Monitoring, Surveillance and Rapid Response Capabilities

In Session X we discussed Global Monitoring, Surveillance and Rapid Response Capabilities and Disaster Management including epidemics and natural disasters.

The 1918 Spanish Flu epidemic is now believed to have been a strain of avian influenza, which mutated and spread from people to people. The epidemic killed an estimated 20-50 million people worldwide. The flu was fast acting and killed the post productive members of society, the working age population of 15-34, whereas during season flu the most vulnerable populations tend to be the elderly and young children.

The current Asian Avian flu strain H5N1 has thus far killed 62 people (122 cases per WHO), most of whom lived with or worked closely with domestic fowl, however it has not yet mutated to spread from person-to-person. The Spanish flu traveled at an unprecedented rate and killed millions within months. In today's fast globalized world it would take only a fraction of that time for such a virus to jump oceans. Therefore, our response systems must be equally fast if not faster to be able to contain the wildfire that could result.

The World Health Organization's Epidemic and Pandemic Alert and Response (EPR) is an integrated and internationally coordinated global alert and response system for epidemics and other public health emergencies.

Epidemic and Pandemic Alert and Response (EPR) has six core functions:
* Support Member States for the implementation of national capacities for epidemic preparedness and response in the context of the IHR(2005), including laboratory capacities and early warning alert and response systems;
* Support national and international training programmes for epidemic preparedness and response;
* Coordinate and support Member States for pandemic and seasonal influenza preparedness and response;
* Develop standardized approaches for readiness and response to major epidemic-prone diseases (e.g. meningitis, yellow fever, plague);
* Strengthen biosafety, biosecurity and readiness for outbreaks of dangerous and emerging pathogens outbreaks (e.g. SARS, viral haemorrhagic fevers);
* Maintain and further develop a global operational platform to support outbreak response and support regional offices in implementation at regional level.
[Source W.H.O. http://www.who.int/csr/en/]

I reminded of Larry Brilliant's INSTEDD, for International System for Total Early Disease Detection, an internet based early warning system that would be:
"transparent, with basic information freely available to everyone, preferably in their own language, and will be housed in a neutral country, independent of any single government, any single company, any single UN agency, but will offer its alerts, data, access to all."

INSTEDD would be based on the Canadian GPHIN, which detected and reported SARS before the W.H.O. and is now being utilized for Avian Flu. Established by Health Canada's Lab Centre for Disease Control, GPHIN stands for Global Public Health Intelligence Network and is an internet based system that continuously scans thousands of online sources, including local newspapers, the wires, blogs and health bulletins worldwide in seven languages, flagging news of infectious disease outbreaks, natural disasters and other public health calamities. The flagged data is then forwarded to public health experts for analysis including the W.H.O.

With Larry Brilliant's transparent technology and the W.H.O.'s capacity building, the framework is being established for rapid response capabilities. Technology and innovation will be the crucial components of any 21st century solutions to epidemic response.

Biometrics in Healthcare

Session IX centered around information technology innovation in healthcare. In discussing the Smartcard, which has been in use in Asia and Europe for several years but has yet to come to the U.S., Dr. Shahi mentioned Biometrics in healthcare, where fingerprint scans identify an individual's medical history and other confidential information, as an alternative to the Smartcard, which can be stolen, it can break and healthcare facilities may not be able to access the card if it's damaged. Whereas biometrics would be completely private, individualized, and HIPPA compliant.

Biometrics refers to the statistical analysis of biological characteristics, which is applied to provide identification and verification of human characteristics for security purposes. While fingerprint scanning is most prolific in the healthcare industry, the category of biometrics also includes handprints, retinal scans, facial geometry and voice recognition.

A well designed biometric IT solution allows healthcare organizations to protect patient confidentiality, eliminate passwords, lower IT support costs, reduce paper use and fraud and support HIPPA compliance.

Fingerprint biometrics are currently the most widely used form of the technology in healthcare. The fingerprint scanner works by analyzing the position of minutiae, the small unique marks on the finger where the two ridges on the fingertip meet. Fingerprint biometric technology is the least expensive form of the technology at initial cost and is capable of being very accurate and yielding low false acceptance if it is well maintained and personnel are well trained.

According to HealthcareItNews.com, the most extensive use of biometrics is in healthcare, in addition to the finance, military, and security sectors. There has been an impressive adoption rate of the technology in healthcare, driven partly by the push toward shifting to electronic medical records, HIPPA compliance and security issues in healthcare. Furthermore, the adoption of the technology by other sectors, including border patrol and national security has driven prices lower and made it more affordable for the healthcare industry.

Biometrics, if adopted industry wide has the potential for efficient security, patient identity protection and confidentiality, as well as possibly reducing costs and time associated with paper based medical records.

