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Global Health Security Global Health Security and Roles of Citiesand Roles of Cities
Dr Shigeru OmiDr Shigeru Omi
Regional DirectorRegional Director
World Health OrganizationWorld Health Organization
Western Pacific Regional OfficeWestern Pacific Regional Office
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History of disease and civilizationHistory of disease and civilizationPeriodPeriod EventEvent DiseaseDisease PlacePlace
PrehistoryPrehistory Human beings lived as Human beings lived as hunters and gatherers of foodhunters and gatherers of foodNo major communicable No major communicable diseasesdiseases
11stst WaveWave(5000 (5000 ––2500 years ago)2500 years ago)
HunterHunter--gatherers gatherers ‘‘settledsettled’’ into into agrarian villagesagrarian villages
Smallpox, measles, Smallpox, measles, chickenpox,tuberculosis chickenpox,tuberculosis Sumeria, EgyptSumeria, Egypt
22ndnd WaveWave(2500(2500--700 years ago)700 years ago)
Contact between different Contact between different civilizations (through trade civilizations (through trade and travel )and travel )
Smallpox, measles Smallpox, measles From Europe to Asia via the From Europe to Asia via the Silk RoadSilk Road
““Black DeathBlack Death”” /bubonic /bubonic plagueplague
Started in Europe in the 6Started in Europe in the 6ththcenturycentury
33rdrd WaveWave(700 years ago and (700 years ago and onwards)onwards)
TransTrans--oceanic movement of oceanic movement of seafarersseafarers
Smallpox, measles, Smallpox, measles, influenza, typhusinfluenza, typhus
To America from Europe To America from Europe (destroyed 90% of the (destroyed 90% of the population)population)
SyphilisSyphilis To Europe from AmericaTo Europe from America
Malaria, yellow fever Malaria, yellow fever To Europe from AfricaTo Europe from Africa
44thth Wave Wave ?? ?? ?? ??(McMicheal, A.J., Human frontiers, environments and diseasesCambridge University Press, 2001)
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1. Globalization1. Globalization The flow of people, goods and The flow of people, goods and information is unprecedentedinformation is unprecedented
2. Urbanization2. Urbanization TThere are more than 20 megacities here are more than 20 megacities today today
3. Consumerism3. Consumerism Consumption has become an end Consumption has become an end in itselfin itself
4. Demographic changes 4. Demographic changes Society is ageing Society is ageing
Characteristics of civilization todayCharacteristics of civilization today
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Emergence of new infectious diseasesEmergence of new infectious diseases
•• Most are zoonosesMost are zoonoses
•• Globally, an Globally, an average of one new average of one new infectious disease infectious disease has emerged each has emerged each year.year.
HIV 1 1983HIV 2 1985Enterocytozoon Bieneusi 1985Human Herpesvirus 6 (HHV 6) 1986Hepatitis C virus 1989Hepatitis E virus 1990Guanarito Virus 1991Barmah Forest Virus 1992Bartonella henselae 1992Sin Nombre Hantavirus 1993Cyclospora cayatenensis 1994Sabia Virus 1994Hendra Virus 1994Human Herpesvirus 8 1994Lyssavirus (in Australia) 1996Nipah Virus 1996New Variant CJD 1996Influenza A(H5N1) 1997West Nile Virus (in US) 1999SARS CoV 2003Monkeypox (in US) 2003
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WHO has verified more than 1800 events between January 2001 and Dec 2007
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Current concern about Current concern about potential influenza potential influenza
pandemicpandemic
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The way in which people live The way in which people live with and handle poultry in Asiawith and handle poultry in Asia
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Influenza pandemics in 20th centuryInfluenza pandemics in 20th century
A(H1N1) A(H2N2) A(H3N2)
1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
40-50 million deaths 1-4 million deaths 1-4 million deaths
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H5N1 viruses H5N1 viruses eevolve rapidlyvolve rapidly
Distinct geneDistinct genettic ic groups have been groups have been identifed.identifed.Different clades and Different clades and subclades have subclades have been circulating in been circulating in different parts of the different parts of the worldworld
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1.1. Outbreak of H5N1 in migratory birds Outbreak of H5N1 in migratory birds in Qinghai province, Chinain Qinghai province, China
Over 6,000 migratory birds died in May and June 2005 in Qinghai Lake. This event was unprecedented –significant mortality in wild birds is very unusual
Naqu, TibetNaqu, Tibet
YushuYushu GuolouGuolou
2.2. Optimum temperature of growthOptimum temperature of growth
Serious Condition of H1N1Serious Condition of H1N1
出典:PLoS Pathog. 2007 October; 3(10): e133.
