User:Lili7777/sandbox

Health Security is a concept defined by the activities required to minimise the danger and impact of public health events. This definition extends across geographical regions and international boundaries.

Historically, factors that have given rise to health security concerns include population growth, globalisation, urbanisation, environmental degradation and the misuse of antimicrobials. Unparalleled global connectivity and travel places emerging diseases at the forefront of health security concerns. Health issues such as HIV, pandemic influenza, Ebola and COVID-19 have encouraged the development of preventative and response frameworks by governments and international institutions.

There are many stakeholders that contribute to global public health outcomes, including governments, NGO’s, corporations as well as medical professionals. The WHO plays a role in coordinating international health outcomes through the United Nations. However, the WHO has faced criticism due to differences in countries ability to achieve equal health goals. Policy makers in industrialised countries emphasise protection of their populations against external threats. Developing countries instead work within the UN framework to interpret the term as a broader public health issue. Criticism also has arisen due to fears the term ‘security’ can be used to justify hidden national security agendas. There are four types of security that are relevant in this context: biosecurity, global health security, human security and national security. Health Security covers several fields and disciplines and complex issues have prevented a uniform understanding of the concept. The top of crisis agenda includes; consequences of a 1918 influenza pandemic, antimicrobial drug resistance, outbreaks of critical regional importance and the prospect of intentional use of biologic agents.

History of Health Security Over the past century, society has witnessed both public health achievements and challenges. Health Security has emerged as an issue due to population growth, rapid urbanization, environmental degradation, and the misuse of antimicrobials. Human mobility, economic interdependence and the globalisation of supply chains add to the threat of rapid international spread of infection.

Technological developments have played a pivotal role in providing safe water, sewage and food distribution systems which contribute to the health of society. Refrigeration of pathogen vulnerable food and pasteurisation of milk supplies are examples of this. Smallpox eradication and major gains for global immunisation led by the World Health Organisation in the 1970s were believed to be major developments to combat the threat of pandemics.

During the outbreak of HIV/Aids in the 1980s, the difficulty of vaccination as a basic public health activity, quadrupling of human population and the unprecedented level of global travel and trade facilitated rapid spread of infection. Coincidingly the threat of an antimicrobial drug resistance changed the worlds view on managing and treating life threatening infections. This placed pressure on governments and organisations to re-consider measures to ensure Health Security. Poverty, inequality and social determinants of health determine transmission rates of infectious diseases, resulting in unequal burdens of morbidity and mortality.

An outbreak of severe acute respiratory syndrome in 2003 indicated the need for a rapid detection mechanism that was able to respond to an international outbreak. This was reiterated by the 2009 pandemic of influenza A(H1N1) which was considered a demonstration of the world’s ill-preparedness for health emergencies. A plethora of challenges such as Cholera in Haiti (2010), Middle East respiratory syndrome coronavirus (MERS-CoV) (2012), chikunguna (2013), Zika (2015), yellow fever (2015-16) and notably the Ebola epidemic further emphasised the prevalence of global deficiencies.

Consequentially the International Health Regulations (2005) and the Global Health Security Agenda (GHSA) (2014) were created to develop co-ordination and accountability internationally. GHSA was launched by 29 countries, the WHO, the Food and Agriculture Organisation of the UN and the World Organisation for Animal Health. The agenda aims to strengthen global means to prevent, detect and respond to infectious disease threats, whether naturally occurring or a biologic agent. GHSA aims to close gaps in preparedness and accelerate progress towards protecting the world from infectious disease threats. The GHSA has 11 areas called action packages targeted to prevent avoidable catastrophises through immunisation and biosecurity, detect threats through surveillance, respond rapidly by linking public health and law enforcement and establishing Emergency Operation Centres.

In 2019 the Global Health Security Index was published. This measures the differences between the 195 countries measured in combatting epidemics or pandemics. In June 2019, over 800 members of the Global Health Security community gathered in Sydney Australia to participate in the first International Scientific Conference on Global Health Security. Representatives from both governmental and non-governmental organisations across 65 countries participated. The “Sydney Statement on Global Health Security” was the product of this conference. Members of the summit agreed on the definition of Global health security as a state of freedom from the scourge of infectious disease, irrespective of origin or source. It is achieved through the policies, programmes, and activities taken to prevent, detect, respond to, and recover from biological threats.’ The summit also concluded 7 principles that should guide addressing global health security threats.

