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Question 1

Salama et al (2004) have defined complex emergencies situations involving an unprecedented increase in crude mortality rate among civilians in the immediate aftermath of armed conflicts. Waldman and Martone (1999) have characterized complex emergencies as situations involving organized violence within either failed or collapsed regimes. The occurrence of complex emergencies is conducive to the increased prevalence of food scarcity, the displacement of civilians, and the transmission of communicable diseases, such as diarrheal diseases, measles, malaria and acute respiratory infections (Toole and Waldman, 1997). Based on the multiplier impact of complex emergencies on public health, complex emergencies tend to become burdensome on public health and mediate a number of health issues.

The magnitude of complex emergencies involving significant health issues warrants the response of the international community, which can either be humanitarian or development aid. Humanitarian aid is designed as to save as many lives as possible and ameliorate the situation during or following complex emergencies, while development aid is designed to help recipients combat underlying issues such as poverty which can retard the process of economic and social development.

Due to the urgent nature of these complex emergencies, there exists a hierarchy of priorities in humanitarian response which needs to be followed. These priorities include, but not limited to:

  1. Initial assessment
  2. Measles immunization
  3. Water and Sanitation
  4. Food and nutrition
  5. Shelter and site planning
  6. Health care in the emergency phase
  7. Control of communicable diseases and epidemics
  8. Public health surveillance
  9. Human resources and training
  10. Coordination between governments and non-state actors

Vaccination against measles

Mediated by displacement, overcrowding and substandard hygiene, measles is incontrovertibly the most prevalent health problem following a complex emergency. Measles is most critical among children in particular. Therefore, it is critical to ensure that every child is vaccinated against measles (Pacquet, 1992).

Water and sanitation

The supply of drinking water and standard sanitation among affected people is key as it can militate against the transmission of a number of serious communicable diseases such as diarrheal disease. Therefore, both government and non-state actors involved in providing humanitarian assistance need to ensure that every person receives 15 to 20 liters of water daily. In addition to ensuring water supply, relief planners need make assessments and provide toilets and waste disposals based on the number of people affected.

Coordination between governments and non-state actors

The humanitarian assistance in the aftermath of complex emergencies involves a number of state and non-state actors, such as UN agencies, host governments, foreign donors and etc. Therefore, for the response to be effective and efficient, it is essential that relief planners coordinate with each other and assess activities which require assistance together.

Question 2

Like education and access to food, public health is a fundamental right incorporated in the Universal Declaration on Human Rights. Article 25 of the Universal Declaration on Human Rights equalizes the right to basic medical treatment to human rights, by stipulating that everyone is entitled to ‘the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…’.  There tends to be a positive relationship between human rights and public health, and these two

The basis for this positive correlation between human rights and public health is based on how the unavailability of basic health care services ultimately leads to a number of human rights breaches.

For instance, when a person is deprived of a right to education, he or she will not be knowledgeable about some communicable diseases such as STDs. Due to their inability to discern some diseases and be more proactive, these people will contract various communicable diseases, which causes a public health issue. Article 3 of the Universal Declaration on Human rights guarantees the right every individual to life, constituting a human right.

Maternal mortality is one of the public health issues which give testament to the inter-relationship between human rights and public health.  The death of women during or following pregnancy can be prevented with a number of viable public health programs (Ratsma and Malongo, 2009). The right to life of these mothers in countries such as Malawi is abrogated as they tend to be the most susceptible to deaths during or after pregnancy.

Deviating from the mutually exclusive relationship between human rights and public health, Tasiouslas and Vayena (2016) suggested that the concept of human rights is not congruent with public health.  Nonetheless, the above examples prove the otherwise, invalidating the findings of Tasiousls and Vayena (2016).

Overall, due to its multiplier impact on human development, access to medical care is a human right and its important role has been delineated above with reference to cases involving mental health and maternal mortality.  Therefore, public health is considered to be intertwined with human rights.

Question 3

Due to the number of multiple health problems such as diseases, disabilities, it can be taxing for health care providers, governments to identify the health issues which should take precedence over others. Therefore, the prioritization of health issues in public health is contingent upon a number of factors such as burden of disease, intervention efficacy, the cost-effectiveness of  an intervention, and political will. The burden of disease can help these actors to evaluate and assess the heath issues and allocate their limited sources accordingly. Therefore, they evaluate the burden disease as measured by a number of indicators including mortality, morbidity and etc.  Consequently, the burden of disease dictates which diseases need to be given priority over others when it comes to treatment. Even though there is no one-size-fits-all approach to calculating the burden of disease, it is still deemed as one of the most viable and credible indicators of relative importance.  On the other hand, the cost-effectiveness of intervention concerns determining whether or not public health interventions are cost-effective (Jamison et al, 1993).    Lin et a; (2016) has concentrated on whether or not public health intervention in the prevention of HIV in the USA was cost-effective and concluded that public health interventions in prevention in HIV was largely cost-effective, particularly when these public health interventions were targeted at high-risk populations.  Pagliccia and Perez (2012) has considered the role of political will in the context of Cuba and concluded that the recent improvements in public health were imputed to the political will of the Cuban Government. Overall, concepts such as burden of disease, intervention efficacy the, cost-effectiveness of intervention are key to the administration of public health.

