise health actions within overall development and economic policies—especially in developing countries and those that have fragile
infrastructures or are emerging from past conflicts; 3. the need to develop and implement health strategies that reflect the diverse and changing health problems being experienced—especially as a consequence of the globalisation of health threats; 4. the need to mobilise resources—both in terms of financial aid and local capacity—more efficiently and equitably; and 5. the need to develop health data to allow effective monitoring of change. Again, these challenges will come as no surprise to anyone working in the field of public health. Indeed, several of our previous editorials in Public Health have drawn specific attention to these issues; whether for effective health planning in the immediate aftermath of conflict3 or the requirement for effective data systems that can monitor health status against a complex and evolving pattern of health needs.4 However, we believe that a further, sixth challenge—that of the need to maintain focus—is also critical. If the last few years have taught us anything, they have highlighted the importance of having the capacity to deal with the unexpected5 or, indeed, the expected. To put this challenge another way; what would the impact of a further outbreak of SARS, or the expected influenza pandemic, be on the delivery of the MDG? In this issue of Public Health, we are publishing a short paper on health care and public health in south Asia.6 How would such systems cope? The WHO report that in the ten years between 1995 and 2004, over 95% of the population in south-east Asia were being cared for by fewer than 15 doctors and 20 nurses and midwives per 10,000 population.1 By comparison, less than 10% of the European population were being cared for by fewer than 15
0033-3506/$ - see front matter Q 2005 Published by Elsevier Ltd on behalf of The Royal Institute of Public Health. doi:10.1016/j.puhe.2005.11.001
94
Editorial
doctors per 10,000 population and less than 30% cared for by fewer than 20 nurses and midwives per 10,000 population. So if a form of avian ‘flu were to become transmissible between humans in south-east Asia— which is not an unlikely scenario—we can assume that, as in the case of other disasters, much of the existing health care capacity will become directed towards dealing with the epidemic in an attempt to interrupt—or avert—a potential pandemic. Dealing with such a situation will impact heavily on the health care services in south-east Asian countries some of whom will undoubtedly have the capacity to cope and recover more quickly than others. Similarly, we can only guess what the impact would be on delivering the MDG. For some countries, the impact may be marginal, for others substantial. The WHO group meeting in Costa Rica were clear that existing development assistance (often in the form of economic aid) was already failing to bridge the gap between what poorer countries could afford to spend on health and the cost of meeting the MGD. As the G8 indicated at its meeting in July 2005 in Scotland, reducing the indebtedness of developing and fragile countries is one component of the solution.7 Better use of resources is critical. Yet there appears to be a remaining need for more money in the system.1 Developing global funding programmes to address global health issues is clearly a WHA priority.2 However, in the short-term it is highly appropriate that national governments focus on the needs of their own populations in response to a pandemic.8 At the same time, we are sure that thought has already been given to how best to support and develop the health care systems in those developing and fragile countries that could be the on front-line9 in the event of a pandemic. We can be less certain, however, that a global focus will be maintained on meeting the structural
challenges that impede the development of robust, locally responsive, sustainable and equitable health care systems, that are, at the same time, sufficiently flexible to meet new health threats.
References 1. WHO. Health and the millennium health goals. Geneva: WHO; 2005. Available at: http://www.who.int/mdg/publications/ mdg_report/en/. 2. WHA. Resolution WHA58.30. Accelerating the achievement of the internationally agreed health-related development goals including those contained in the Millennieum Declaration. Available at: http://www.who.int/gb/ebwha/pdf_files/ WHA58-REC1/A58_2005_REC1-en.pdf. 3. Sim F, Mackie P. When the guns fall silent. Public Health 2003; 117:219–20, doi:10.1016/S0033-3506(03)00125-2. 4. Mackie P, Sim F. Counting counts. Public Health 2005;119: 457–8, doi:10.1016/j.puhe.2005.03.001. 5. Sim F, Mackie P. The Asian Tsunami remembered Public Health 2005;119:345–6, doi:10.1016/j.puhe.2005.02.001. 6. Shaikh BT, Kadir MM, Hatcher J. Health care and public health in South Asia. Public health, (this issue), doi:10.1016/ j.puhe.2005.08.018. 7. G8 Gleneagles 2005. Chairman’s Summary. Available at: http://www.g8.gov.uk/servlet/Front?pagename=Open Market/Xcelerate/ShowPage&c=Page&cid=1119518698846. 8. UK Dept. of Helath. Influenza pandemic contingency plan (Oct 2005). Available at: http://www.dh.gov.uk/Publica tionsAndStatistics/Publications/PublicationsPolicyAndGuid ance/PublicationsPolicyAndGuidanceArticle/fs/en? CONTENT_ID=4121735&chk=Z6kjQY. 9. WHO (2005). WHO global influenza preparedness plan. Available at: http://www.who.int/csr/resources/publica tions/influenza/WHO_CDS_CSR_GIP_2005_5/en/index.html.
Phil Mackie Fiona Sim Royal Institute of Public Health, 28 Portland Place, London W1B 1DE, UK E-mail address: [email protected] Tel.: C44 20 72918359; fax: C44 20 72918383 Available online 22 December 2005
In this Issue Evaluating the impact of health care is an essential tool for public health. In this issue we explore the impact of health care on avoidable mortality in Australia and western European countries. We also consider the effects of socioeconomic status on the consistency of self-reported health status of common risk factors of major disease. Three papers report on impact of injury and the potential for prevention with studies from South Africa, describing the epidemiology of burn injury, and the UK considering the causes of injury amongst higher education students. A third study, exploring injury in Nicaragua, continues to highlight the emergence of injury as a major threat to health and wellbeing in developing countries. In studies of communicable disease control we publish new data on factors affecting vaccination coverage in southern Anatolia and compliance with TB management standards in an English setting. Finally we publish papers considering participation amongst children with cerebral palsy, health and road transport in Pakistan and the increased incidence of fatty liver amongst non-obese children in Japan.