Technology in Healtcare: How HIT can reduce costs

During Session VIII, we made a shift in class from discussing all that ails the world to possible solutions to the problems the global community currently faces. Technology's role in revolutionizing many industries, including medicine and healthcare over the past several decades is undeniable. In fact, according to Dr. Shahi, none of the innovations in healthcare including the mapping of the human genome would have been possible without the tools that computer systems have provided to scientists.

Healthcare Information Technology (HIT) includes electronic medical records, Decision Support systems and Computerized Physician Order Entry for medication prescriptions. HIT systems provide access to patient information and if networked with other providers and hospitals can communicate patient health information to other providers making the patient's care at various providers integrative and efficient.

According to the Rand Corporation, there are three additional benefits in implementing HIT industry-wide, including efficiency savings, increased safety, and increased health benefits.

Efficiency savings refers to the care provided to patients using less resources, including reduced hospital stays because of increased safety and better coordination of care, reduced administrative time of nurses and more efficient drug utilization. Rand estimates a potential efficiency savings of $77 billion annually if HIT were implemented system-wide.

Increased safety would be obtained mainly during the prescription process through the Computerized Physician Order Entry system, which will generate alerts and warnings for any drug interactions and adverse effects. According to Rand's research, $1 billion dollars can be saved by eliminating annual 200,000 adverse drug events.

In terms of increased health benefits, HIT would be instrumental in chronic disease management by helping providers maintain constant communication with patients, by providing remote monitoring and transmission of patient's vital signs and by responding very quickly when the patient is in distress. Effective disease management can reduce the need and duration of hospitalization, which will reduce costs and maintain good health.

Currently, there are a number of hindrances in the marketplace and the healthcare industry to implementing HIT, including low numbers of providers/hospitals who have HIT systems, especially in rural and poorer facilities. Additionally, there is currently no market pressure for creating systems that can talk to each other and as a result HIT systems are currently fragmented and interconnectivity is limited.

Rand's policy recommendations center on government action, including continuing current efforts to implement HIT, accelerating market forces, and instituting subsidies to encourage adoption. These can further be accomplished by aggressively using federal purchasing power to overcome obstacles in the market.

System-wide implementation of HIT has the potential of improving health status and the healthcare system in the U.S. by improving efficiency of service delivery and reducing costs.

In his 2006 State of the Union speech, President Bush called for the widespread adoption of HIT, especially electronic medical records. Mr. Bush appointed David Brailer, M.D. to lead the Office of the National Coordinator for Health Information Technology within the Department of Health and Human Services. Mr. Brailer strongly supports organizational interconnectivity, which will encourage health care IT investments and facilitate health care reform. While some industry experts are excited by the renewed attention on HIT, the administration must focus continued efforts and attention on the promises made by the President.

Source: Rand Corporation. Research Brief. Health Information Technology. Available online at: http://www.rand.org/pubs/research_briefs/RB9136/index1.html

Water and Sanitation

Women carry water 5 kilometers to their homes in Azad and Jammu Kashmir, Pakistan. (Image by Prof. Jennifer Davis.)


Image from UNICEF New Zealand


During Week 7, Session VII of class, we discussed lack of access to clean water and sanitation in developing nations. Lack of clean water and sanitation services seems so foreign to us living in the abundant U.S., we never stop to think about how many people lack these basic rights to human life and dignity around the globe. Indeed, access to clean water and sanitation is at the heart of so many other global problems, including disease and conflict. Without access to clean water and sanitation the other Millennium Development Goals cannot possibly be accomplished and in fact they are prerequisites to all of the other goals.

The Gender Perspective on Water and Sanitation, of the United Nations Commission on Sustainable Development, is an empowering work, as it contends that giving women control of water and sanitation in developing nations goes a long way in improving water source management and living standards, because in most countries women are primarily responsible for the use and management of water and women have an inherent "environmental wisdom."

At present, women are solely responsible for fetching water from communal sources which may be several hours away from home. These women and girls spend several hours a day carrying heavy water jugs, which takes away from their ability to attain education and can lead to injuries and assault. Furthermore, lack of privacy in sanitary facilities in schools discourage girls from attending classes. Building separate bathrooms for boys and girls is essential for gender equality. For instance, in Bangladesh, construction of separate latrines for girls and boys resulted in an 11% increase in attendance of girls per year from 1992 to 1999.

According to the article, empowering women in communities like Kerala, India and Cameroon, where women have banded together to manage and build community water projects have proven to be more successful than when men were in charge of the maintenance, because men were absent during the day and lacked service orientation and financial management skills. Equitable access to water for household and agricultural use is imperative for women in developing nations as it is essential for gender equality, sustainable development, and poverty alleviation.

“The human right to water entitles everyone to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses. It is essential that both women and men be involved in decision making processes regarding the provision, location and technology of water and sanitation facilities in the community and household.”

I Belong to an International Humanitarian Organization called CARE, this video comes from CARE and it shows the impact of empowering women to bring about change. Please watch this short video of an Ethiopian woman who is changing social norms in her community. ABAY