Comm Med: International Health

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History of international health

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Disease in any part of the world is a threat to other countries.14th century brought out quarantine to protect against importation of plague for 40 days into Europe. This was the origin of international health as it was practiced in many countriesOpposition rose as 40 days was inconveniencing to international trade and travelAn international conference was set up for discussion, agreement, and cooperation on matters of international health. 1st was the international sanitary conference held in paris in 1851.8 european countries attended it.Its objective was to introduce order and uniformity into quarantine measures with country variationsPrepared sanitary code with 137 articles dealing with cholera, plague, yellow fever.However all these never came into implementation. It ended in failure.In 1902, pan american sanitary bureau was started as a first international health agency. Aimed to coordinate quarantine procedures in American states.In 1958, pan american health organisation grew as a major health agency with headquarters in washington DC.This was to establish permanent international health bureau in 1903 (pasb)Office international d’hygiene publique started in paris in 1907(oihp)aimed to disseminate information on communicable diseases and to supervise international quarantine measureOihp and pasb joinrd togetherBritish india joined oihp.It continued to exist until 1950 and then taken over by WHO

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Health organization of the league of Nations

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After the 1st world war of 1914-1918, league of nations established a better world known as health organisationAimed at international concern for prevention and control of diseasesNot concerned only on nutrition.Branched into nutrition, housing, rural hygiene, training of health workers Until 2nd world war the 3 co-existed (Ho,OIHP, PASB)Later only HO was existing

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United Nations relief and Rehabilitation administration

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It aimed at recovery from the effect of 2nd world warDid outstanding work of preventing spread of typhus and other diseasesGave assistance to malaria control in Italy and Greece In 1946, it was taken over by interim commission on the WHO

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Birth of WHO

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Was in 1945 when the united nations conference in san francisco, USA unanimously agreed and approved the establishment of a new autonomous international health organisationIn 1946, the international health conference in New York approved the constitution of the WHO in July.In 1947, the epidemiological information service was established.

It tracks information on disease subject to the international sanitary regulation and other communicable disease of international importance.

Later renamed international health regulation.

The WHO constitution came into being on 7th April 1948.

Its first director general was Dr brock Chisholm from Canada.

The world health assembly established world health day to be on April 7 annually.

It had world health themes that focussed attention on specific aspect of public health (check last 10 years)

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Objectives of WHO

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"The attainment by all peoples of the highest level of health."

With a major task of combatting of disease, especially key infectionsAnd to promote the general health of the people of the world.

Membership is open to all countries and each member state contribute annually to its budget.

All member states has a right to vote states 6 regional states

•Africa; congo, brazzaville

•Americas; washington DC, •Eastern meditterean; cairo, egypt.

•Europe;copenhgen, denmark

•South east asia; new delhi, india

•Western pacific; manilla, phillipines

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Work of WHO

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•Constitutional function: Acts as directing and coordinating authority on all international health

•Prevention & control of specific diseases

•Development of comprehensive health services

•Family health

•Environmental health

•Health statistics

•Biomedical research

•Health literature & information

•Cooperation with other organisation

•All communicable diseases are subject of WHO activitiesEg. Was global eraducation of small pox

•Epidemiological surveillance of CD

•WHO collects info & send to int health reguations

•IHR ensure the maximum security against the international spread of diseases with minimum interference with world traffic

•Attentive to NCD’s cancer, DM, CVD,Genetic disorders, mental disorders, drug addiction

•Vector biology, control

•Immunology

•Quality control of drugs and biological products

•Drug evaluation and monitoring

•Health lab technology (relevant to CD & NCD)

•Immunisation against common childhood diseases of childhood

•Cooperation with other organisation

•International Health

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When did mass TB immunization start

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1950

BCG used for childhood protection from TB

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When was malaria eradication program launched

When was it's objectives modified

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1955

1969

Later it was turned into malaria control programs at national levels

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When was the first report on DM issued

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1965

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How many people carried DM in the year 2000

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171 million

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When was the international agency for research on cancer established

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1965

For epidemiology and lab research into causes of human cancer

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When was the headquarter building for WHO inaugurated in geneva

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1966

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When was onchocerciasis control program launched

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1974

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When was expanded program on immunization launched

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1974

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When was the special programme for research and training in tropical disease established

