Geopolitical Challenges for Infectious Disease

Prevention and Control

international law
- harmonizing the inconsistent national quarantine
regulations
- facilitates the exchange of epidemiological
infromation on infectious diseases
- establishing international health organizations
- standardization of surveillance

The globalization of public health has employed

international law as an indispensable tool in global
health governance aimed at diminishing human
vulnerability to the mortality and morbidity burdens
of communicable disases.

Globalization of public health and the challenge of

governance.

- globalization of public health: express the

translational or globalized nature of public health
threats including the spread of diseases and DE-
EMPHASIZES the territorialization or nationalization
of diseases brought about by the process of
globalization

-communicable diseases do not respect the

geopolitical boundaries of nation states and state
sovereignty

- vulnerability of all humanity to the emerging and

re-emerging threats of communicable diseases.

- WHO's International Health Regulations (IHR)

- WTO's TRIPS and SPS agreements and the WHO-

Food and Agriculture Organization (FAO) Codex
Alimentairu Commission standards on food safety.

(Aginam, 2002)
Emerging infectious diseases have exacted heavy
public health and economic tolls.

Examples:
SARS
Influenza A H5N1 - avian influenza

WHO definition of emerging infectious diseases:

"newly recognised, newly evolved or occured
previously but have shown an increase in incidence
or expansion of geographical, vector or host range"

especially in the southeast asia

These processes include:

- Population growth and movement
- urbanization
- changes in food production
- agriculture and land use
- water and sanitation
- effect of health systems through generation of drug
resistance

- influencing the factors that drive disease

emergence
- making surveilance systems fit for purpose
- ensuring regional governance mechanisms work
effectively to improve control interventions.

Governance of infectious diseases control is

challenging
- overlapping institutional roles and responsibilities
- complexity in politics
- intranational and international tensions

Challenges in the control of infectious diseases in

SEA:
- Surveillance system
-- ability to anticipate emergence of diseases,
emergence of diseasses, support of outbreak
responses and facilitation of the monitoring and
evaluation of responses.
-- in SEA, prediction lacks specificity and
sensitivity.
-- zoonoses, poor countries have underdeveloped
surveillance systems of animals.
-- absence of specific government policies and legal
frameworks for surveillance and control of
zoonoses.
-- Example: SARS, H5N1 and H1N1 in Laos 2004,
-- health-care sectors are unwilling or unable to
report cases of emerging diseases. Decentralised
health system have become less actuve un case
reporting
-- in order to address, EXAMPLE

- Capacity of health-service response

-- weak veterinary services in many developing
areas of the world
-- poor animal farm biosecurity.
-- low-income countries spend less than the
necessary for health systems to function to meet
Millennium Development Goals
-- density of health-care professionals is lower
(Cambodia, Indonesia, Laos, Myanmar and
Vietnam)

- regional coordination and support

-- translational support
-- ASEAN, APEC, Ayeyawady-Chao Phraya-
Mekong Economin cooperation with WHO SEA and
Western pacific Offices.

Challenges in the region:

- reforming or modifying of upstream driving forces
of emerging infectious diseases
- prediction with improved accuracy of where and
what diseases are likely to emerge
- improvement of governance, financing and
operational capacity of sruveillance systems
- use of timely generation of data and information to
identify feasible and appropriate responses
(Coker, Hunter, Rudge, Liverani, &
Hanvoravongchai, 2011)

national political and economic systems affect

health and the distribution of life-chances

geopolitics and global economic governance

(translational economic rules and treaties)

State of global health in the early 21st century:

- life expectancy and patterns of disease

Michael MccGwire's
'adversarial national security paradigm' /
'cooperative global security paradigm'
'lost its way'
shoft towards:
a. relationships characterized by inclusion, detente
and engagement
b. diplomacy that is cooperative, compromising,
multilateral, magnanimous and reciprocal
c. new attitudes to power that would foster
persuasion and reward
d. puruit of security at an international level
through reassurance and cooperation on a global
scale.

accdg to him, progress will be possible only if

attitudes about relationships, diplomacy, power and
security can be reshaped outside the current
paradigm:

a.relationships characterized by exclusion,

confrontation, domination and enmity
b. diplomacy that is adversarial, intransigent,
unilateral, vengeful, and exploitative
c. power that is used to maintain superiority
through compulsion and punishment
d. ideas of security based on inequality, deterrence,
coercion and national interests.

(Benatar, Gill, & Bakker, 2009)

Global health security is the protection of the health

of persons and societies worldwide.

