Carlos Applewhaite

The Role of
Parliament in
Combatting
Communicable
Diseases
POLICY BRIEF


1

Introduction
Communicable or infectious diseases present severe health risks to society due to the relative
ease with which they are spread if not controlled. These diseases are disorders caused by organisms,
such as bacteria, fungi, viruses or parasites...diseases can either be spread person to person or from bites
by insects or animals, while others are from contaminated foods and water
1
. The ability of diseases to
adapt and evolve presents a continuing challenge to researchers. The chikungunya virus presents a clear
example of a disease which adapted to changing environmental and population practices, carried by the
same species of mosquito as dengue fever.
The potential loss of life and reduction in productivity of a nation from these types of illnesses
presents a major challenge to small developing states notwithstanding the burden on healthcare costs to
provide treatments. While great emphasis is being placed on the impact of chronic and non-
communicable diseases, the effects of communicable diseases (CDs) remains a challenge to society.
The spread of CDs can be mitigated by implementation of policies to control and/or eradicate the
incidence of these illnesses whether preventative or reactionary. Three areas of interest to policymakers
in the prevention of CDs and overall public health are health improvement, health protection and service
improvement
2
. Parliaments role in this context therefore is linked to these objectives mainly in the
development of policy rapidly to combat the likelihood of outbreaks and facilitation of research on
infectious diseases.
Nature of the problem
The spread of communicable diseases can be propagated by various types of activity. These
diseases are biological and social and as such should be of great interest to policymakers. The catalyst
for most communicable diseases can be found in the categories identified below
3
:
Water borne
Vector borne
Physical contact
Airborne
2

While the categories above mention the method of transmission; the causative agents are also
relevant in understanding how to control and monitor CDs. The main agents are: biological (virus,
bacteria, fungi etc.), chemical (pesticides, pharmacologic, air pollutants, food additives) and physical
(heat, light, contact etc.). Symptoms of communicable diseases are either acute or chronic, i.e.
symptoms appear for a short period (3 months) or for a prolonged period (more than 3 months). Cholera
is an acute CD while HIV is a chronic CD. The chain of infections for CDs requires the agent to infect
a reservoir (environment, animal or human) and the disease be transmitted from the portal of exit and
be transmitted in the methods outlined above and thus absorbed into the body gastro intestinally,
respiratory, via skin, intravenous or orally
4
.
Communicable diseases require the bacteria, parasite or virus to mature in the body for an
incubation period. Despite the use of antibiotics for decades, health professionals and researchers are
cognizant of the reality that diseases mutate. This character of communicable diseases presents the
greatest challenge to researchers and society, the pace at which these diseases are able to mutate. The
bacteria in CDs is able to mutate and become resistant to the existing antibiotics, a process that occurs
due to changes in the natural environment and is amplified due to exposure to treatment which creates
a resistant clone
5
.
While public health strategies have lowered the profile of CDs globally, these diseases are still
cause for concern in many countries. Jamaica however has been able to thwart the high incidences of
diseases such as tuberculosis meningitis, diphtheria and tetanus due to the emphasis placed on early
vaccinations
6
.
In the recent contribution to the Sectoral Debates 2014, Minister of Health Dr. Fenton Ferguson
highlighted HIV/AIDS (sexually transmitted), dengue fever, chikungunya virus and cholera (vector
borne) as areas of special attention to Jamaica
7
. The status of the CDs would be informed by the Pan
American Health Organisation (PAHO) which conducts research and reports on the threats facing the
Latin American and Caribbean region. From these reports the most prevalent threats are from vector
borne and sexually transmitted diseases.
3

Rates of HIV/AIDS prevalence place Jamaica at 1.7% (2012) down from 2.4% in 2001, below
Haiti and the Dominican Republic. However the number of HIV cases annually are fluctuating between
minimum 1530 (2001) and maximum 2121 (2006). By 2012 the number of reported cases dropped to
1551. By 2012 UNAIDS estimates there were 28, 000 Jamaicans living with HIV/AIDS down from
34,000 in 2001. The drop in cases is not solely attributable to loss of life but the increased use of safe
sexual practises (lowering the growth of cases annually) and sensitisation by agencies and civil society.
Further, access to anti retro viral drugs has been improved with a wider scale currently 74% of
individuals are using the treatment after being diagnosed
8
.
Along with sexually transmitted diseases, vector borne diseases like dengue fever and
chikungunya virus have been a menace to health professionals regionally. Both diseases are carried by
the mosquitoes of the genus aedes. Dengue cases in Jamaica have been falling recently due to
interventions from authorities via vector control measures reducing incidences from 545 confirmed in
2012 to 159 confirmed 2013
9
. Nonetheless confirmed cases of chikungunya fever in the region are
4,356
10
in 6 months since its appearance. The disease has already affected over 9 Caribbean territories.
Chikungunya and dengue are autochthonous and require domestic control practises be implemented.
The cholera epidemic in Hispaniola and Cuba presents cause for concern for Jamaican health
professionals. However maintenance of hygiene standards, regulation of sanitation and border policies
have been effective in the prevention of an outbreak locally so far. There have been cases where
migration has caused the importation of disease, in 2004 the increased migration of Haitians brought
more incidences of malaria from an average of below 10 to 141 in 2004 and 88 in 2005.
The prevention of communicable diseases can therefore be targeted to the areas through which
the diseases present themselves as outlined above. Vector control programmes, public awareness
campaigns, housing programmes and sanitation policies are key tasks.
How can parliament help?
Public health action requires full support of parliamentarians. Reducing the levels of mortality
require cohesion and assertive action. Parliament stands at the precipice of decision making, regulating
4

