OP-ED: A global investment in public health is vital for the survival of future generations

2020-09-03 05:47:00 AM
OP-ED: A global investment in public health is vital for the survival of future generations

OP-ED: A global investment in public health is vital for the survival of future generations

Africa Centres For Disease Control And Prevention, Covid-19

OP-ED: A global investment in public health is vital for the survival of future generations

Every evening during the early days of the pandemic, people opened their windows at a set hour to applaud the heroic women and men who were putting their health on the line in the fight against Covid-19 . In New York, London, Madrid and other cities, it became something of a ritual. For me, it was a daily reminder of those invisible workers, the public health professionals who battle the pandemic behind the scenes. It was also a reminder of how now, more than ever, we must invest in public health.

Did this catastrophe need to happen? The answer is no. If only we had prioritised public health, we might have been able to stop this epidemic in its tracks. As the first cases were identified in various countries around the world, it fell upon public health systems to go into action. Yet, many simply did not have the means to do so.

But the capacity of public health resources to meet the demands of the early critical containment phase was quickly overwhelmed. In the US, for example, this calamity can be directly attributed to the failure to invest in what it takes to safeguard its people.

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Save In a few short but seemingly endless months, an infinitesimal and invisible force has brought even the wealthiest and most resourced countries to their knees.Mashaba v De Vos series .article in New Frame , residents of areas in Thokoza, South Johannesburg, cited frustration about their own mass unemployment to justify evicting migrant neighbours and burning their property in the streets.More Whitehall and its civil servants have long been regarded as the guardians of probity and the checks and balances in Britain’s unwritten constitution.

The power of the novel coronavirus to shut down human activity has been so great that seismologists registered a decrease in the vibration of the earth. The human toll has already been devastating and, in the few minutes it takes to read this article, Covid-19 will almost certainly claim more lives, particularly the lives of the most vulnerable. He does not base his argument on the theory of deterrence, he says. Did this catastrophe need to happen? The answer is no. CLOSE I believe the virus in South Africa is not an immigrant. If only we had prioritised public health, we might have been able to stop this epidemic in its tracks. In criminology circles this is called the ‘incapacitation argument’, and it has been discussed and examined in various jurisdictions around the world. As the first cases were identified in various countries around the world, it fell upon public health systems to go into action. The Whitehall mandarinate has long abandoned its role of keeping the ship of state stable and parliamentary democracy healthy, and succumbs increasingly to complacency.

Yet, many simply did not have the means to do so. I have written about this . This is a seriously deadly slogan that can even destroy the nation. Going into action means being poised to mobilise surveillance systems to be able to detect and count cases; to put in place ways to effectively isolate cases and quarantine contacts; and to ensure that overarching epidemic prevention measures are implemented and scaled up. Such rapid, co-ordinated action at scale would have made an enormous difference in stopping the virus early, and it would have saved many lives. (Photo: Gallo Images / Sharon Seretlo) But Mashaba would prefer incapacitation by execution. But the capacity of public health resources to meet the demands of the early critical containment phase was quickly overwhelmed. On top of that, these wrongful sayings and words prevent us from integrating, from trusting and from unifying with each other . In the US, for example, this calamity can be directly attributed to the failure to invest in what it takes to safeguard its people. He notes: “There is a shocking rate of recidivism by rapists and murderers in South Africa. (Photo: EPA-EFE / Andy Rain) Language is one example.

Again and again – in 1988, 2003, 2012 and 2016 – well-respected national scientific organisations called for investment in public health. But a report in 2017 noted that public health represented only 2.” The lower end (55%) Mashaba references is the recidivism ‘estimate’ of 55%-95% that can be traced back to a 1995 article that, along with similar articles that followed, stated: “recidivism is a phenomenon not uniformly conceptualised and no classification system exists whereby a recidivist can be formally classified.” Most people take memes as a joke, but this kind of meme can destroy an individual or many lives.5% – just $274 per person – of all health spending in the US. With the advent of Covid-19, this disinvestment in public health has proven to be a serious liability, with profound repercussions and deadly consequences. My concern with Mashaba’s point about recidivism is that the very studies he is reading posit compelling reasons why recidivism, at whatever rate it is present, continues to be a problem. Unfortunately, the situation in other countries around the world, including in low- and middle-income countries, does not differ. Most memes have no obvious facts, like who created them and for what purpose. We are bombarded with statistics — “an unprecedented amount ” (of x millions of pounds, officials are at least adept at supplying ministers with briefing papers full of figures) is being spent on such-and-such a programme or public service, we are told.

Investment in putting in place the foundations on which epidemic preparedness and response must rest is often not sufficiently recognised. Our prisons do not offer meaningful, effective rehabilitation programmes or sufficient education opportunities. Despite its profound successes, public health is rarely in the spotlight. In the absence of a raging epidemic like Covid-19, this bulwark against such threats is rapidly forgotten. So Mashaba now knows that recidivism would be prevented by rehabilitating and educating offenders. They are actually the most dangerous, yet-to-be-uncovered virus in our community. But in good times and bad, it is public health on which we depend to maintain and improve the health of populations. From putting in place systems for the collection of data on health outcomes, researching disease and injury prevention, and detecting, preventing and responding to infectious and non-communicable diseases, public health puts science and data to work at the community level. Furthermore, we are already in the business of incapacitation. Boris Johnson and Donald Trump would like that.

Even when there are no epidemics in sight, the benefits of a strong public health system are clear. I believe the reason why many South Africans distance themselves from fellow African refugee brothers and sisters is linked to these false memes. For example, for each 10% increase in local public health spending in the US, infant deaths decrease 6.5% (second only to India), and 22.9%, cardiovascular deaths de crease 3.2%, diabetes deaths decrease 1. Put differently, we are very, very good at putting people away for a very, very long time after we have convicted them. These memes are purposely used as propaganda with hidden agendas by those who are benefiting from it.4% and cancer deaths decrease 1. “The fewer elections the better”, a most senior civil servant once told me as he strongly attacked proposals for a Scottish parliament and a Welsh assembly.