• Seasonal epidemic viruses (human to human transmission) replicatemost efficiently at 33℃.
• H5N1 replicates most efficiently at37 ℃.
• A recent study points out thatsome H5N1 viruses now canreplicate at 33℃
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May Jun Jul
Aug
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May Jun Jul
Aug
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06-J
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June July
Aug
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May Jun
July
Aug
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08-J
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May
Date of onset
No.
of c
ases
0
10
20
30
40
50
60
70
80
90
100
CFR
(%)
Viet Nam (N=105)* Thailand (N=25) Cambodia (N=7) Indonesia (N=120)*China (N=30) Azerbaijan (N=5)* Egypt (N=32)* Turkey (N=11)*Iraq (N=2)* Nigeria (N=0)* Pakistan (N=3) Myanmar (N=1)Djibouti (N=1) Lao PDR (N=2) Bangladesh(N=1) CFR Trend**
Human Avian Influenza A (H5N1) Cases by Onset Human Avian Influenza A (H5N1) Cases by Onset Date and Country (n=347) (as of 19 June 2008)Date and Country (n=347) (as of 19 June 2008)
As of 19 June 2008, total of 385 cases were reported officially to WHO* Cases missing onset date are excluded:
1 Viet Nam, 13 Indonesia, 3 Azerbaijan, 18 Egypt, 1 Turkey, 1 Iraq, 1 Nigeria ** CFR Trend: computed based on cumulative dead & total
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Spread of 1918 Pandemic in USASpread of 1918 Pandemic in USA
Spread of 1918 Influenza Pandemic in USA
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Strategy: Pandemic PreparednessStrategy: Pandemic Preparedness
NonNon--Medical Medical interventionsinterventions
MedicalMedicalIntervenInterven--
tionstions
Security Security Food & water supplyFood & water supplyPower supplyPower supplyTransportation Transportation TelecommunicationTelecommunicationOther essential servicesOther essential services
Personal hygienePersonal hygieneTravel restrictionTravel restrictionQuarantine Quarantine Social distancing Social distancing Risk Communication Risk Communication
Antiviral drugsAntiviral drugsVaccines, etcVaccines, etcMedical care, PPEMedical care, PPE
Social ServicesSocial Services(keep a society running)
Public Health Measures
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1918 Death Rates: Philadelphia v St. Louis
0
2000
4000
6000
8000
10000
12000
14000
16000
1918
-09-14
1918
-09-21
1918
-09-28
1918
-10-05
1918
-10-12
1918
-10-19
1918
-10-26
1918
-11-02
1918
-11-09
1918
-11-16
1918
-11-23
1918
-11-30
1918
-12-07
1918
-12-14
1918
-12-21
1918
-12-28
Date
Dea
ths
Rat
es /
100,
000
Popu
latio
n (A
nnua
l Bas
is)
PhiladelphiaSt. Louis
Weekly mortality data provided by Marc Lipsitch
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TimeTime Check !Check !
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2. Increasing burden of 2. Increasing burden of noncommunicable diseasenoncommunicable disease
0
2
4
6
8
10
12
2000 2010 2020 2030
Year
Pro
ject
ed g
loba
l dea
ths
(mill
ions
)
Malaria
Cancers
HIV/AIDS
Road traffic accidents
TB
IHD
Stroke
Other infectious
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2020
AFR EMR EURSEAR WPR AMR
Noncommunicableconditions
InjuriesInjuries
25
50
75%
Heavy burden of NCD compared Heavy burden of NCD compared to other conditionsto other conditions
DALY = Disability-Adjusted Life YearSource: World Health Report, 1999
Communicable diseases, maternal and perinatal conditions and nutritional deficiencies
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Causes of chronic diseasesCauses of chronic diseases
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Outcome of risk reductionOutcome of risk reduction
HealthyHealthy diet, regular physical activity diet, regular physical activity and avoidance of tobaccoand avoidance of tobacco
Could avoidCould avoid 80% of CVD, 80% of CVD, DDM M and 40% of cancersand 40% of cancers..
