“Old” Governance vs. “New” Governance: The (Nation)State and Public Health
PUBLIC GOODS vs. PRIVATE GOODS
WELFARE STATE: a state that concerns itself with issues other than law and order; a government that
undertakes responsibility for the welfare of its citizens through programs in public health and public
housing and pensions and unemployment compensation.
ORIGINS OF THE WELFARE STATE:
Liberation of Women (emancipation)
the impactof war (WW II)
Development of the Middle Class
HEALTH AND DEVELOPMENT
1. Better health is central to human happiness and well-being.
2. Makes an important contribution to economic progress- more productive labour force.
Many factors influence health status and a country's ability to provide quality health services for its
people. Ministries of health are important actors, but so are other government departments, donor
organizations, civil society groups and communities themselves. For example: investments in roads can
improve access to health services; inflation targets can constrain health spending; and civil service
reform can create opportunities - or limits - to hiring more health workers.
WHO's work on 'Health and development' tries to make sense of these complex links. It is concerned
with the impact of better health on development and poverty reduction, and conversely, with the
impact of development policies on the achievement of health goals. In particular, it aims to build
support across government for higher levels of investment in health, and to ensure that health is
prioritized within overall economic and development plans. In this context, 'health and development'
work supports health policies that respond to the needs of the poorest groups. WHO also works with
donors to ensure that aid for health is adequate, effective and targeted at priority health problems.
This website provides an update on WHO activities in the area of health and development, including
recent publications, reports of country work and information on training courses and capacity-building
HEALTH EMERGENCIES ACCORDING TO WHO:
1 1. Iraq
3. Western Cote d’Ivoire
1. Health is a state of complete physical, mental and social well being and not merely
the absence of disease or infirmity (WHO Constitution).
2. The extent to which an individual or a group is able to realize aspirations and satisfy
needs, and to change or cope with the environment. Health is a resource for everyday
life, not the objective of living; it is a positive concept, emphasizing social and personal
resources as well as physical capabilities (Health Promotion: A Discussion Document,
Copenhagen: WHO 1984).
3. A state characterized by anatomic, physiologic and psychological integrity; ability to
perform personally valued family, work and community roles; ability to deal with
physical, biologic, psychological and social stress a feeling of well-being; and freedom
from the risk of disease and untimely death (J. Stokes et al. "Definition of terms and
concepts applicable to clinical preventivemedicine", J Common Health, 1982; 8:33-41).
4. A state of equilibrium between humans and the physical, biologic and social
environment, compatible with full functional activity ( JM. Last, Public Health and
Human Ecology, 2nd ed. Stamford, CT: Appleton and Lange, 1997).
Emergency is a term describing a state. It is a managerial term, demanding decision and
follow-up in terms of extra-ordinary measures (Oxford Pocket Dictionary, 1992). A "state
Emergency of emergency" demands to "be declared" or imposedby somebody in authority, who, at
a certain moment, will also lift it. Thus, it is usually defined in time and space, it requires
threshold values to be recognized, and it implies rules of engagement and an exit
strategy. Conceptually, it relates best to Response.
A public health emergency (the condition that requires the governor to declare a state
of public health emergency) is defined as "an occurrence or imminent threat of an
emergency illness or emergency health condition, caused by bioterrorism, epidemic or pandemic
disease, or (a) novel and highly fatal infectious agent or biological toxin, that poses a
2 substantial risk of a significant number of human facilities or incidents or permanent or
long-term disability (WHO/DCD, 2001). The declaration of a state of public health
emergency permits the governor to suspend state regulations, change the functions of
The degree to which a socio-economic system is either susceptible or resilient to the
impact of natural hazards and related technological and environmental disasters. The
degree of vulnerability is determined by a combination of several factors including
Vulnerability hazard awareness, the condition of human settlements and infrastructure, public policy
and administration, and organized abilities in all fields of disaster management. Poverty
is also one of the main causes of vulnerability in most parts of the world.
Equity in Equity in health implies that everyone should have a fair opportunity to attain hisor her
full health opportunity, and that no one should be disadvantaged from achieving this
health potential (EURO European Centre for Health Policy, ECHP, Brussels, 1999).
3 Air quality and health
Fact sheet N°313 (WHO)
Updated September 2011
• Air pollution is a major environmental risk to health. By reducing air pollution levels, we
can help countries reduce the global burden of disease from respiratory infections, heart
disease, and lung cancer.
• The lower the levels of air pollution in a city, the better respiratory (both long- and short-
term), and cardiovascular health of the population will be.
• Indoor air pollution is estimated to cause approximately 2 million premature deaths
mostly in developing countries. Almost half of these deaths are due to pneumonia in
children under 5 years of age.
• Urban outdoor air pollution is estimated to cause 1.3 million deaths worldwide per year.
Those living in middle-income countries disproportionately experience this burden.
• Exposure to air pollutants is largely beyond the control of individuals and requires action
by public authorities at the national, regional and even international levels
• The WHO Air quality guidelines represent the most widely agreed and up-to-date
assessment of health effects of air pollution, recommending targets for air quality at
which the health risks are significantly reduced. The Guidelines indicate that by reducing
particulate matter (PM10) pollution from 70 to 20 micrograms per cubic metre, we can
cut air quality related deathsby around 15%.
