Map of life expectancy at birth from Global Education Project.

Thursday, September 20, 2007

The Boy Scout Motto

That's "Be Prepared." I commend the work done by Revere at Effect Measure and Daily Kos diarist DemfromCT to promote public awareness of the threat of a flu pandemic posed by the H5N1 strain currently epizootic in birds. This has been a useful handle to sling the issue of public health emergency preparedness generally. But now I think it's time to move this discussion onto much broader ground.

Frankly, in my view, the more time passes without the H5N1 bird flu evolving into a human transmissible strain, the less likely it is that it will ever happen. Meanwhile, after a few years of raising the alarm, it's starting to sound to a lot of people like Chicken Little. As far as I'm concerned, the issue was never one particular strain of one particular virus, and the leadership of the World Health Organization clearly agrees with me. WHO has just released the World Health Report for 2007, and it focuses on public health emergency preparedness -- but it never once mentions bird flu. Here's the WHO's blurb on the document:

The World Health Report 2007 - A safer future: global public health security in the 21st century marks a turning point in the history of public health, and signals what could be one of the biggest advances in health security in half a century. It shows how the world is at increasing risk of disease outbreaks, epidemics, industrial accidents, natural disasters and other health emergencies which can rapidly become threats to global public health security. The report explains how the revised International Health Regulations (2005), which came into force this year, helps countries to work together to identify risks and act to contain and control them. The regulations are needed because no single country, regardless of capability or wealth, can protect itself from outbreaks and other hazards without the cooperation of others. The report says the prospect of a safer future is within reach - and that this is both a collective aspiration and a mutual responsibility.

Chapter 2 of the report presents examples of several categories of threat. WHO believes that the absence of any major, widespread communicable disease outbreak in recent decades has lulled people into a false sense of security. And that's exactly the attitude Revere and DemfromCT have tried to shake up by the focus on H5N1 influenza. But by offering a broader range of concerns, I believe the WHO is more persuasive and also provides a more sound basis for effective planning. WHO first discusses the worldwide HIV epidemic to illustrate the importance of surveillance. They then discuss the following categories of public health emergency:

Emergencies created by armed conflict. Trying, I suppose to avoid getting embroiled in current politics, they do not discuss Iraq but rather recent conflicts in Africa such as the Angolan civil war that ended in 2002. Iraq, however, is very much on point today, with the collapse of the public health and health care infrastructure now further complicated by an incipient cholera epidemic.

Microbial drug resistance. This is a major, looming threat to humanity which I have discussed here before. Since the latter half of the 20th Century, we have just taken it for granted that children will live to adulthood and that a minor wound or a sore throat isn't going to end up killing us. If we lose antibiotics, we'll be back in the 19th Century with a 45 year life expectancy. It's really that simple.

Animal husbandry and food processing. Okay, here's where they could have talked about bird flu, but they use instead the example of Nipah virus, which emerged in Malaysia in 1998 and turns out to have come from pigs. It did not, fortunately, become human-to-human transmissible on a large scale but there is evidence that it may be developing that capability. Who needs bird flu?

Weather-related events and infectious disease. The current African floods have this on the front page. Will we have a typhus or cholera outbreak the next tie New Orleans is destroyed?

"Other" public health emergencies -- chemical or radiological events, whether intentional or accidental, or even natural.

We absolutely need to be promoting emergency preparedness as an essential role of government, in partnership with private institutions and communities. Let's have the vision and courage to encompass the full range of dangers confronting us and base our preparations on a comprehensive understanding of the threats to public health.

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