Question 4

Socioeconomic status of an individual is a composite measure of their social and economic position in comparison to others and is predicated upon an individual’s income, educational background, financial security and social perceptions regarding a social status and position. Socioeconomic status of an individual has a significant bearing on their education, social mobility, and health, as there tends to be an almost positive relationship between a person’s socioeconomic status and their health.  Adler and Ostrove (1999) contend that the more advantaged individuals are, the better their health. The findings of Adler and Ostrove (1999) can be substantiated by numerous study, suggesting the concerns on the positive correlation socioeconomic status and health. The mortality rate among children under 5 in countries such as Sierra Leone is 316 per 1000 childbirths, while only 3 children per 1000 children under 5 prematurely die in countries such as Iceland (Marmot, 2005), testifying to the role of social and economic determinants of health.

Firstly, the positive correlation between can be illustrated by how people in poorer countries still tend to use biomass fuels such as wood, hay, dried leaf, cow dung and sea weed to cook or heath their homes.  The combustion of biomass releases detrimental smoke into the air, which is consequently inhaled by those who are close to the biomass being combusted.  There is concrete evidence that inhaling biomass combustion leads to a number of health issues such as lower respiratory infections and chronic obstructive pulmonary disease. The least harmful source of heat is electricity, used mainly in rich countries. Therefore, those using biomass to cook and heat are advised to switch to cleaner fuels. Secondly, the disparity in health between rich and poor countries can be attributed to how rich countries tend to have the requisite resources to ensure an effective and efficient health system, while poorer countries do not have that luxury. Finally, in most countries including US and Australia, access to medical care is contingent upon whether or not individuals have an insurance, which can be quite expensive.  Therefore, individuals in the lower end of the social hierarchy tend to be the most susceptible to a host of health problems.

Overall, socioeconomic status of an individual is one of the most important determinants is an important factor in health.

Question 5

Ebola (i.e. EDV) has pervaded much of West Africa during 2014, prompting an international humanitarian response. The effects of the Ebola outbreak were more unprecedentedly more pronounced in countries such as Liberia and Sierra Leone. The World Health Organization (WHO) has come to describe health systems in terms of six building blocks (i.e. components). These building blocks include (a) service delivery, (b) health workforce, (c) health information systems, (d) access to essential medicines (e) financing, (f) leadership and governance. The outbreak of Ebola and its aftermath in countries such as Liberia and Sierra Leone was a testament to how their health systems did not ensure each core component of a health system was in place. Firstly, the health systems of Liberia and Sierra Leone were overwhelmed and broke down primarily because of the unavailability of essential medicine including vaccination against Ebola. Consequently, the vaccines required to mitigate the dissemination of Ebola were not forthcoming, compelling the World Bank and other large donors such USA, Germany to donate a total of US$ 459 million.

Secondly, the role played by the last bridling block, (f) leadership and governance, is key and there have been voluminous researches indicate that proactive leadership on behalf of the leadership in Liberia was one of the key contributing factors to the unprecedented outbreak of Ebola in the country. For instance, the Liberian President did disclose the outbreak of Ebola in the country until July of 2014, retarding the treatment processes

Thirdly, unlike other countries such as Nigeria which were able to deploy qualified health workforce in response to Ebola outbreak, Liberia and Sierra Leone simply did not have the requisite resources. Nor did they have enough skilled health workers to help prevent Ebola from disseminating further.  Overall, the outbreak of Ebola has had the most impact on Sierra Leone and Liberia as there were significant problems with the core components or building blocks of the health systems in these countries.

Question 6

Gender-based violence (i.e. violence against women) is an all-encompassing term for any detrimental acts committed against a person without their will and is predicated on how women are perceived to assume a subordinate role in society. Gender- based violence can include crimes such as rape, domestic abuse, sexual harassment and etc. There are a number of categories of violence prevention: primary prevention, secondary prevention and tertiary prevention. The issue of gender-based violence is exacerbated by a number of social and physical factors. Therefore, the prevention and mitigation of gender-based violence entail addressing these social and physical factors which are conducive to the gender-based violence. These factors have been compartmentalized into three categories: society-level contributing factors, community-level contributing factors, individual level contributing factors. Subjection to gender-based violence makes women susceptible to a number of critical issues such as depression, harmful alcohol use, induced abortion, low birth rate and etc.