The outbreak of Coronavirus disease (COVID-19) in 2020 is the most recent example of a global pandemic. Believed to have originated in the Wuhan province of China, January 30 2020 saw the WHO officially declared this outbreak an international public health emergency. The WHO characterised the situation as a pandemic on March 11, 2020 due to measurements of spread, severity and inaction. This triggered country worldwide to implement differing rapid response frameworks. A combination of mitigation and containment regulations were deemed necessary due to the risk of surges in demand for hospital beds and the need to protect those vulnerable to infection. This included contact tracing, social distancing, the promotion of self-isolation measures and public health measures such as handwashing. China’s response framework included strict quarantine, isolation of infected populations and social distancing. These strict measures were shown to reduce the impact of the virus. Countries such as Australia, New Zealand, Singapore and South Korea have reiterated the importance of government intervention to implement these measures. Governments developed health security frameworks with aim of balancing the importance of social distancing and economic repercussions. Epidemiologists have to engage with policy makers to decide the main objectives of mitigation, being rates of infection and economic shutdown. Attention was also brought to health systems, particularly public health systems to prepare for infection control.

Inequities between public health security frameworks have led to varied distribution of case and mortality statistics. Countries with lower levels of government intervention in health care and inadequate policy responses have had higher mortalities. Social determinants of health are linked to infectious diseases. These factors include poverty, race, marginalization and physical environment.

World Health Organisation The World Health Organisation (WHO) works within the United Nations System to coordinate inter-governmental health security frameworks. The WHO aims provide a healthier future globally by combatting communicable and noncommunicable diseases within 194 member states. The WHO consists of 7000 people working in 150 country offices, six regional offices and at their headquarters in Geneva Switzerland. The WHO supports countries to coordinate both governments, other organisations (such as funds and foundations) and the private sector by supporting national health policies and strategies.

The WHO plays a pivotal role in creating a uniform globalised approach to Health Security. Their mission of helping countries ensure the safety of individuals focuses especially on the poorest and most vulnerable in the global community. This includes facing emergencies and monitoring health consequences resultant from any occurrence. The WHO undertakes proactive and reactive activities to minimise the vulnerability of citizens to acute public health events. This strives to ensure the collective health of international populations. Often, health emergencies can have significant social, economic and political impacts that last beyond the health crisis itself. The WHO hopes to guide policy-makers to anticipate the health needs of people affected by health crises to save lives and stop them from escalating Recommendations from the WHO include strengthening stewardship, implementing health systems preparedness, planning a continuous process with a multi hazard approach, establishing sustainable crisis management and health risk reduction programmes in health ministries and establishing multisectoral coordination mechanisms.

The International Health Regulations (IHR) (2005) were “to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade”. The WHO intended for these regulations to not be limited to specific diseases or time, to ensure the long-lasting relevance of international response framework to the emergence and spread of disease. This document provides a legal basis for many health regulations within travel, transport and sanitary protections in international airports, ports and ground crossings. IHR (2005) also requires all countries to develop, strengthen and maintain eight core public health capacities. These core capacities cover: (i) national legislation, policy and financing; (ii) coordination and national focal point communications; (iii) surveillance; (iv) response; (v) preparedness; (vi) risk communication; (vii) human resources; and (viii) laboratory. The World Health Assembly in 2015 identified a need to evaluate and share the lessons learnt from countries that have implemented IHR (2005).

The WHO has specific responsibilities under the IHR, and their health security interface coordinates the efforts of international organisations, military doctors, armed forces and law enforcement. The WHO has delegated authority for eradicating infectious diseases and guides R&D collaboration to develop new vaccines and treatments for epidemic-prone diseases. The WHO has come under criticism during the COVID-19 pandemic due to accusations of failing to exercise global health leadership, whilst simultaneously providing a resource for Chinese politics, control and propaganda.

Controversies

Obstruction of Civil Liberties Surveillance has been defined by the WHO as the ‘continuing scrutiny of all aspects of the occurrence and spread of disease that are pertinent to effective control.’ This is often collected without requiring individual patient consent, justified by the government’s asserted responsibility to protect the public’s health. There are many government and nongovernment stakeholders who provide and receive sharing. The development of global public health policy often is developed following a security rationale. This securitisation of global health has led to the development of security and surveillance technology, increasingly impeding on the privacy of individuals. Concerns of confidentiality and patient privacy have enabled restrictive policies on data accesses. The sacrifice of individual autonomy is considered to be justified to improve health, reduce inequities and prevent the health of vulnerable and disadvantaged individuals. The promotion of equitable sharing of public health surveillance data aims to reduce the spread and impact of infectious diseases. Public health surveillance data is considered to be ongoing and systematic with the aim to disseminate and utilise information in policy decision making.

