Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Public Health Infrastructure”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed2004

China's public health-care system: facing the challenges.

The severe acute respiratory syndrome (SARS) crisis in China revealed not only the failures of the Chinese health-care system but also some fundamental structural deficiencies. A decentralized and fragmented health system, such as the one found in China, is not well-suited to making a rapid and coordinated response to public health emergencies. The commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of the under-provision of public services, such as health surveillance and preventive care. For the past 25 years, the Chinese Government has kept economic development at the top of the policy agenda at the expense of public health, especially in terms of access to health care for the 800 million people living in rural areas. A significant increase in government investment in the public health infrastructure, though long overdue, is not sufficient to solve the problems of the health-care system. China needs to reorganize its public health system by strengthening both the vertical and horizontal connections between its various public health organizations. China's recent policy of establishing a matching-fund financed rural health insurance system presents an exciting opportunity to improve people's access to health care.

Capitalism↗
PubMed2002

Biological terrorism: understanding the threat, preparation, and medical response.

The thought of an outbreak of disease caused by the intentional release of a pathogen or toxin in an American city was alien just 10 years ago. Many people believed that biological warfare was only in the military's imagination, perhaps to be faced by soldiers on a far-away battlefield, if at all. The "anthrax letters" and the resulting deaths from inhalation anthrax have changed that perception. The national, state, and local governments in the United States are preparing for what is now called "not if, but when and how extensive" biological terrorism. In contrast to the acute onset and first-responder focus with a chemical attack, in a bioterrorist attack, the physician and the hospital will be at the center of the fray. Whether the attack is a hoax, a small food-borne outbreak, a lethal aerosol cloud moving silently through a city at night, or the introduction of contagious disease, the physician who understands threat agent characteristics and diagnostic and treatment options and who thinks like an epidemiologist will have the greatest success in limiting the impact of the attack. As individual health care providers, we must add the exotic agents to our diagnostic differentials. Hospital administrators must consider augmenting diagnostic capabilities and surveillance programs and even making infrastructure modifications in preparation for the treatment of victims of bioterrorism. Above all, we must all educate ourselves. If done correctly, preparation for a biological attack will be as "dual use" as the facility that produced the weapon. A sound public health infrastructure, which includes all of us and our resources, will serve this nation well for the control of the disease, no matter what the cause of the disease.

Biological Warfare↗
PubMed2004

The public health workforce.

The development of a fully-competent public health workforce as a key component of the nation's public health infrastructure has become the focus of increasing attention. The subject is included in one, and is the major topic of a second, report from the Institute of Medicine published late in 2002. Workforce issues have stimulated the convening of the majority of public health-related associations in a range of collaborations on the subjects of defining, enumerating, credentialing, educating, and studying the workforce. The authors review the major questions confronting the field and introduce key components of current thinking about approaches to improvement.

Disaster Planning↗
PubMed2002

Terrorism from a public health perspective.

The use of biological and chemical weapons as agents of warfare and terrorism has occurred sporadically, but recent events demonstrate the increasing risk and possibility that terrorist groups with grievances against the government or groups may employ them. Historically, most evaluations of the potential risk for biological weaponry have focused on the military, but the recent release of anthrax in the United States demonstrates that civilian populations are also at risk. More likely than not, most bioterrorism events will be of a small scale; however, agents such as Bacillus anthracis and Yersinia pestis could leave hundreds of thousands dead or incapacitated. The impact of the attack will depend on a number of variables, including the agent used, method of dispersal, and the responsiveness of the public health system. With any large-scale event, the public health infrastructure will be called upon to deal with mass casualties and the "worried well."

Bioterrorism↗
PubMed2003

Has bioterrorism preparedness improved public health?

In anticipation of future terrorist attacks, the nation has been focused on emergency preparedness, including threats to public health and the ability of communities to respond to them. The Center for Studying Health System Change's (HSC) recent site visits to 12 nationally representative communities found early benefits to public health due to heightened attention to bioterrorism preparedness: more visibility and credibility for public health, stronger public health infrastructure and improved communication and coordination across sectors. Modest negative effects included staff diversions and delays in some program implementation. As the site visits continued from fall 2002 into 2003, concerns grew that the federal smallpox vaccination program was diverting resources from such traditional public health activities as routine immunizations, health promotion and screening.

Bioterrorism↗
PubMed2001

Emerging illness and bioterrorism: implications for public health.