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1975

Aimed to coordinate, support and influence global efforts to combat neglected infectious disease

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When did WHO adopt a resolution on disability prevention and rehabilitation

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1976

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When was the first essential list of medicines published

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1977

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When was the international conference on PHC in Alma-atta with a goal of health for all

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1978

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When did global commission certify worldwide eradication of small pox

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1979

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When was the global programme on AIDS created to develop and coordinate a global strategy to fight AIDS

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1986

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When did WHO endorse a resolution on nondiscrimination of PLWHA

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1988

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When was global eradication of polio in collaboration with international, UNICEF & US centers for disease control and prevention

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1988

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Quarantine

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To quarantine is to separate and restrict the movement of people, activities or the transport of goods for a certain period of time, to prevent the spread of disease or pests. This is used for those who may possibly have been exposed to a communicable disease, but do not have a confirmed medical diagnosis.

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Isolation

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To isolate is to separate ill persons who have a communicable disease from those who are healthy and is for patients whose diagnosis has been confirmed.

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Define International health

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International health is a health activity involving persons, communities and/or institutions in two or more countries. A disease in any part of the world is a threat to other countries. This is worsened by the speed of modern day travel as people now move from one continent to another in a matter of hours.

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Origin of International health

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Originated from commercial international trade and travel Traders and travellers were known to bring disease with them. So International Health was born out of: •Fear/ Self Interest •Compassion/Missionary Spirit •Mutual Benefit/Scientific Challenge •Fear - of spread of epidemics e.g. plague. •Compassion-shown by medical missions and humanitarian agencies in response to health crisis. •Mutual benefit- with regard to cooperation and joint investments in health goals and research. (It is estimated that 300 million people died from smallpox in 20th century alone).

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First International Health Agency

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Pan American Sanitary Bureau (America, 1902)

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When was United Nations formed

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1945 at a conference inbSan Francisco

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What is WHO

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It is the international body primarily responsible for regulating and governing health-related policies and practices across nations

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Headquarters of WHO

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Geneva, Switzerland

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Characteristics of WHO

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•It is a specialized, non-political health agency of the UN.

•It is a part of UN, not subordinate to it.

•Has its own constitution, governing bodies, members and budget.

•Open to all countries.

•Each member contributes to the budget and is thus entitled to its services and also has a right to vote.

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International agencies that promote health

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Three categories: 1. Multilateral govt agencies e.g. WHO, UNICEF, and other UN agencies like the World Bank 2. Bilateral govt aid programmes (between 2 countries). Much of the foreign aid to developing countries is made available through bilateral government to government programmes involving industrialized countries as donors and developing countries as receipients e.g. UK Dept for International Development (DFID), Swedish Int. Dev. Agency (SIDA), United States Agency for Int. Dev. (USAID). 3. Non-governmental organizations e.g. League of red cross and red crescent, private foundations and charities - Rockefeller Foundation, Ford Foundation, etc

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The only disease currently designated under the IHR for which proof of vaccination or prophylaxis may be required for travellers as a condition of entry to a country.

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Yellow fever

The “International certificate of vaccination or prophylaxis” (ICVP) or “Yellow card” is used to document the traveller’s yellow fever vaccination.

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Effectiveness of Yellow fever vaccine

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Yellow fever vaccine is effective 10 days after vaccination and re-vaccination is every 10 years. Yellow fever vaccination must be given at a certified center in possession of an official “Uniform Stamp” which can be used to validate the ICVP.

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When did Port Health Service start in Nigeria

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1925

In response to the plague pandemic

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Port health services is deployed through

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a division in the public health department of the federal ministry of health

The Division has the responsibility of implementing the WHO International Health Regulations, the International Maritime Organiastions (IMO) laws on health matters, the International Civil Aviation Organisation (ICAO) laws, the Nigeria Quarantine Act (aircraft and ship), the Public Health Laws of Nigeria and any other relevant laws.

