POLA84 Wk 06.pdf

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University of Toronto Scarborough
Political Science
Christopher Cochrane

“Old” Governance vs. “New” Governance: The (Nation)State and Public Health PUBLIC GOODS vs. PRIVATE GOODS “Obamacare” 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: Social justice Catholicism Democratic Corporatism The Left 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 activities. HEALTH EMERGENCIES ACCORDING TO WHO: 1 1. Iraq 2. Somalia 3. Western Cote d’Ivoire 4. Libya 5. Haiti 6. Pakistan 7. Zimbabwe 8. Sudan 9. Liberia SOME DEFINITIONS: 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 Health 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 Public health 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 state agencies. 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 Key facts • 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%. Background 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. Particulate matter Guideline values PM 2.5 10 μg/m annual mean 3 25 μg/m 24-hour mean PM 10 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. Health effects 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 Guideline values O 3 100 μg/m 8-hour mean 3 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. Health effects 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 3 mortality rises by 0.3% and that for heart diseases by 0.4 %, per 10 µg/m increase in ozone exposure. Nitrogen dioxide (NO ) 2 Guideline values NO 2 3 40 μg/m annual mean 200 μg/m 31-hour mean 3 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 AQGs. 6 Definition and principle sources As an air pollutant, NO h2s several correlated activities. 3 • 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). Health effects 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 )
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