Biological weapons have the potential to inflict deliberate, potentially devastating epidemics of infectious disease on populations. The science and technology exist to create deliberate outbreaks of human disease, as well as disease among plants and animals, crops, and livestock. A new awareness among policymakers of the link between public health and national security requires the attention of public health professionals. The issues posed by biological weapons are likely to challenge the political assumptions of many progressive public health professionals and will demand new coalitions. The prospect of bioterrorism may offer new opportunities for improving the public health infrastructure and its capabilities.

Bioterrorism↗
PubMedDate not supplied

[Bioterrorism: notes for an agenda in case of the unexpected].

UNLABELLED: The vulnerability of human populations to chemical, biological, radiological, and nuclear terrorism has been widely discussed but insufficiently studied. Current public health policies are not guided by solid and relevant information to design cost-effective programs for preventing or controlling this kind of incidents in the future. Governmental budgets are insufficient to respond to bioterrorist attacks. To face these threats, developing countries like Mexico should frame strategies and devise specific preventive actions that consider the transmission dynamics of potential infectious agents likely to be used in a bioterrorist attack. PROPOSALS: The international reaction to a biological attack must be supported by international agreements that ban the use of biological agents for warfare and/or defense purposes, as well as on academic and technological exchange for the prevention of bioterrorist attacks. At the national level, the recommendations in the event of a biological attack are: a) establishing a legal defense strategy against bioterrorism; b) implementing education programs as a key strategy for defense against bioterrorism; c) devising a national program of interinstitutional anti-bioterrorist coordination that includes medical emergency assistance and collection of medical forensic evidence; d) including a biological weapon registry in epidemiological surveillance systems; e) implementing a laboratory for biological material analysis related to terrorist incidents; f) devising public health information campaigns, g) assuring the supply of diagnostic testing, special protection, and emergency treatment materials; h) decentralizing alert systems for the timely detection of bioterrorist attacks; i) responding to bioterrorist actions addressed against animals and plants, and j) organizing Ethics Committees in case of urgent events derived from a biological attack. CONCLUSIONS: The proper response to sudden and unexpected events of emergent or unusual infectious diseases involved in a bioterrorist attack requires an adequate public health infrastructure. Modern technology allows the timely identification of multiple infectious agents by nucleic acid analyses and should be widely available in reference laboratories. All these measures require sufficient funding to respond to this potential threat. Resource allocation to respond to bioterrorist attacks must be consonant with their potential public health consequences.

Biological Warfare↗
PubMed2002

Preparing for an era of weapons of mass destruction (WMD). Are we there yet? Why we should all be concerned. Part 1.

In the aftermath of September 11th and autumn 2001, tremendous efforts have been expended to enhance national preparedness to protect against terrorism and weapons of mass destruction (WMD). However there remain significant vulnerabilities across domains, including communications, health care facility preparedness, professional training, interagency collaborations, public health infrastructure, surveillance capabilities, the food supply, the environment and resource allocation. It is a significant challenge to prepare for an unknown event, without a clear-cut indicator of who to protect and from whom. The daunting tasks of preparing a nation, remedyingyears of under-investment in public health, and promoting cooperative endeavors among agencies unaccustomed to working together cannot be solved merely by money, brief overview training programs, and quick fixes. None the less, much progress has been made and hope is on the horizon. Although it would seem obvious to include toxicologists in WMD planning, often this is not the case. What role should the poison control and toxicology communities play? What follows is the first of a two-part discussion of our current state of WMD preparedness and the vulnerabilities we must address. Part 2 will examine possible solutions and discuss the critical leadership role toxicology can play in this important arena.

Algorithms↗
PubMed2000

Biological terrorism: understanding the threat, preparation, and medical response.

The thought of an outbreak of disease caused by the intentional release of a pathogen or toxin in an American city was alien just 10 years ago. Many people believed that biological warfare was only in the military's imagination, perhaps to be faced by soldiers on a far-away battlefield, if at all. Political factors--and possibly biotechnology--have changed that. As we enter the new millennium, national, state, and local governments in the United States are preparing for what is now called "not if, but when" biological terrorism. In contrast to the acute onset and first-responder focus with a chemical attack, in a bioterrorist attack, the physician and the hospital will be at the center of the fray. Whether the attack is a hoax, a small food-borne outbreak, a lethal aerosol cloud moving silently through a city at night, or the introduction of contagious disease, the physician who understands threat agent characteristics and diagnostic and treatment options and who thinks like an epidemiologist will have the greatest success in limiting the impact of the attack. As individual health-care providers, we must add the exotic agents to our diagnostic differentials. Hospital administrators must consider augmenting diagnostic capabilities and surveillance programs and even making infrastructure modifications in preparation for the treatment of victims of bioterrorism. Above all, we must all educate ourselves. If done correctly, preparation for a biological attack will be as "dual use" as the facility that produced the weapon. A sound public health infrastructure, which includes all of us and our resources, will serve this nation well for the control of disease, no matter what the cause of the disease.

