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Bird Flu and Public Health Systems: Lessons of History

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(image: Wikipedia Commons)


Here we go again!  In the last couple of weeks there has been a lot of media buzz about the outbreak of H7N9, a new deadly bird flu virus in China, centered in Shanghai and surrounding provinces and now reported in Beijing.  This outbreak follows the global panic and economic and travel disruptions caused by the severe acute respiratory syndrome, or SARS, in 2003 and the H5N1 avian influenza outbreak in 2006. 


Compared to previous episodes, according to The Economist, this time the government response in China has been “far swifter and more open.” Does this mean that across the world governments have adopted policies and made the necessary investments to develop and strengthen essential public health infrastructures to respond effectively to this type of public health crisis?


I would say the answer in many countries is “no.”  Disease surveillance systems, public health laboratory networks, and epidemiological intelligence capacity, which are critical for understanding how infectious diseases spread and mounting an effective response, continue to be the most deteriorated, underfunded, and often underdeveloped, components of the health systems.


So what can countries do to be ready to deal with the spread of viruses such as H7N9 and outbreaks of infectious diseases that transcend national borders and swiftly move across continents, making governments, businesses and the population jittery?


Country experiences show that a coordinated effort is needed to identify the strengths and weaknesses in veterinary and public health systems, and develop interventions to sustain good practices and bridge gaps to tackle the animal and human health dimensions of infectious diseases such as bird flu.


Building strong bridges between systems, institutions and professions is critical to promoting effective prevention and response to contagious diseases arising at the animal-human and ecosystems interface. Such an approach is strongly advocated in a recent World Bank Public Health Policy Note, Connecting Sectors and Systems for Health Results, and is key to addressing the “diseases of today and tomorrow,” to paraphrase Dr. Jim Yong Kim.


This implies, as countries such as Argentina and Brazil have done with the support of the Pan American Health Organization and the World Bank, that governments need to prioritize the adoption of policies and target investments to develop and maintain institutional capacity at the national and local levels to perform essential public health functions.


Such functions include: 1)  monitoring, evaluation, and analysis of  population health status; 2) surveillance, research, and control of the risks and threats to public health; 3) health promotion;  4) social participation in health; 5) development of policies and managerial capabilities to support public health efforts; 6) public health regulation and enforcement capacity; 7) evaluation and promotion of equitable access to necessary health services;  8) human resources development and training in public health; and 9) reduction of the impact of emergencies and disasters on health.


The lessons of history clearly demonstrate the importance for countries of having well-developed public health systems (the latter not to be confused, as is often the case, with medical care services delivered in clinics and hospitals run by Ministries of Health or other public entities). 


Just as the spread of “pestilences” in the Latin American and Caribbean colonies during the early 16th century was facilitated by maritime trade and required first quarantine systems, new laws and regulations, sanitation campaigns in the major port cities, and eventually the creation of ministries and departments of health to administer the public health functions to control the spread of diseases that disrupted trade (e.g., yellow fever) and agricultural production (e.g., hookworm disease, malaria), in the 21st century, newly emerged and re-emerging infectious diseases threaten the entire global community and require similar systemic efforts.


I would argue, then, that efforts to address the systemic deficiency of public health systems and to build the institutional capacity for performing essential public functions should be a priority component of any global health initiative for the post-2015 period. After all, the prevention and control of infectious disease epidemics that extract a heavy human, economic and social toll are a "global public good" that merits priority support from national governments and the international community, including the World Bank.



Follow the World Bank health team on twitter: @worldbankhealth






"Crying wolf? Contagion is a real threat!"



Patricio V. Marquez

Former World Bank Group (WBG) Lead Public Health Specialist

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