Environment, Emerging Health issues and recommendations

Outline Of Presentation Definition of Health Emerging health issues Reasons for emerging health issues Examples Recommendations

HEALTH Recent work on the concepts of health, disease and related notions has suggested that health in an individual is a matter of that individual having the resources to cope with her needs (Nordenfelt, 1987, 2001, 2007; Kovacs, 1998; Bircher, 2005). While there are differences in the details of such accounts, the basic idea seems plausible.

Defining health The most commonly quoted definition of health is that formalized by the World Health Organization (WHO) over half a century ago; “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity.” Bircher(Bircher, 2005,338).defines health as “a dynamic state of well- being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility”.

Emerging health issues Emerging health issues are those that pose either a threat or relief from threat to the overall health of the population. An emerging issue can be a disease or injury that has either increased incidence or prevalence in the past decade or threatens to increase in the near future. It can also be a “horizon issue” that has just begun to develop in our society and the future public health effects of which are uncertain. It can as well be an increased visibility in a long-standing health issue that continues to obstruct the public health goal of reducing death and disability

 Defining ……  Re-emerging infectious disease Infectious agents that have been known for some time, had fallen to such low levels that they were no longer considered public health problems & are now showing upward trends in incidence or prevalence worldwide

Emerging health issues contd… The emerging issues affecting health status reflect the dramatic changes in our society and environment. Personal and population health status are broadly defined to include, the physical environment (e.g. air and water); the socio-economic environment (e.g. poverty, age); the personal health habits of the population (e.g. smoking, use of seat belts); and the presence of disease and injury. Each of these areas evolves and affects the overall health status of the population.

AIDS Avian Influenza Ebola Marburg Cholera Rift Valley Fever Typhoid Tuberculosis Leptospirosis Malaria Chikungunya Dengue JE Antimicrobial resistance UP Guinea worm Smallpox Yaws Poliomyelitis Measles Leprosy Neonatal tetanus DOWN Infectious Diseases: Transitional trend

Climate & Environmental Changes Deforestation forces animals into closer human contact- increased possibility for agents to breach species barrier between animals & humans El Nino- Triggers natural disasters & related outbreaks of infectious diseases (Malaria, Cholera) Global warming- spread of Malaria, Dengue, Leishmaniasis, Filariasis

Poverty, Neglect & Weakening of Health Infrastructure  Poor populations- major reservoir & source of continued transmission  Poverty- Malnutrition- Severe infectious disease cycle  Lack of funding, Poor prioritization of health funds, Misplaced in curative rather than preventive infrastructure, Failure to develop adequate health delivery systems

Uncontrolled Urbanization & Population Displacement Growth of densely populated cities- substandard housing, unsafe water, poor sanitation, overcrowding, indoor air pollution. Problem of refugees & displaced persons Diarrhoeal & Intestinal parasitic diseases, Lyme disease (B. burgdorferi)- Changes in ecology, increasing deer populations, suburban migration of population

Human Behaviour Unsafe sexual practices (HIV, Gonorrhoea, Syphilis) Changes in agricultural & food production patterns- food- borne infectious agents (E. coli) Increased international travel (Influenza) Outdoor activity

Bioterrorism Possible deliberate release of infectious agents by dissident individuals or terrorist groups Biological agents are attractive instruments of terror- easy to produce, mass casualties, difficult to detect, widespread panic & civil disruption

HUMAN ANIMAL S ENVIRONMENT VECTORS Zoonosis Population Growth Mega-cities Migration Exploitation Pollution Climate change Vector proliferation Vector resistance Transmission Antibiotics Intensive farming Food production Occurrences and interactions of Emerging health issues

Examples of recent emerging diseases Source: NATURE; Vol 430; July 2004;

Recommendations Public health surveillance & response systems High level commitment is crucial for rapid containment. Global partnerships & rapid sharing of data/information enhances preparedness and response Rapidly detect unusual, unexpected, unexplained disease patterns Track & exchange information in real time

Recommend…. Internet-based information technologies Improve disease reporting Facilitate emergency communications & Dissemination of information Human Genome Project Role of human genetics in disease susceptibility, progression & host response

Recommend…. Microbial genetics Methods for disease detection, control & preventio Improved diagnostic techniques & new vaccines Geographic Imaging Systems Monitor environmental changes that influence disease emergence & transmission

Recommend…. Strengthened response capacity Political commitment & adequate resources to address underlying socio-economic factors International collaboration & communication