Air pollution, both indoors and outdoors, is a major environmental health problem affecting
everyone in developed and developing countries alike. The 2005 WHO Air quality guidelines
(AQGs) are designed to offer global guidance on reducing the health impacts of air pollution.
The guidelines first produced in 1987 1and updated in 1997 had a European scope. The new
(2005) guidelines apply worldwide and are based on expert evaluation of current scientific
evidence. They recommend revised limits for the concentration of selected air pollutants:
particulate matter (PM), ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2),
applicable across all WHO regions.
Key findings in 2005 Air Quality Guidelines are as follows.
• There are serious risks to health from exposure to PM and O3 in many cities of developed
and developing countries. It is possible to derive a quantitative relationship between the
pollution levels and specific health outcomes (increased mortality or morbidity). This
4 allows invaluable insights into the health improvements that could be expected if air
pollution is reduced.
• Even relatively low concentrations of air pollutants have been related to a range of
adverse health effects.
• Poor indoor air quality may pose a risk to the health of over half of the world’s
population. In homes where biomass fuels and coal are used for cooking and heating, PM
levels may be 10–50 times higher than the guideline values.
• Significant reduction of exposure to air pollution can be achieved through lowering the
concentrations of several of the most common air pollutants emitted during the
combustion of fossil fuels. Such measures will also reduce greenhouse gases and
contribute to the mitigation of global warming.
In addition to guideline values, the AQGs give interim targets related to outdoor air pollution, for
each air pollutant, aimed at promoting a gradual shift from high to lower concentrations. If these
targets were to be achieved, significant reductions in risks for acute and chronic health effects
from air pollution can be expected. Progress towards the guideline values, however, should be
the ultimate objective.
10 μg/m annual mean
25 μg/m 24-hour mean
20 μg/m annual mean
50 μg/m 24-hour mean
The 2005 AQG set for the first time a guideline value for particulate matter (PM). The aim is to
achieve the lowest concentrations possible. As no threshold for PM has been identified below
which no damage to health is observed, the recommended value should represent an acceptable
and achievable objective to minimize health effects in the context of local constraints,
capabilities and public health priorities.
Definition and principle sources
PM affects more people than any other pollutant. The major components of PM are sulfate,
nitrates, ammonia, sodium chloride, carbon, mineral dust and water. It consists of a complex
mixture of solid and liquid particles of organic and inorganic substances suspended in the air.
The particles are identified according to their aerodynamic diameter, as either PM 10(particles
with an aerodynamic diameter smaller than 10 µm) or PM 2.5(aerodynamic diameter smaller than
2.5 µm). The latter are more dangerous since, when inhaled, they may reach the peripheral
regions of the bronchioles, and interfere with gas exchange inside the lungs.
The effects of PM on health occur at levels of exposure currently being experienced by most
5 urban and rural populations in both developed and developing countries. Chronic exposure to
particles contributes to the risk of developing cardiovascular and respiratory diseases, as well as
of lung cancer. In developing countries, exposure to pollutants from indoor combustion of solid
fuels on open fires or traditional stoves increases the risk of acute lower respiratory infections
and associated mortality among young children; indoor air pollution from solid fuel use is also a
major risk factor for chronic obstructive pulmonary disease and lung cancer among adults. The
mortality in cities with high levels of pollution exceeds that observed in relatively cleaner cities
by 15–20%. Even in the EU, average life expectancy is 8.6 months lower due to exposure to
PM 2.5roduced by human activities.
Ozone (O ) 3
100 μg/m 8-hour mean
The previously recommended limit, which was fixed at 120 μg/m 8-hour mean, has been
reduced to 100 μg/m based on recent conclusive associations between daily mortality and ozone
levels occurring at ozone concentrations below 120 µg/m . 3
Definition and principal sources
Ozone at ground level – not to be confused with the ozone layer in the upper atmosphere – is one
of the major constituents of photochemical smog. It is formed by the reaction with sunlight
(photochemical reaction) of pollutants such as nitrogen oxides (NO x from vehicle and industry
emissions and volatile organic compounds (VOCs) emitted by vehicles, solvents and industry.
The highest levels of ozone pollution occur during periods of sunny weather.
Excessive ozone in the air can have a marked effect on human health. It can cause breathing
problems, trigger asthma, reduce lung function and cause lung diseases. In Europe it is currently
one of the air pollutants of most concern. Several European studies have reported that the daily
mortality rises by 0.3% and that for heart diseases by 0.4 %, per 10 µg/m increase in ozone
Nitrogen dioxide (NO ) 2
NO 2 3
40 μg/m annual mean
200 μg/m 31-hour mean
The current WHO guideline value of 40 µg/m (annual mean) set to protect the public from the
health effects of gaseous NO 2emains unchanged from the level recommended in the previous
6 Definition and principle sources
As an air pollutant, NO h2s several correlated activities.
• At short-term concentrations exceeding 200 μg/m , it is a toxic gas which causes
significant inflammation of the airways.
• NO i2 the main source of nitrate aerosols, which form an important fraction of PM 2.5
and, in the presence of ultraviolet light, of ozone.
The major sources of anthropogenic emissions of NO are co2bustion processes (heating, power
generation, and engines in vehicles and ships).
Epidemiological studies have shown that symptoms of bronchitis in asthmatic children increase
in association with long-term exposure to NO . R2duced lung function growth is also linked to
NO a2 concentrations currently measured (or observed) in cities of Europe and North America.
Sulfur dioxide (SO )