Creating a new normal with a new global public health system – World

By Frederick M. Burkle

“Ask a big enough question and you need more than one discipline to answer it,” said modern dance legend Liz Lerman.

As the COVID-19 pandemic spread across the world, the World Health Organization (WHO) warned that there would be no going back to normal. They knew that failure to make timely and accurate public health decisions in the event of a pandemic would prove to be the “difference between life and death.” How correct they were.

The problem: global pandemics without a global public health management system

In the early stages of COVID-19, key public health decisions in the United States about prevention and preparedness were not made by public health experts. Instead, experts have been systematically ignored, suppressed and taken over by political and economic decision makers. For this reason, at the start of the pandemic, traditional hospital and community care providers – trained to diagnose and care for individual patients – were increasingly confronted with rapidly and widely emerging public health and triage decisions. expanses that have impacted large populations far beyond their local community. community. Population-based management systems refer to the engagement and coordination of social and structural factors that focus on entire communities, states, and nations, rather than individuals. Traditional health care providers have not been trained to work at this scale.

Public health professionals are trained to create healthy communities through community-wide chronic disease prevention, education, and surveillance in their patients. However, they were also unprepared to handle the growing population-based decisions that the global pandemic demanded of them, resulting in more political decision-making.

To deal with this magnitude of challenges, the primary tool for public health professionals is current demographic data. Globally, the WHO surveillance network collects data from all countries, but few national datasets can detect outbreaks or adequately warn relevant public health agencies and the public.

Many public health departments have struggled in the past to successfully manage infectious disease outbreaks, such as the H1N1 and SARS outbreaks. Past outbreaks in the United States have required additional expertise and testing from the Centers for Disease Control and Prevention (CDC) to be sent to individual states, but lessons learned on how to continuously provide more expertise in public health to communities, states and nations were not heard.

Outcome: We must build a universal system for future global health challenges

Public health professionals normally work behind the scenes in the prevention, preparedness, vaccines, and control of infectious and environmental diseases. They often describe themselves as the “invisible health profession”, but members of the profession are largely responsible for the majority of improvements in life expectancy around the world.

It became increasingly clear that the key to success required public health professionals practicing population-based management with a strong multidisciplinary public health workforce, current demographics, and leadership at all levels of society. For example, in the COVID-19 pandemic, this management scale involved identifying public safety measures – such as social distancing and mask-wearing to reduce the spread – as well as managing the development and delivery of vaccines. and sort out the management of scarce resources. Many of these crucial decisions were initially delayed, mismanaged or ignored due to political interference.

What should be done ?

To improve global public health, WHO should lead the creation of a global public health system. To support its adoption, WHO should lead the creation of:

  1. a fully independent and well-resourced WHO and International Health Treaty, with global authority under the aegis of the United Nations;
  2. a highly trained and multidisciplinary public health workforce focused on population-based management teams (PBMTs) serving all population centers in each country;
  3. a global public health database that monitors and maintains essential public health data that every PBMT needs, from the outset, to manage any epidemic, epidemic and pandemic in the world;
  4. and, the development of CDCs in each country or region (see Figure 1).

Under this model, permanent, highly trained PBMTs would be placed in each CDC regional or country office and would be led by public health experts trained in the entire “disaster cycle” of crisis management (prevention , preparedness, response, rehabilitation, recovery) . Figure 1 shows how the system would have PBMT professionals at national and international levels communicating and coordinating, as well as the constant data provided by the Global Public Health Database. This would optimize efficiency at all levels of the “disaster cycle” by emphasizing prevention and preparedness between pandemics and coordinating responses and recovery during and after pandemics.

PBMTs would be managed by public health experts with interdisciplinary expertise, trained as health crisis managers and scientists. PBMTs would improve early detection, prevention, preparedness and response in every community, basing their decisions on what the global public health database reveals every day. Similar to how traditional healthcare providers are equipped with individual patient histories for those they serve, the Global Public Health Database would help PBMTs understand, monitor and respond quickly to the region they serve. serve.

Between crises, regularly updating and reviewing the global database would prepare MTBPs to identify vulnerabilities that need attention, improve those vulnerabilities, and develop appropriate responses in the event of a future crisis. For example, the social distancing and masking strategies developed for the current pandemic were developed by understanding population densities and pockets of vulnerable populations such as the poor and the elderly.

CDCs in each country or region supported by the Global Public Health Database would report to both WHO and relevant government authorities, strengthening their role as an essential communications resource and nonpartisan decision-maker.

Conclusions: how to improve global health

We must demand a global public health system and create incentives to support it. This will involve addressing and managing more than just pandemics, as the Global Public Health Database could also alert and identify public health decision-makers where lack of prevention and preparedness was contributing to worsening climate change, deforestation, unsustainable urbanization, population migrations and working to resolve multiple crises such as conflicts and food and water insecurity.

Non-medical professionals can also help improve the global public health system. Progress is underway. Over the past two decades, public health has generated considerable interest among the non-medical community, including students of law and economics, which will greatly contribute to the interdisciplinary and multidisciplinary requirements and understanding of public health decisions based on the population. Organizations such as the Wilson Center could use their unique expertise to develop a multidisciplinary forum for discussion and debate. These organizations could help society identify gaps in public health or potential ways to mitigate these gaps, both in policy and in practice. Think tanks could also organize a forum for deans of schools of public health to discuss how their responsibilities, roles, teachings, and multidisciplinary decision-making roles for impending crises need to be reconsidered.

Public health must move from a passive and narrow focus on health and medicine to leading the proposed global public health system. The model suggested here would institutionalize the global system and an increasingly interdisciplinary professional network would further support it.

Dr. Frederick M. Burkle, Jr., retired professor, is now a senior fellow and researcher at the Harvard Humanitarian Initiative, Harvard University and Harvard TH Chan School of Public Health, and a Wilson Center Global Fellow.

Sources: Centers for Disease Control and Prevention, CNBC, Kaiser Family Foundation, Minnesota Department of Health Center for Public Health Nursing, Prehosp Disaster Med., The Harvard Gazette, and Tohoku J Exp Med.


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