PUBLIC HEALTH IN A PUBLIC HEALTH IN A FLATFLAT WORLDWORLD

A Singaporean’s PerspectiveA Singaporean’s Perspective

THOMAS FRIEDMANTHOMAS FRIEDMAN

Pulitzer Prize Pulitzer Prize winnerwinner

Bestseller released Bestseller released in 2005in 2005

Focus on trade and Focus on trade and commercecommerce

Opportunities and Opportunities and challenges of challenges of GLOBALIZATIONGLOBALIZATION

GLOBALIZATIONGLOBALIZATION

Not just a geopolitical policyNot just a geopolitical policy It is a phenomenonIt is a phenomenon Confluence of new technologiesConfluence of new technologies

“…“…it presents 2 contradictory faces – new technologies, it presents 2 contradictory faces – new technologies, greater wealth and rising living standards for millions of greater wealth and rising living standards for millions of people; and at the same time, new instabilities, new risks, people; and at the same time, new instabilities, new risks, new uncertainties…”new uncertainties…” Renato Ruggiero (1998) Renato Ruggiero (1998) Former DG, WTO Former DG, WTO

DG, WHODG, WHO

Dr Margaret ChanDr Margaret ChanSingapore 2007Singapore 2007

““Globalization has helped spread a costly epidemic Globalization has helped spread a costly epidemic of chronic diseases to the developing world. of chronic diseases to the developing world. Consumer behaviors the world over are being Consumer behaviors the world over are being shaped by global forces of production, trade, shaped by global forces of production, trade, marketing and distribution. In the developing marketing and distribution. In the developing world, a strong national asset – the healthy diet world, a strong national asset – the healthy diet and physical activity associated with rural and physical activity associated with rural farming – is being lost.”farming – is being lost.”

The MASS EffectThe MASS Effect

Mass travelMass travel Mass productionMass production Mass Mass

communicationscommunications

Mass transfer of Mass transfer of risks, including risks, including harmful lifestylesharmful lifestyles

GLOBAL HEALTHGLOBAL HEALTH

The original idea of The original idea of InternationalInternational HealthHealth – flow of information and – flow of information and resources from developed to resources from developed to developing countriesdeveloping countries

Global HealthGlobal Health emphasizes the emphasizes the interdependence of countries and interdependence of countries and organizations on universal concernsorganizations on universal concerns

What we need…..What we need…..

A new visionA new vision A research A research

intensive cultureintensive culture An innovative An innovative

healthcare delivery healthcare delivery strategystrategy

A “global public A “global public policy”policy”

The cost of a PANDEMICThe cost of a PANDEMIC

World Bank estimates loss of $800bn World Bank estimates loss of $800bn worldwide, and greatest cause will worldwide, and greatest cause will arise from uncoordinated efforts to arise from uncoordinated efforts to avoid infection (2005)avoid infection (2005)

““It is also an issue of self-interest; can the world It is also an issue of self-interest; can the world afford to leave vast populations vulnerable to the afford to leave vast populations vulnerable to the high morbidity and mortality that inevitably high morbidity and mortality that inevitably accompany pandemics?accompany pandemics?Is it not in our collective best interest to strive for Is it not in our collective best interest to strive for more equitable protection?”more equitable protection?” DG WHO (2007)DG WHO (2007)

1) Eradicate extreme poverty and hunger*1) Eradicate extreme poverty and hunger* 2) Achieve universal primary education2) Achieve universal primary education 3) Promote gender equality & empower women3) Promote gender equality & empower women 4) Reduce child mortality*4) Reduce child mortality* 5) Improve maternal health*5) Improve maternal health* 6) Combat HIV/AIDS, malaria, and others*6) Combat HIV/AIDS, malaria, and others* 7) Ensure environmental sustainability*7) Ensure environmental sustainability* 8) Develop global partnership for development*8) Develop global partnership for development*

* Health-related as identified by WHO* Health-related as identified by WHO

An assessment by the DG, WHO (2008):An assessment by the DG, WHO (2008):

““For many priority diseases, trends such as For many priority diseases, trends such as globalization and urbanization have introduced a globalization and urbanization have introduced a commonality to health problems seen in every commonality to health problems seen in every part of the world.part of the world.Among the health-related MDGs, there appears to Among the health-related MDGs, there appears to be difficulty in reducing maternal mortality. The be difficulty in reducing maternal mortality. The causes are broad and closely linked to social and causes are broad and closely linked to social and economic factors. There is no single pill, bednet economic factors. There is no single pill, bednet or vaccine that can guarantee results.or vaccine that can guarantee results.

Clearly, the problem of weak health systems Clearly, the problem of weak health systems includes the shortage of human resources as well includes the shortage of human resources as well as issues of infrastructure and financing.”as issues of infrastructure and financing.”

Contributions of PH ProfessionalsContributions of PH Professionals

Handling the Information ExplosionHandling the Information Explosion

“The world of 2020 will be a global “The world of 2020 will be a global knowledge village of 8 bn people…”knowledge village of 8 bn people…”

Using the skills of health, information Using the skills of health, information and risk assessment as well as and risk assessment as well as communications – to guide public communications – to guide public actionaction

Contributions of PH ProfessionalsContributions of PH Professionals

Creating New KnowledgeCreating New Knowledge

Promoting Evidence-based Promoting Evidence-based HealthcareHealthcare

Developing competence in Developing competence in population-based research, using the population-based research, using the latest biomedical tools with rigorous latest biomedical tools with rigorous study designsstudy designs

What do we do in such timesWhat do we do in such times

““..it is a..it is abottomlessbottomlesspit of panicpit of panicand despair.”and despair.”

We will have We will have to do moreto do morewith less – with less – evidence-basedevidence-basedcost-effectivecost-effectivehealth carehealth care..

Public Health in AsiaPublic Health in Asia

We have issues in public housing, We have issues in public housing, environmental sanitation, infectious environmental sanitation, infectious disease control, health promotion, disease control, health promotion, innovations in healthcare & financinginnovations in healthcare & financing

Combining local experience with an Combining local experience with an international perspectiveinternational perspective

“…“…the health and well-being of people around the the health and well-being of people around the world depend critically on the performance of the world depend critically on the performance of the health systems that serve them.”health systems that serve them.”

Our role in capacity-buildingOur role in capacity-building

Training is keyTraining is key New areas of concern: obesity, New areas of concern: obesity,

bioterrorism, flu-pandemicbioterrorism, flu-pandemic Plugging the “gaps” in managementPlugging the “gaps” in management Developing core skills in PHDeveloping core skills in PH Making a significant contribution by equipping Making a significant contribution by equipping

and encouraging a professional worker with a and encouraging a professional worker with a broad understanding of health issues and the broad understanding of health issues and the skills to deal with disease prevention, health skills to deal with disease prevention, health promotion and the delivery of health servicespromotion and the delivery of health services

CONCLUSIONCONCLUSION

THINK BIG:THINK BIG: Challenge of a borderless worldChallenge of a borderless world

ACT SMART:ACT SMART:Show competence in a focused Show competence in a focused mannermanner

Our future in a flat worldOur future in a flat world