Primary prevention involves implementing programs with a view to reducing the number of women who are subject to gender-based violence and is proactive in nature as it is designed to prevent the victimization or perpetration of violence in the first place. Secondary prevention, on the other hand, is an intervention which aims to intervene in a gender-based violence and take steps to improve and ensure that future occurrences of gender-based violence are prevented. Regarding tertiary prevention, it concerns the development and implementation of programs and policies on a national level with a view of preventing and decreasing occurrences of gender-based violence and rehabilitate the perpetrators to ensure they do not become recidivists.

Question 8

Globalization has had a key impact on how communicable diseases disseminate and the methods used by to militate against them spreading further. For instance, globalization has been conducive to increased travel between countries, making the dissemination of communicable diseases easier. The impact of globalization on outbreaks of epidemics was illustrated in the case of Ebola. Governments, including the USA, have discouraged their citizens from traveling to Ebola-affected areas including Sierra Leone, Liberia, and Ghana because of how communicable the disease was. Furthermore, the US Government also required travelers from these two countries to fly out of US airports with screening procedures in place (Roberts,2014).

British Airways also suspended flights to countries such as Sierra Leone and Liberia, to prevent the dissemination of Ebola in the UK also.  Like Ebola, tuberculosis is considered a detrimental communicable disease and is more prevalent in developing countries (Gulshuakand MacPerson, 2004). The increased migration of individuals from developing countries has compelled the US and the UK Government to start requiring tuberculosis diagnosis from those wishing to immigrate to either country.

These viable examples give credence to how globalization has mediated a number of changes in how governments across the world respond to the disseminating of epidemics, which is accelerated by globalization. The examples also corroborate the findings of Fiddler (1996). Fiddler (1996) has considered the implications of globalization on the pervasiveness of communicable epidemics and concluded that the advent of globalization has been conducive to how even local outbreaks accelerate into global epidemics.

 

 

Question 7

The level of lead in paint on walls tends to be high, prejudicing the health of people who reside in the rooms. Therefore, it is key to responsible parties to inspect and remove any paint containing higher lead levels.

The New York City Housing Authority (NYCHA), a public-benefit corporation based in New York, provides housing to low and middle- income families with housing in New York City. Therefore, as a landlord, the New York City Housing Authority (NYCHA) is responsible for ensuring that the amount of lead in paintings is low with a view of protecting the health of its tenants. The New York City Housing Authority derogated and violate the duty by disclosing doctored data about the lead levels in its rooms to the State of New York. The corruption around the New York City Housing Authority (NYCHA) can be correlated to a number of concepts such as exposure, poverty and social determinants of health.

Lead is a chemical element which is heavy, gray metal, yet soft and flexible.  The exposure of individuals to lead can have culminated in a number of health issues such as anemia, weakness, and kidney and brain damage. Furthermore, exposure to high levels of lead can compromise the development of a baby’s brain. Therefore, it is key for public health administrators to ensure that individuals are not exposed to lead.

Reference

  • Toole MJ1, Waldman RJ, 1997. ‘The public health aspects of complex emergencies and refugee situations’. Annual Review of Public Health
  • Salama, P. et al 2004. ‘Lessons learned from complex emergencies over past decade’. The Lancet, Vol. 364. Issue. 9447
  • Waldman R, and Martone, G. 1999. ‘Public health and complex emergencies: new issues, new conditions. Annual Review of Public Health
  • Ratsma, Y and Malongo, J 2009. ‘Maternal health and human rights’. Malawi Medical Journal
  • Gulshuak, B and MacPerson, D. 2004. ‘Globalization of Infectious Diseases: The Impact of Migration’ Clinical Infectious Diseases, Vol. 38, Issue 12
  • Roberts, D. 2014. ‘US imposes Ebola travel restrictions on passengers from west Africa. The Guardian, accessed 6 May 2018 <https://www.theguardian.com/us-news/2014/oct/21/us-limited-ebola-travel-restrictions-west-africa>
  • Fidler, D. 1996. ‘Globalization, International Law, and Emerging Infectious Diseases’. Emerging Infectious Diseases. Vol. 2. Issue. 2
  • Tasioulas, J and Vayena, E. 2016. ‘Public Health and Human Rights’. JAMA
  • Lin et al. 2016. Cost Effectiveness of HIV Prevention Interventions in the U.S. Am J Prev Med
  • Pagliccia, N. and Perez, A. 2012. ‘The Cuban experience in public health: does political will have a role?’. International Journal of Health Servicez, Vol. 42. Issue 1
  • Jamison DT, Breman JG, Measham AR, et al., 2006. Disease Control Priorities in Developing Countries. New York: Oxford University Press.
  • Adler, N. and Ostrove, M. 1999. ‘Socioeconomic status and health: what we know and what we don’t.’ Ann NY of Academic Science
  • The Universal Declaration on Human Rights

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