Biological Warfare↗
PubMedDate not supplied

Better prepared but spread too thin: the impact of emergency preparedness funding on local public health.

Local public health authorities (LPHAs) are recognized as playing critical roles in response to biological, chemical, and other health emergencies. An influx of emergency preparedness funding has created new and expanding responsibilities for LPHAs. Concern that funding for emergency response is diverting attention and resources away from other core public health responsibilities is increasing. In order to determine the impact of emergency preparedness funding on public health infrastructure, qualitative interviews with 27 LPHAs in the metro-Boston area were conducted as part of an on-going evaluation of preparedness planning in Massachusetts. Feedback on the benefits and challenges of recent emergency preparedness planning mandates was obtained. Benefits include opportunities to develop relationships within and across public health departments and increases in communication between local and state authorities. Challenges include budget constraints, staffing shortages, and competing public responsibilities. Policy recommendations for improving planning for emergency response at the local level are provided.

Bioterrorism↗
PubMed2003

The Mumbai experience in building field level partnerships for DOTS implementation.

In February 1999, the Revised National Tuberculosis (TB) Control Programme (RNTCP) was implemented in the city of Mumbai after a pilot phase of 5 years. The city has a population of more than 12 million people and an estimated annual TB incidence of 21,000 cases, 8000 of these being infectious. This paper describes a partnership between the TB programme and a Non Governmental Organization (NGO), which began with a methodological analysis of the problems faced by the programme to help identify other key organizations, who might usefully be involved. The work focussed on "networking" to ensure the optimum use of existing resources. The problems encountered affected all levels of TB control from access to drug supply and treatment. The major issues related to an inadequate public health infrastructure resulting in poor technical and administrative support to field staff. There was confusion over roles of the health personnel in the TB programme and the public health facility, as well as poor technical performance. Partnerships were found to be useful in addressing the following areas: (1) the implementation of an external quality assurance scheme for sputum microscopy through involvement of microbiologists from large hospitals and research organizations; (2) training and capacity strengthening of programme and public health facility staff through innovative training and team building exercises organized by the programme, NGOs and the private sector; (3) development of Information, Education and Communication (IEC) material through partnerships with NGOs, and (4) the involvement of local NGOs and private doctors to increase case finding and to improve access to direct observation of treatment (DOT). The paper discusses the lessons learnt in this process and identifies some of the key issues in urban TB control, for consideration by policy makers.

Communicable Disease Control↗
PubMed2001

West Nile virus: success of public health response underlines failure of the system.

The West Nile virus outbreak in 1999 demonstrated the country's capacity to meet an emerging public health threat. However, while the tracking and monitoring efforts that were put into place by 2000 were impressive, the response to the West Nile virus underscores a fundamental deficiency in the capacity of public health regarding the nation's environmental health efforts. Chronic diseases such as asthma, neurological diseases, and birth defects and their potential links to environmental factors are not being adequately tracked and monitored. New public health infrastructure resources are required.

Disease Outbreaks↗
PubMed1993

Forging the future: the public health imperative.

During the 1980s, national policy promoted military expenditures and downsized domestic programs. These priorities, along with tax reform and deregulation, created a "domestic gulf crisis" with a new wave of vulnerable populations--poor children, the homeless, the elderly, and the uninsured. Our lack of a national health program compounds the problem. The 1990s will be a decade of change and challenge. To forge a healthier and stronger future for our nation, we must implement five public health imperatives: (1) We must have a national health program that is universal, comprehensive, and prevention-oriented, with built-in assurances for quality, efficiency, and a strong public health infrastructure. (2) We must have a comprehensive national health education and promotion program for all schoolchildren. (3) Women must have freedom of choice. (4) Prevention and public health must become one of our country's highest health priorities. (5) The federal government must increase its leadership, commitments, and resources to reach the goals set forth in Healthy Communities 2000 and Healthy People 2000.

Delivery of Health Care↗
PubMed2005

Community-based public health interventions in North Korea: one non-governmental organization's experience with tuberculosis and hepatitis B.