1%. With a 2% prosecution rate, the number of people we incapacitate with life sentences is a fraction of those that offend. A multitude of professional staff with different skill sets are required in an intermediate care isolation service —doctors, clinical associates, nurses (registered and cadres) and, very importantly, allied health professionals including physiotherapists, occupational therapists, dieticians and psychologists. Mainly in townships and across the main xenophobic hot-spot sites in the country, community members raise burning issues like basic electricity supply, basic water, households, education, healthcare, job opportunities, social justice like drugs, crimes and the horrifying abuse against women and children, infrastructure development like schools, health centres, youth centres, roads and transport, poor governance, and the main virus, which is corruption. These committed staff need to work for at least six hours in full PPE without being able to drink or go to the bathroom — not an easy physical or mental undertaking. Mashaba intends to enter public office once again. (Photo: Chris Collingridge) Globally, these investments demonstrate even greater impact. A recent study showed that three basic public health interventions – scaling up treatment of high blood pressure to 70%, reducing sodium intake by 30% and eliminating the intake of artificial trans fatty acids – could save 94-million lives in 25 years. I can’t help but think he has forgotten this. The money that they steal is supposed to be used to build roads for the cars they drive, hospitals so that many lives can be saved, schools for the new generation to come and homes for the needy. The mandarins are now losing the bullet-proof job protection privileges they have enjoyed for so long.

Moreover, these interventions prove to be extremely cost-effective. For example, reducing sodium intake by 15% has been estimated to cost less than $0. Like others , he has forsaken the option of elevating the issue of crime and punishment into the realm of informed debate.40 per person per year in low-income countries. That is why we have this big gap and unbalanced life between our societies. But when an epidemic threatens, the dividends paid by a strong public health system investment skyrocket. Mashaba promotes the simplistic and misleading idea that there is a clear divide between victims and offenders. This is because public health gives us the means to anticipate epidemics before they occur. British prime minister Boris Johnson with his home secretary Priti Patel.

And when an infectious disease does spread widely, public health provides the tools to identify the epidemic and monitor it, as well as the means for reaching into communities. The hopelessness I feel is deepened when I consider how many might look to a person like Mashaba – someone with power and influence – for answers, only to hear that empowering the state to kill the people it has failed to save or reform, is the answer. But we do not hear justice being served frequently. Alarmingly, the US Centers for Disease Control and Prevention has noted that more than 70% of the world remains underprepared to prevent, detect and respond to a public health emergency. Even as deaths continue to accumulate and health officials scramble to procure masks, oxygen and ventilators, we are beginning to see a glimmer of light at the end of the tunnel.. There is increasing evidence that mitigation measures put in place, such as movement restrictions, mask-wearing and physical distancing, have been making a difference in some epidemic hotspots. Everything starts at home. Eventually, successful treatments and vaccines for Covid-19 will be developed. A company hired to work with Dominic Cummings on the Vote Leave campaign during the EU referendum has been awarded valuable government.

However, until then, it is public health that is limiting the damage, flattening the epidemic curve, and buying us the precious time we need to understand this virus and how to tackle it. At the same time, we must remain cognisant of the cost of these measures. Even though we live in a globalised world in the 21 st century, where the world is getting closer to one another to become one, where human brains are so powerful to reason before action, and super creative to unify the world, we still live in a society that hasn’t recovered from the previous era – unsettled, uninformed, frustrated, untrusting with unbalanced economies and lifestyles, and poor integration across society. Indeed, we must not ignore the disproportionate impact of Covid-19 on certain populations, whether they be racial/cultural minorities in the US, migrants and displaced people, or the poor around the world. For those with limited resources, population restrictions come at a high price. Having the systems in place to measure these effects at a population level and to inform interventions to mitigate them is of paramount importance. This is where xenophobia is born and the most vulnerable targets in this country are refugees because they are not protected by the law or government.

The good news is that as the pandemic evolves, we are seeing a new appreciation of public health. The recently launched Africa Centres for Disease Control and Prevention is an important step forward. In addition, the current crisis has made evident that epidemics know no borders. Why is it always refugees who get killed or spaza shops that get looted? If any community has a complaint or issues, asylum seekers or refugees also have their own representative, so why can we not sit and discuss together with the government as a civilised society? Why do we have to be hated or be accused and attacked unreasonably for something which we do not know about it? It is not fair at all. An outbreak in any one region or country is a threat to all, and a strong global public health investment is our best defence. People are coming to understand what epidemiology can contribute, how case-finding and contact tracing works, and the importance of paying attention to the evolution of the epidemic in their communities, as well as how various control measures are working or not working.

Increasingly, there is a greater understanding of the distinction between public health and healthcare, recognising the importance of both. This is pure hatred of refugees and a crime against humanity. When we emerge from this crisis, let the memory of people banging their pots, blowing their horns and applauding from their windows for healthcare workers inspire us to invest seriously in public health – for the sake of our generation and generations to come. DM/MC Dr Wafaa M. El-Sadr, MD, MPH, MPA, is founder and director of ICAP, a global health centre based at the Columbia University Mailman School of Public Health working extensively in sub-Saharan Africa, and a professor of epidemiology and medicine. But what most people miss and do not understand is that you cannot justify your point or victimise the minority or needy ones who actually need to be protected from these unjustifiable attacks by lawless people. This article is based on an address delivered by Dr El-Sadr at a virtual symposium on Covid-19 in Africa.

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