- access to medicines, vaccines, and health care

challenges:
- vision for health security lacks drive and speed for
proposals to materailize
-global health threats connected to zoonosis are
expected to rise
-- to address: worldwide early alerting and reporting
mechanism, disease maps, gathering of disease
intelligence

- free-rider problem and moral hazards. low income

countries with weak governance --> fragile health
systems.
- advocacies on surveillance, identification and
control of zoonotic disease to uphold global public
health security

(Ear & C??ceres, 2009)

disease is now seen as a geopolitical issue:

- destabilisation
public health problems have been linked to te
workings of the global political economy.
- sovereignty
potential for disease to disrupt sovereignty
- instrumentalisation of health
implications for the political map and international
security.
- geopolitical economy
actors in health, foreign policy and security -->
health interventions
(Ingram, 2005)
An assessment of the quality of health care delivery in the geographically isolated and
disadvantaged areas in the Philippines.

WHAT IS GIDA?

Name of Office: Bureau of Local Health Development

Refer to communities with marginalized population physically and socio-economically separated

from the mainstream society and characterized by:

1. Physical Factors - isolated due to distance, weather conditions and transportation difficulties
(island, upland, lowland, landlocked, hard to reach and unserved/underserved communities).

2. Socio-economic Factors (high poverty incidence, presence of vulnerable sector, communities

in or recovering from situation of crisis or armed conflict).

WHAT IS THE GOAL OF GIDA?

Name of Office: Bureau of Local Health Development

To establish and institutionalize a system for managing local health development in GIDA
communities to ensure provision of quality health care services.

WHAT ARE THE PROGRAM COMPONENTS OF

GIDA?

Name of Office: Bureau of Local Health Development

The program components of GIDA are:

1. Community development

 Community organization and mobilization

 Community needs analysis
 Participative community planning
 Generation and allocation of resources (resource mobilization)
 Alliance building and multi-sectoral partnership

2. Provision of technical and financial assistance

 Upgrading of health facilities
 Capacity and capability building

3. Monitoring and Evaluation

 Documentation of best practices

 GIDA Indicators

WHAT ARE THE OBJECTIVES OF GIDA?

Name of Office: Bureau of Local Health Development

The objectives of GIDA are the following:

1. To empower communities, local government units (LGUs) and key stakeholders toward good
governance for health.

2. To generate LGU and community commitment to manage and sustain health care.

3. To strengthen multi-sectoral linkages through convergence and efficient use of resources.

4. To improve access and provision of health services.

An assessment of the quality of health care delivery

in the geographically isolated and disadvantaged
areas in the Philippines.
Objectives:
1. To review extent of implementation of
Department of health (DOH)
programs/projects in GIDA
 2. To determine the quality of health services
(preventive and curative) provided in the
GIDAs, including best practices and gaps
3. To recommend policies or program
intervention/support packages to
institutionalized organizational mechanisms
and structures to support the development
of a manual of operation
 How indigenous people fared in terms of health
and services in GIDAs
 2 IP areas: The Buhid of Southeastern Oriental
Mindoro, Higaunon of Northern Mindanao
 Action research, the IPs involved intended to
utilize the research process and data to beef up
health component of their Community
Development Plans (CDPs) and contribute to
further consolidation their territories.

Results and Recommendations:

- Result: dearth of health data disaggregated for
ethnicity and IP data aggregated to the macro
 level acceptable to health policy makers and
program designers. Lack of data with regards to
geographically disadvantaged people
(including ethnicity of Indigenous people)
Recom: set up a health information and
monitoring system for IPs.
- Recom: produce an accurate identification of IP
areas at the local government unit (LGU) level
to guide LGUs in the provision of health services
to them.
Results: most Ip communities are geographically
hard to reach. GIDAs are identified by barangay
while IP areas do not necessarily reflect
administrative boundaries and are varied. Not
all LGUs recognize IPs in their jurisdiction.
Communities are geographically hard to reach
and the jurisdiction is not clearly identified.
- Recom: inculcate culture-sensitivity not only
among health care providers but also at the
level of policy makers.
Results: IPs hesitate to avail health care services
because of discriminatory attitudes of health
 care providers. Hesitancy to avail health care
services
- Recom: find ways of providing for the additional
costing entailed in providing health services to
the IP areas.
Results: many LGUs may be sympathetic to the
more dire health situation of IPs but declare
with regret that they do not have the funds to
be able to provide more-IP appropriate health
services. Lack of funds for the provision of
more IP-appropriate health services.
- Recom: emulate and propagate good practices
that do exist.
Result: the provincial government of Oriental
Mindoro has a Mangyan ward in its provincial
hospital. Low reception to the needs of the IPs.

- April 2013, Department of Health, National

Commission on Indigenous People, and
Department of Interior and Local Government
 Joint Memorandum Order (JMC) No. 2013-01
– “Guidelines on the delivery of Basic Health
Services for Indigenous Cultural Communities/
Indigenous Peoples”