and oversight. Nonetheless these attributes can only be exercised with cooperation from all relevant
stakeholders. Therefore actions cannot be done isolated, but with consultation with private sector and
civil society. Implementation of new regulations (while in the best interest of the people) may cause
concern for businesses or harm the rights of citizens. Therefore cooperation in planning and
implementation is vital for success of public health programmes. In times of crisis it is further necessary
to maintain solidarity and competent leadership to quell the fears of citizens and administer strategies
established in emergency management protocols.
The objectives of parliament in public health are thus to ensure that the operational domains
and requirements are being met. As such cooperation with professionals in the sector is required to
inform decision making and knowledge of public health standards to ensure efficiency. In 2010, the
Ministry of Health in collaboration with the WHO and PAHO conducted its second workshop on
measuring the performance of Jamaicas essential public health functions. In this report, the monitoring,
evaluation and analysis of health status performance fell to 0.62, down from 0.85 in 2001. Meanwhile
the development of policies and strengthening of public health capacity also dropped to 0.73 and 0.29
respectively, down from 0.81 and 0.68 in 2001. These areas are directly relevant to the public health
responsibilities of the administration. The below graphic illustrates the domains which guide the process
of policy development, monitoring and evaluation for administrators.
5


Retrieved from (Gray, et al. 2006)

Services improvement are so far being met with the heavy investment in education through
tertiary institutions bolstering human resource capacity. However investment in health care represents
only 5.8% of GDP, with government supporting 3% and private sector 2.8%. Delivery of services has
so far been maintained at the primary level as there are over 340 primary health care centres island
wide. Secondary and tertiary facilities are plenty however not substantial as the use of public facilities
has increased since 2007 and the burden continues to grow as user fees were removed. Healthcare
should be treated as a public good until a substantial portion of the population can meaningfully meet
costs. The current $1 billion estimated for investment in upgrading health facility infrastructure
represents a significant boost for resource development, along with the proposed strengthening of
public-private partnerships
11
. Parliaments role in approving legislation thus has the final say through
informed debate on the amount to be disbursed, as established by the ruling party. A needs assessment
of the industry would be required to inform debate on the adequate amount of disbursement to improve
all services. This can be done in conjunction with local professionals and consultation with the Pan
American Health Organisation which has provided such services in the past.
6

Parliaments role in health improvement ought to be directed through projects which target
social epidemiology. Social epidemiology being understood to be the branch of epidemiology which
focuses on the effects of socio cultural factors on states of health
12
. These social factors are under the
remit of parliamentarians such as housing, employment, education and reducing inequality. Gray et al.
also emphasise the importance of effective community planning and healthy lifestyles (important in the
prevention of non-communicable diseases). CDs spread through physical contact require direct
intervention in social projects, such as mass education on sexually transmitted diseases and
empowerment programmes. Along with housing regulations which reduce incidences of overcrowding
specifically in urban areas, where diseases are spread more rapidly due to population density. Poverty
is one of the greatest contributors to the spread of CDs and this can be remedied by meaningful
employment, therefore employment creation programmes and incentives for job creation must come
from the nations decision making body. The availability of affordable housing, increased employment,
education on sexual health and proper sanitary practices contribute tremendously to the mitigation of
CDs.
The establishment of safety regulations within legislation to protect public health are essential.
These regulations/guidelines on reporting and monitoring communicable diseases should be in line with
regional and international standards. This requires cooperation with international organisations and
experts (regional and international) to ensure maintenance of best practice with regards to food quality,
air quality and solid waste management among others. Further the mandatory reporting of research by
agencies responsible for investigating CDs and continued oversight of projects being conducted by
health departments. Oversight roles can be facilitated by parliamentary committees with information
being disseminated among the public through forums and electronic sharing.

