Health Equity: 05/05/09

Tuesday, May 5, 2009

[EQ] Pandemic influenza preparedness in Latin America: analysis of national strategic plans

Pandemic influenza preparedness in Latin America: analysis of national strategic plans

Ana Mensua, Sandra Mounier-Jack and Richard Coker

Communicable Disease Policy Research Group, Health Policy Unit, Department of Public health and Policy, London School of Hygiene and Tropical Medicine, London, UK.

Health Policy and Planning Advance Access published May 1, 2009

Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine

Health Policy and Planning 2009;1–8 doi:10.1093/heapol/czp019

Full text at: http://bit.ly/AsZJI

PDF: http://heapol.oxfordjournals.org/cgi/reprint/czp019v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Mensua&author2=Mounier-Jack+&andorexacttitle=and&andorexacttitleabs=and&fulltext=Pandemic+influenza+preparedness+&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

“…..The threat of a human pandemic of influenza has prompted the development of national influenza pandemic preparedness plans over the last 4 years. Analyses have been carried out to assess preparedness in Europe, Asia and Africa. We assessed plans to evaluate the national strategic pandemic influenza preparedness in the countries of Latin America.

Published national pandemic influenza preparedness plans from Latin American countries were evaluated against criteria drawn from the World Health Organization checklist. Plans were eligible for inclusion if formally published before 16 November 2007.

Fifteen national plans were identified and retrieved from the 17 Latin American countries surveyed. Latin American countries demonstrated different degrees of preparedness, and that a high level of completeness of plans was correlated to a country's wealth to a certain extent. Plans were judged strong in addressing surveillance requirements, and provided appropriate communication strategies directed to the general public and health care personnel.

However, gaps remained, including the organization of health care services’ response; planning and maintenance of essential services; and the provision of containment measures such as the stockpiling of necessary medical supplies including vaccines and antiviral medications.

In addition, some inconsistencies and variations which may be important, such as in border control measures and the capacity to contain outbreaks, exist between country plans—issues that could result in confusion in the event of a pandemic. A number of plans remain developmental in nature and, as elsewhere, more emphasis should be placed on strengthening the operability of plans, and in testing them. Whilst taking account of resources constraints, plans should be further developed in a coherent manner with both regional and international imperatives. …..”

KEY MESSAGES

Most Latin American countries now have national strategic pandemic influenza preparedness plans.

Many plans are developmental in nature, although a minority includes more specific and operational guidelines to support pandemic response. Plans should be harnessed to generic preparedness.

Surveillance and communication areas are fairly well addressed while the health care sector and the use of public health interventions, notably related to pharmaceutical interventions, are ill-prepared for pandemic influenza. Contingency planning for essential services is largely absent from plans.

Operational planning needs further strengthening in most plans.

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[EQ] Capitalism Beyond the Crisis

Capitalism Beyond the Crisis

Amartya Sen, is Lamont University Professor at Harvard. He received the Nobel Prize in Economics in 1998.
His most recent book is Identity and Violence: The Illusion of Destiny. (March 2009)

The New York Review of Books - Volume 56, Number 5 · March 26, 2009

Available online at: http://www.nybooks.com/articles/22490

“…... That the market economy can be particularly bad in delivering public goods (such as education and health care) has been discussed by some of the leading economists of our time, including Paul Samuelson and Kenneth Arrow. (Pigou too contributed to this subject with his emphasis on the "external effects" of market transactions, where the gains and losses are not confined only to the direct buyers or sellers.) This is, of course, a long-term issue, but it is worth noting in addition that the bite of a downturn can be much fiercer when health care in particular is not guaranteed for all.

For example, in the absence of a national health service, every lost job can produce a larger exclusion from essential health care, because of loss of income or loss of employment-related private health insurance. The US has a 7.6 percent rate of unemployment now, which is beginning to cause huge deprivation. It is worth asking how the European countries, including France, Italy, and Spain, that lived with much higher levels of unemployment for decades, managed to avoid a total collapse of their quality of life. The answer is partly the way the European welfare state operates, with much stronger unemployment insurance than in America and, even more importantly, with basic medical services provided to all by the state.

The failure of the market mechanism to provide health care for all has been flagrant, most noticeably in the United States, but also in the sharp halt in the progress of health and longevity in China following its abolition of universal health coverage in 1979. Before the economic reforms of that year, every Chinese citizen had guaranteed health care provided by the state or the cooperatives, even if at a rather basic level.

When China removed its counterproductive system of agricultural collectives and communes and industrial units managed by bureaucracies, it thereby made the rate of growth of gross domestic product go up faster than anywhere else in the world. But at the same time, led by its new faith in the market economy, China also abolished the system of universal health care; and, after the reforms of 1979, health insurance had to be bought by individuals (except in some relatively rare cases in which the state or some big firms provide them to their employees and dependents). With this change, China's rapid progress in longevity sharply slowed down….”

“……The present economic crises do not, I would argue, call for a "new capitalism," but they do demand a new understanding of older ideas, such as those of Smith and, nearer our time, of Pigou, many of which have been sadly neglected. What is also needed is a clearheaded perception of how different institutions actually work, and of how a variety of organizations—from the market to the institutions of the state—can go beyond short-term solutions and contribute to producing a more decent economic world…..” [AU]

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[EQ] Pandemic Influenza Planning in the United States from a Health Disparities Perspective

Pandemic Influenza Planning in the United States from a Health Disparities Perspective

Philip Blumenshine,*1 Arthur Reingold,† Susan Egerter,‡ Robin Mockenhaupt,§ Paula Braveman,‡ and James Marks§

*Weill/Cornell Medical College, Ithaca, New York, USA; †University of California, Berkeley, California, USA; ‡University of California, San Francisco, California, USA; and §Robert Wood Johnson Foundation, Princeton, New Jersey, USA

EID Journal Home > Volume 14, Number 5–May 2008

CDC Journal Emerging Infectious Disease

Available online at: http://www.cdc.gov/eid/content/14/5/709.htm

"……We explored how different socioeconomic and racial/ethnic groups in the United States might fare in an influenza pandemic on the basis of social factors that shape exposure, vulnerability to influenza virus, and timeliness and adequacy of treatment. We discuss policies that might differentially affect social groups' risk for illness or death.

Our purpose is not to establish the precise magnitude of disparities likely to occur; rather, it is to call attention to avoidable disparities that can be expected in the absence of systematic attention to differential social risks in pandemic preparedness plans. Policy makers at the federal, state, and local levels should consider potential sources of socioeconomic and racial/ethnic disparities during a pandemic and formulate specific plans to minimize these disparities…." Abstract

"…..We have focused here on the United States, but similar fundamental principles—the need for systematic and concrete planning to minimize the social disparities that can be expected to occur in the face of natural disasters such as an influenza pandemic—apply worldwide.

Countries with universal financial access to healthcare and strong social safety nets will be best positioned to minimize such disparities. Countries in which large proportions of the population are impoverished or otherwise socially excluded and countries that have more limited resources and weaker public health and social welfare infrastructures will face the greatest challenges. The framework used here—considering and proactively addressing social vulnerability in exposure to pathogens, susceptibility to disease once exposed, and consequences of illness—should be applicable across national and subnational settings…."

Article Contents

· Conceptual Framework

· How Could Disparities Arise?

· Discussion

· Conclusions

· References - Figure - Table

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"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.