BACKGROUND: The Democratic People's Republic of Korea, also known as North Korea, is the most isolated country in the world, and has been a source of interest, politically and socially, since the 1953 ceasefire of the Korean War. While in the past year, interest has focused on the nuclear dispute with the USA, over the past decade, most interest has revolved around the economic plight of the country, the lack of funds and resources for health care, and the subsequent public health declines. North Korea's present economic and public health problems began in the early 1990s due to the gradual loss of economic support from its communist allies (i.e. after the fall of the Soviet Union and the capitalization of China), combined with an inordinate number of natural disasters (floods, famine and drought) all occurring within the same time span. These simultaneous events initiated a 'snowball effect' of severe economic depression and a rapid deterioration of the overall public health infrastructure in the country. North Korea's continued isolation and reluctance to release health statistics has left the international community uncertain of the precise extent of the public health devastation. The uncertainty of the situation has been further complicated by disparate accounts of the public health declines. For instance, the North Korean Government has estimated that approximately 220,000 people died due to famine in the 1990s, while the World Health Organization (WHO) claims that this figure is closer to 2 million. In the past few years, the willingness of the North Korean Government to engage the outside world has increased. This is reflected by the growing number of foreign aid organizations or non-governmental organizations (NGOs) that have been permitted entry into the country. NGOs have not only served to improve various aspects of the public health system but also serve as a source of 'on-the-ground' information for the outside world. This role has proven critical not only for public health purposes but for facilitating improved international relations between countries.

Altruism↗
PubMed1998

Dengue and dengue hemorrhagic fever.

Dengue fever, a very old disease, has reemerged in the past 20 years with an expanded geographic distribution of both the viruses and the mosquito vectors, increased epidemic activity, the development of hyperendemicity (the cocirculation of multiple serotypes), and the emergence of dengue hemorrhagic fever in new geographic regions. In 1998 this mosquito-borne disease is the most important tropical infectious disease after malaria, with an estimated 100 million cases of dengue fever, 500,000 cases of dengue hemorrhagic fever, and 25,000 deaths annually. The reasons for this resurgence and emergence of dengue hemorrhagic fever in the waning years of the 20th century are complex and not fully understood, but demographic, societal, and public health infrastructure changes in the past 30 years have contributed greatly. This paper reviews the changing epidemiology of dengue and dengue hemorrhagic fever by geographic region, the natural history and transmission cycles, clinical diagnosis of both dengue fever and dengue hemorrhagic fever, serologic and virologic laboratory diagnoses, pathogenesis, surveillance, prevention, and control. A major challenge for public health officials in all tropical areas of the world is to develop and implement sustainable prevention and control programs that will reverse the trend of emergent dengue hemorrhagic fever.

Dengue↗
PubMedDate not supplied

The next administration and Congress: a new look at old problems.

The 2000 general election brings a new administration and Congress to Washington. It also provides the opportunity for a fresh look at the national health policy agenda. Both of the major parties have focused on health as one component of their national agendas. A booming economy and growing public concern about domestic issues presents policymakers with the opportunity to resolve some of the nation's long-standing concerns about the health of its citizens. The year 2001 can be a burst or boon for human health. Top health care issues include Medicare reform, prescription drug coverage, insuring the uninsured, managed care reform, the public health infrastructure, and health care quality.

Health Care Reform↗
PubMed1993

Commentary: tuberculosis in New York City--the consequences and lessons of failure.

The resurgent tuberculosis epidemic represents--especially in New York City--a failure to maintain a public health infrastructure that was focused on preventing active disease in high-risk populations (i.e., individuals with the human immunodeficiency virus [HIV]) and on treating active tuberculosis patients until cured. Although the tuberculosis problem in New York City and other localities is worsened by homelessness, poverty, and substance abuse, it is possible to bring tuberculosis under control by directing public health resources into targeted programs that enhance compliance with tuberculosis treatment regimen and expand chemoprophylaxis efforts among HIV-infected individuals. These two avenues will decrease, respectively, the number of cases of multidrug-resistant tuberculosis and the total number of new cases.

AIDS-Related Opportunistic Infections↗
PubMed2002

Threat of a biological terrorist attack on the US food supply: the CDC perspective.

Deliberate contamination of food with biological agents has already been perpetrated in the USA. The US food supply is increasingly characterised by centralised production and wide distribution of products. Deliberate contamination of a commercial food product could cause an outbreak of disease, with many illnesses dispersed over wide geographical areas. Dependent on the biological agent and contaminated food, such an outbreak could either present as a slow, diffuse, and initially unremarkable increase in sporadic cases, or as an explosive epidemic suddenly producing many illnesses. Preparedness for a bioterrorist event affecting the food supply, therefore, entails augmentation of the traditional public-health infrastructure to enhance disease surveillance, accelerate capacity of laboratory detection, rapidly investigate and control outbreaks, and develop capacity for response to mass-casualty disasters.

Bioterrorism↗