Further action can be taken via:
Control of expenditure on healthcare and research. Access to vaccination is vital in
preventing the spread of communicable diseases. While charitable organisations and
7

international donors have specific interests, parliament as the head decision making
body in the country reserves the right to control action. Further securing financing for
large scale vaccinations reaching societys most vulnerable is in the interest of
policymakers. This social spending requires approval for subsidising vaccines and the
other healthcare costs attached to providing services across the population. Provision
of financing or securing financing to labs and organisations which conduct surveillance
and epidemiological investigations domestically and regionally. E.g. CARPHA, PAHO
Legislation to legally bind individuals to maintain sanitary surroundings. E.g.
enforcement of the penalties under the National Solid Waste Management Act (2002)
Periodic review of existing health related policies and acts to ensure current application
is addressed e.g. Public Health Act (1985) last amended in 1996, Quarantine Act (1951)
last amended in 1991, Jamaica Water Sector Policy, Strategy and Action Plan (2004)
Ensure cooperation of departments and ministries in sensitising communities on
initiatives and projects. Utilise the Ministry of Local Government and Social
Development Commission to pursue activities in the over 758 communities in Jamaica,
mobilising community organisations and citizens to pursue safe practices.
Positive actions:
Grenadian response to the cases of chikungunya on the island. After four reported
cases, authorities enacted the Mosquito Destruction Act (1952)
13
.
The reclassification of HIV/AIDS as a communicable disease in 2012
Access to health care through the National Health Fund
Continued public-private partnerships in healthcare provision
Joined up government to tackle dengue through control programmes



8

Conclusion
Parliament as an institution is premised to protect all citizens despite party affiliation, placing
national security at the pinnacle of its mandate. National security concerns in a globalised world can
no longer be limited to military threats and border issues. Public health concerns are a matter for the
highest decision making body to make impartial decisions in the best interest of the people. As diseases
continue to mutate and microbes adapt to population and environmental changes the need for policy
must adapt as well. Continuity and consistent monitoring and reporting of communicable diseases is
paramount in securing life and reducing mortality rates.















9

Notes
1
Mayo Clinic. n.d. Infectious Diseases. Accessed July 3, 2014. http://www.mayoclinic.org/diseases-
conditions/infectious-diseases/basics/definition/con-20033534.

2
Gray, Selena; Pilkington, Paul; Jewell, Tony. 2006. Public Health in the UK: Success or failure?
Journal of the Royal Society of Medicine 99 (3) 107-111. Accessed July 3, 2014.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383753/#ref5

3
World Health Organisation. 2006. Communicable Diseases Following Natural Disasters: Risk
Assessment and Priority Interventions. Accessed July 2, 2014.
http://www.who.int/diseasecontrol_emergencies/guidelines/CD_Disasters_26_06.pdf?ua=1.

4
Luo, Ping. 2004. Epidemiology: Prevention and Control of Disease and Health Conditions in An
Introduction to Community Health. Accessed July 5, 2014.
www.csustan.edu/kinesiology/Faculty/PingLuo/DATA/teaching/PowerPoints/Chapter04.ppt

5
Southwick, Frederick. 2007. Infectious Diseases: A Clinical Short Course. New York: McGraw-Hill.
6
PAHO. 2012. Health in the Americas, Country Volume, Jamaica. Accessed July 5, 2014.
http://www.paho.org/saludenlasamericas/index.php?option=com_docman&task=doc_view&g
id=136&Itemid=

7
Ferguson, Hon. Dr. Fenton. 2014. "Developing Systems of Excellence: Providing Quality Accessible
Healthcare for All." Sectoral Debate Presentation. Accessed July 2, 2014.
http://jis.gov.jm/media/MOH-Sectoral-Debate-2014-BOOK-2.pdf.

8
UNAIDS. 2013. Global Report: UNAIDS report on the global AIDS epidemic 2013. Accessed July 2,
2014.
http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/
UNAIDS_Global_Report_2013_en.pdf.

9
PAHO.2014. Epidemiological Update: Number of Reported Cases of Dengue and Sever Dengue in
the Americas. Accessed July 2, 2014.
www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=index.php?option=
com_docman&task=doc_download&gid=25996&Itemid=

10
PAHO. 2014. Epidemiological Update: Chikungunya fever. Accessed July 2, 2014.
http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=25702&Itemi
d=.

11
Patterson, Chris. 2014. $1 billion to upgrade health facilities. Jamaica Information Service.
Accessed July 5, 2014. http://jis.gov.jm/1-billion-upgrade-health-facilities/


10


12
Honjo, Kaori. 2004. Social epidemiology: Definition, history and research examples.
Environmental Health and Preventative Medicine 9 (5) 193-199. Accessed July 6, 2014.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723602/

13
Grenada enforces 1952 legislation to deal with Chikungunya virus, Caribbean360,
http://www.caribbean360.com/news/grenada-enforces-1952-legislation-to-deal-with-
chikungunya-virus?utm_source=Caribbean360%20Newsletters&utm_campaign=f9e1840c94-
Vol_9_Issue_131_News7_2_2014&utm_medium=email&utm_term=0_350247989a-
f9e1840c94-39323833