Global health: current issues, future trends and foreign policy

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					■ CONFERENCE REPORTS                                                                     Clinical Medicine 2009, Vol 9, No 3: 247–53




Global health: current issues, future trends and foreign policy

Daniela Kirwan


Introduction                                                              Increasing population densities have led to increased contact
                                                                       between humans and livestock, facilitating the evolution and
With increasing global connectivity, the impact of an event            transmission of zoonotic infections. Furthermore, the exponential
travels across today’s world with the speed of a broadband             increase in travel over the last four generations has huge implica-
internet connection. The relevance of national borders is              tions for infectious diseases. Over 4.5 billion individual air jour-
dwindling, and people and determinants of health flow freely in        neys are made every year, and each has the potential to carry dis-
every direction. It is no longer possible to address healthcare in     ease. The global aviation network map indicates that the largest
the UK without taking a global view.                                   and most interesting change is occurring over China; the problems
   This timely conference followed a series of publications            of a rural Chinese village have become the problems of the world.
including Lord Crisp’s Global health partnerships and Sir Liam            The severe acute respiratory syndrome (SARS) outbreak in
Donaldson’s Health is global: proposals for a government-wide          2003 alerted the world to the inadequate international notifica-
strategy.1,2 The ambitious programme drew together a range of          tion mechanisms. This zoonotic infection began in a rural
key players in global health who addressed many challenges             Chinese province, spread swiftly to Hong Kong, and within a
facing those working in the field, and proposed positive mea-          week had infected 8,000 people worldwide. Analysts found that
sures to take old and new collaborations forward.                      there had been a series of delays in reporting the outbreak,
   The conference was energetic and facilitated networking and         allowing it to gain a foothold. The International Health
sharing of ideas between politicians, policy makers and clini-         Regulations (IHR) mechanism for disease notification dated
cians. The eminence of the speakers and enthusiasm of the del-         back to 1969 and focused on the main infectious threats of the
egates highlighted the abundance of expertise, political will, and     time: cholera, plague, and yellow fever. SARS led to the realisa-
sheer number of healthcare professionals with an interest in           tion that a new, more relevant, formal network for alerting and
global health.                                                         communicating between countries was needed.
                                                                          The World Health Assembly passed a resolution in 2005 to
The changing context: epidemiology                                     ‘prevent, protect against, control and provide a public health
and public health challenges                                           response to the international spread of disease’, and to do this ‘in
                                                                       ways that are commensurate with and restricted to public health
Although changes in health indicators have been favourable             risks, and which avoid unnecessary interface with international
overall, distribution of gains has been unequal. Despite a             traffic and trade’. The new regulations affirmed each country’s
global decline in population numbers and density, there is             duty to participate in global surveillance. National IHR focal
rapid growth in areas of Asia, and severe exceptions in life           points must now notify all potential international public health
expectancy improvements exist; for example, the HIV/AIDS               emergencies and respond to requests for verification of reports
pandemic has contributed to the reversal of previous advances          within 24 hours, and disclose suspected risks in other areas.
in Zimbabwe, where life expectancy at birth is currently only             During the SARS response, the World Health Organization
40.9 years.3                                                           (WHO) used a pre-existing laboratory network with impressive
   The dramatic changes in global food prices, with rice prices        results: within six weeks, the pathogen had been isolated and its
reaching an unprecedented $1,000/ton on the week of the con-           genome sequenced. This was an astounding response, but did
ference in April 2008, have brought food provision to the fore-        not lead to the termination of the epidemic, which thankfully
front of public health concern. The effect is felt the most in areas   burnt out by itself. We were lucky. WHO has now developed an
least able to cope with the problem. In sub-Saharan Africa, a          Integrated Capacity Development for Laboratory Specialists,
consequential rise in child undernutrition is anticipated, and         with a vision of the earliest possible detection of epidemic
although unlikely to face starvation, South-East Asian countries       threats through a network of effective diagnostic laboratories. A
will suffer severe economic difficulties following reduced rice        training programme based on world regions aims to support
exportation. As gross domestic product (GDP) falls mortality           areas with a poor laboratory network, in order to achieve a sus-
rises, and the long-term impact on this region must not be             tainable improvement in laboratory infrastructure.
underestimated.4                                                          Despite these recent effort
				
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