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Port Health Service locations

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The port health authority monitor the ports of entry into a country:

• Land borders

•Airports

•Sea ports

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International Airports

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Six (6) International Airports:

1. Murtala Mohammed International Airport Lagos.

2. Port Harcourt International Airport, Port Harcourt.

3. Margaret Ekpo International Airport, Calabar

4. Akanu Ibiam International Airport, Enugu

5. Aminu Kano International Airport, Kano

6. Nnamdi Azikiwe International Airport, Abuja – FCT.

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Seaports

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Five (5) Seaports: -

1. Apapa Port – Lagos

2. Tin Can Island Port, Lagos (TCIP) - Lagos

3. Warri Port – Warri

4. Port Harcourt Port

5. Calabar Port – Calabar

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Land borders

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Land Borders are present in 22 of the 36 states of the federation.

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Functions of port health services

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1. Disease surveillance – •They give health clearance to passengers (including immunization and Issuance of International Health Certificate - Yellow Card) and free Pratique to ships. Free pratique means permission for a ship to berth and it indicates that it is disease free.

•Health response to disasters such as plane crash, bomb explosions, terrorism etc.

•Boarding and inspection of ships, aircrafts and road vehicles

•Food Control Activities

~Medical examination of food handlers

~Water sampling 2. Environmental Health activities e.g. sanitation, pollution control, waste disposal etc.

•Inspection of sea ports, ships, airports, aircrafts, land border stations, motor vehicles

•Disinfection

Disinsection

•Deratting •Decontamination 3. Provision of curative and preventive health care services including referral and laboratory service

4. Ad-hoc activities e.g. hajj operations, screening of refugees, deportees etc

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Aircraft. Disinsection

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“Disinsection” means the procedure whereby health measures are taken to control or kill the insect vectors of human diseases present in baggage, cargo, containers, conveyances, goods and postal parcels.

Aircraft disinsection is the use of insecticide on international flights and in other closed spaces for insect and disease control. Insect vectors of disease, mostly mosquitoes, have been introduced into and become indigenous in geographic areas where they were not previously present. Dengue, chikungunya and Zika spread across the Pacific and into the Americas by means of the airline networks. Cases of "airport malaria", in which live malaria-carrying mosquitoes disembark and infect people near the airport, may increase with global warming. Disinsection is mandated by the IHR.

The WHO recommends d-phenothrin (2%) for space spraying and permethrin (2%) for residual disinsection.

Neither is harmful when used as recommended, according to WHO.

Disinsection is one of two applications of the IHR likely to be encountered by travelers; yellow fever vaccination is the other.

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Maritime Declaration of Health

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Maritime Declaration of Health. When a vessel arrives at a port to which health regulations apply, the captain is required to make a report about the health conditions on board his vessel and also about any circumstances on board which are likely to cause the spread of infectious disease. He needs to make a report if his ship is not a “healthy ship”.

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International Maritime signal

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The ship is expected to put up a flag with a colour code which is according to the International Maritime signal indicating the health status of the ship. The vessel can be declared as: •“healthy”

•“suspected”

•“infected”

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Healthy ship

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1. A vessel is a “healthy ship” if it is neither infected nor suspected.

By Day;

a) Yellow flag or Q flag – Signifying "My vessel is 'healthy' and I request free pratique."

By Night;

b) Red Light over a White light signifying, I have not received Free pratique’ The ship must be declared healthy by Port Health Authority before passengers embark or disembark.

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Pratique

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Pratique is the license given to a ship to enter port on assurance from the captain to convince the authorities that she is free from contagious disease. The clearance granted is commonly referred to as Free Pratique.

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Suspected ship

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2. A ship is a “suspected ship” if it does not have on board persons who have certain diseases but which has stopped at some infected places before arrival or where there was cholera on board before arrival or where there is evidence of abnormal mortality among rodents, the cause of which is unknown - Yellow-yellow flag or QQ flag (double yellow flag)

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Infected ship

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3. The ship can be an “infected ship” if it has on board on arrival a case of a disease subject to the International Health Regulations or other infectious disease or where a plague infected rodent is found on arrival - Yellow-blue flag or QL flag

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Action taken in case of suspected or infected ship

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The ship is diverted to a mooring Station called the “Quarantine Anchorage” which is an area in the port where it can be isolated from other ships and necessary health measures taken to rid the ship of the infection.

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Disinfection

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"Disinfection" means the procedure whereby health measures are taken to control or kill infectious agents on a human or animal body surface or in or on baggage, cargo, containers, conveyances, goods and postal parcels by direct exposure to chemical or physical agents.