By Melvin J. Howard
Global public health securitycovers a wide range of complex issues, including the health consequences ofhuman behavior, climate change, weather-related events and infectious diseases,as well as natural catastrophes and man-made disasters. Many people don’t thinkof national security when it comes to health care. But lets go back inhistory Europeans brought the first diseases against which theNative Americans had no immunity. Chicken pox and measles, though common andrarely fatal among Europeans, often proved fatal to Native Americans, and moredangerous diseases such as smallpox were especially deadly to Native Americanpopulations. It is difficult to estimate the total percentage of the NativeAmerican population killed by these diseases. Epidemics often immediatelyfollowed European exploration, sometimes destroying entire villages. Somehistorians estimate that up to 80% of some Native populations may have died dueto European diseases. Inaddition to the diseases brought over by the first wave of immigrants toHawaii, leprosy, whose origin is not known and for which there has never been acure, had a profound effect on the public health of native Hawaiians. Becauseof the social stigma attached to the diseases (it was mistakenly thought to bea venereal disease) as well as its extreme contagiousness, lepers were isolatedon the island of Molokai beginning in 1886. For 16 years, a Belgian priestnamed Demian Joseph de Veuster provided medical care for these patients, whomthe medical community refused to treat, before succumbing to the illnesshimself in 1889.
Compared toHawaiians of European and Asian ancestry, native Hawaiians have continued tobear the brunt of the archipelago's health problems. Whereas Hawaii as a wholeboasts the longest average life span of any state (males live an average 75.37years, females, 80.92 years), the death rates of native Hawaiians at all agesare above average. The infant mortality rate for native Hawaiians is 6.5 per1,000 live births. In addition, native Hawaiians experience high rates ofdiabetes and hypertension. Health workers consider poor diet a major factor,and economic problems undoubtedly contribute to this situation.
Then there was thedreaded 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 shortperiod,. Thousands of people died each week. This plague killed entire familiesat a time and destroyed at least 1,000 villages.Once a family member had contracted the disease, the entire household wasdoomed to die. Parents abandoned their children, and parent-less childrenroamed the streets in search for food. If the people weren't dead they ran awayin vain attempts to save themselves. Victims, delirious with pain, often losttheir sanity. Life was in total chaos. The Black Death struck the Europeanpeople with very little warning. They did not understand the causes of infectiousdisease, or how they spread. They did not have the ability to understandwhere this sudden cruel death had come from. And they did not know whether itwould ever go away. The Plague was a disaster without a parallel, causingdramatic changes in medieval Europe, contributing to what is called the Crisisof the Fourteenth Century.
National Security
The Obama's administration
National Security Strategy, is a 52page 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 unilateralmilitary action," the policy puts "heavy emphasis on the value ofglobal cooperation, developing wider security partnerships and helping othernations defend themselves." The strategy also outlined the importance ofimproving the U.S. economy for national security "through bettereducation, national
debt reduction, a stronger
U.S.clean energy industry, greater scientific research and a revamped healthcare system. In
the strategy President Obamawrites that the U.S. Armed Forces "will always be a cornerstone of oursecurity, but they must be complemented." Obama adds, "Our securitydepends on diplomats who can act in every corner of the world ... development expertswho can strengthen governance and support human dignity. Part of the documentfocuses on promoting national security through
globalhealth and related efforts. "Thefreedom that America stands for includes freedom from want. Basic human rights cannot thrive inplaces where human beings do not have access to enough food, or clean water, orthe medicine they need to survive," the document states, noting the U.S.role in assisting with efforts to achieve the U.N. Millennium DevelopmentGoals.
The strategy cites examples of how the U.S. aims to"promote dignity ... through development efforts." They include, theGlobal Health Initiative (GHI), U.S. foodsecurity programs and leadership inhumanitarian crises. The U.S. "has a moral and strategic interest in promotingglobal health. When a child dies of a preventable disease, it offends ourconscience; when a disease goes unchecked, it can endanger our own health; whenchildren are sick, development is stalled," according to a section of thedocument that focuses on the GHI. On food security, the document states thatinstead of simply providing aid for developing countries, we are focusing onnew methods and technologies for agricultural development. This is consistentwith an approach in which aid is not an end in itself – the purpose of ourforeign assistance will be to create the conditions where it is no longerneeded. We are promoting child and maternal health. We are combating humantrafficking, especially in women and girls, through domestic and internationallaw enforcement. And we are supporting education, employment, and micro-financeto empower women globally. Global public healthsecurity depends on actions to prevent and respond to threats that endanger thecollective health of the global population. Those threats have an impact oneconomic or political stability, trade, tourism, access to goods and servicesand, if they occur repeatedly, on demographic stability.
Environmental threats to global health security
Non-occupational human exposure to arsenic in theenvironment is primarily through the ingestion offood and water. Of these, food is generally the principal contributor to thedaily intake of total arsenic. In some areas arsenicin drinking water is a significant source of exposure to inorganic arsenic. Inthese cases, arsenic in drinking water often constitutes the principalcontributor to the daily arsenic intake. Contaminated soils such as minetailings are also a potential source of arsenic exposure. Inorganic arseniclevels in fish and shellfish are low. Foodstuffs such as meat, poultry, dairyproducts and cereals have higher levels of inorganic arsenic. Pulmonaryexposure contributes to smokers and non-smoker alike, and more in pollutedareas. The concentration of metabolites ofinorganic arsenic in urine (inorganic arsenic, MMA and DMA) reflects the absorbeddose of inorganic arsenic on an individual level. Exposure ofthe general population to arsenic occurs mainly through food and water and inmost areas, food is the main source. Arsenic in food is mainly in the form oforganic arsenic, which is generally thought to pose less health problems thaninorganic arsenic. About one-quarter of the arsenic present in the diet isinorganic arsenic, mainly from foods such as meat, poultry, dairy products andcereals. Fish and shellfish contain the highest concentrations ofarsenic, 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 watermay be the main source of intake. In drinking water, arsenic is present inthe more toxic, inorganic form. Contaminated soils such as mine tailingsare also a potential source of arsenic exposure.
Urbanization, increasing international trade and travel hascontributed to the rapid spread of viruses andinsects that carry them. For instance, dengue causedan unprecedented pandemic in 1998, with1.2 million cases reported to the WHO World HealthOrganization in 56 countries. Since then, dengue epidemics havecontinued and have affected millions of people from Latin America to South-EastAsia. Globally, the average annual number of cases reported to WHO has nearlydoubled in each of the last four decades. Surveillance is crucial for public health securityand without it, it is impossible to detect and respond to emerging healththreats. For instance, HIV and AIDS had perhapsbeen occurring for many years in Africa and Haiti but had not been detected dueto inadequate surveillance and health systems in these developing countries. Thisnew disease was only brought to international attention when the first fewcases appeared in the United States. Even then, the disease was not detected bysurveillance systems but by chance, when epidemiologists noticed an unusualnumber of orders for drugs to treat a rare infection thatis common in AIDS cases.
The behavior of individuals at all levels – politicalleaders, policy-makers, military commanders, public health specialists and thegeneral population – can have major health consequences, both negative andpositive. Threatsto public health security such as natural disasters, epidemics ofinfectious diseases, chemical and radioactiveemergencies or other health events, can have one or more causes. The causes maybe natural or man-made, environmental or industrial, accidental or deliberate,and in many cases related to human behaviour. Public health is undermined notonly by human action but also by the lack thereof. Complacencyand a false sense of security can tempt governments to reduce spending onpublic health and to scale down prevention programmes with potentiallydisastrous consequences for collective global health.