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0
5
10
15
20
25
30
1993-1997 1998-2002
?Death rate Per 100,000
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Suicide Death rate
Per 100,000
0
5
10
15
20
25
30
1993-1997 1998-2002
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Lack of connectedness
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DENGUE CASES & TEMPERATURE, SINGAPORE, 1989 - 2006
9441733 2179
2878
946 12392008
31284300
5258
1355673
2372
39454788
9459
14209
3126
26.9
27.6
27.427.3
27.4
27.6 27.627.5
28.3 28.3
27.7
27.527.6
28.1
27.76 27.8
28.2
27.5
0
2000
4000
6000
8000
10000
12000
14000
16000
89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06
YEAR
NO. O
F CA
SES
26
26.5
27
27.5
28
28.5
DEG
. CEL
CIUS
CasesTemperatureLinear (Temperature)
(e-w k 10)
Dengue cases 1989Dengue cases 1989--20062006
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History of disease and civilizationHistory of disease and civilizationPeriodPeriod EventEvent DiseaseDisease PlacePlace
PrehistoryPrehistory Human beings lived as Human beings lived as hunters and gatherers of foodhunters and gatherers of foodNo major communicable No major communicable diseasesdiseases
11stst WaveWave HunterHunter--gatherers gatherers ‘‘settledsettled’’ into into agrarian villagesagrarian villagesSmallpox, measles, Smallpox, measles, chickenpox,tuberculosis chickenpox,tuberculosis Sumeria, EgyptSumeria, Egypt
22ndnd WaveWave Contact between different Contact between different civilizationscivilizationsSmallpox, measles Smallpox, measles fromfrom Europe to AsiEurope to Asiaa
““Black DeathBlack Death”” Europe in the 6Europe in the 6thth centurycentury
33rdrd WaveWave TransTrans--oceanic movement of oceanic movement of seafarersseafarers
Smallpox, measles,Smallpox, measles, etcetc To America from EuropeTo America from Europe
SyphilisSyphilis To Europe from AmericaTo Europe from America
Malaria, yellow fever Malaria, yellow fever To Europe from AfricaTo Europe from Africa
44thth Wave Wave
GlobalizationGlobalizationUrbanizationUrbanizationConsumerismConsumerismDemographic Demographic changeschanges
Noncommunicable Noncommunicable diseasesdiseasescommunicable communicable diseasesdiseasesIncreasing Increasing environmental health environmental health risksrisks
All over the All over the worldworld
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To what extent are human beings To what extent are human beings responsible for diseases?responsible for diseases?
PastPast NowNow
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100100
Industrial Industrial RevolutionRevolution
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Key message:Key message:
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1.1.Be innovative in technology and Be innovative in technology and policy development; and policy development; and live responsibly with nature live responsibly with nature Change the ways in which humans coChange the ways in which humans co--exist with other exist with other speciesspecies
Proactively identify, report and contain threats to public Proactively identify, report and contain threats to public health securityhealth security
Maintain a healthy lifestyleMaintain a healthy lifestyle
Build supportive environments conducive to healthBuild supportive environments conducive to health
Promote policies which enable us to use cleaner and Promote policies which enable us to use cleaner and greener technologiesgreener technologies
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2.2.Be agents for change by establishing Be agents for change by establishing ““newnew”” connectedness in societyconnectedness in society
Build up a “common forum” which includes representatives of civil society, the older persons, scholars, NGOs, private companies and public organizations and capitalize on the decentralization movement and higher education of citizens to influence local and national conditions.
Discuss issues based on longDiscuss issues based on long--term visionterm vision
Take up various issues which are being neglected by Take up various issues which are being neglected by existing institutions/mechanismsexisting institutions/mechanisms
Share the sense of social responsibilityShare the sense of social responsibility
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