Global health has become a didactic tool for government officials, health professionals and academics to argue for healthcare spending, new laws and regulations to enhance surveillance and curtail civil liberties’ These include but are not limited to contact tracing. nationalising national guard, travel ban and migration policy changes/

Global Distribution of Disease Burden The map pictured represents the unequal distribution of mortality and morbidity from infectious disease. Many European countries as well as Canada, Israel, South Korea, Taiwan Australia and the Maldives are considered to have the best health scores. The worst scoring of countries measures are predominately in Sub-Saharan Africa.

Generally, these factors are considered to create high ratings of public health: •	Biology and genetics •	Public policy and regulation, for example vaccination policy •	Healthcare •	Habits including diet and lifestyle factors such as smoking •	Social and environmental factors such as crime and pollution

Xenophobic Responses to Disease Threats There are historical examples that demonstrate newness of disease creates extreme insecurity and fear, including mass violence towards minorities. Persecution and blaming of minorities during times of crisis has also focused international regulations on protecting North American and European interests. Aggressive racist and xenophobic responses to disease disguised as health controls can be seen in the 1901 outbreak of the Black Plague in Cape Town. This saw forced removal of black populations as a part of racial segregation movements.

The history of anti-Chinese sentiment in relation to disease outbreak is evident, whereby quarantine measures were restricted to the city’s Chinatown in both Honolulu and San Francisco during the bubonic plague epidemic of 1900-04. Honolulu’s quarantines specifically limited employment, movement and access to supplies, as well as burning down Chinese owned and non-US properties near the harbour.

More recently, infectious disease control policies have been developed alongside national security concerns. Donald Trump claimed in his 2015 presidential campaign “Tremendous infectious disease is pouring across the border.” COVID-19  prompted verbal and physical attacks on people of Asian descent on the basis of minimising the danger of the spread of the virus. Donald Trump labelled the virus the “Chinese Virus,” with similar xenophobic sentiment displayed globally. This interrupted global supply chains and stock markets as huge sell offs occurred, prices dropped, and trading and travel bans were implemented.

The UN released a statement “COVID-19: UN Counters Pandemic related Hate and Xenophobia.” This statement protests against the hate speech, stigma, discrimination and xenophobia that has arisen due to COVID-19. The UN support migrants and refugees and chastises those who blame or vilify these minorities for spreading the virus. The UN made phone calls to migrants to check in on their wellbeing with positive response from recipients. According to the International organisation for Migration (IOM) migrants have been scapegoated for endangering native populations. As diseases are labelled as foreign, xenophobia has arisen as seen in cases of cholera, HIV/AIDs or the H1N1 influenza. The UN states that people of Asian have been stigmatised for spreading the virus. Further, antisemitic and anti-Muslimism conspiracy theories have been spread that have resulted in verbal and physical assault.

Xenophobic responses and associated stigma have also led people to hide their illness, causing reluctance to seek health care. This also impacts integration and social cohesion due to growing anti-migrant rhetoric and scapegoating in the public domain and online. This has led the UN to issue a ‘guidance to address COVID-19 hate speech’ document. These statements by the UN indicate the prevalence of discrimination concerns arising due to epidemics and threats to health security.

[1] WHO, 2020

[2] Colin McInnes

[3] William Alidis (2008)

[4] Ibid.

[5] Ibid.

[6] Michael T. Osterhold, 2017.

[7] WHO 2020

[8] Ibid

[9] WHO, 2020

[10] Michael T Osterholm, 2017

[11] Ibid

[12] Ibid

[13] Ibid.

[14] Kamradt-Scott A. (2015)

[15] Us Department of Health and Human Services, 2017

[16] GHS, 2019

[17] Ibid.

[18] Ibid.

[19] WHO, 2020

[20] WHO, 2020

[21] Ibid

[22] Ibid

[23] WHO, 2005

[24] Amitabh B Suthar a, Lisa G Allen b, Sara Cifuentes c, Christopher Dye d & Jason M Nagata e (2017)

[25] Ibid