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Adopting a human security perspective, this paper argues that health is essential for development, and that health risks are increasingly globalised. The author divides global health risks into three major categories. 'Traditional' poverty-related diseases, such as malnutrition and diarrhoea, still cause widespread illness and death in developing countries. Women and children are particularly vulnerable to these diseases, many of which can be easily prevented or treated. Non-communicable diseases cause sixty per cent of deaths globally, and are a growing threat in many developing countries. Emergent highly-infectious diseases, such as HIV/AIDS, multi-drug-resistant tuberculosis, and avian flu form the third category. Based on case studies, the author develops a framework for change. She argues that political commitment and leadership are key to securing health. Functioning health systems are needed to translate commitment into action, while civil society participation supports government accountability. Improved commitments and better governance at global level are essential for national-level improvements.
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    Health Risks Nina Henderson-Andrade    Adopting a human security perspective, this paper argues that health is essential for development, and that health risks are increasingly  globalised. The author divides global health risks into three major categories. ‘Traditional’ poverty-related diseases, such as malnutrition and diarrhoea, still cause widespread illness and death in developing countries. Women and children are particularly vulnerable to these diseases, many of which can be easily prevented or treated. Non-communicable diseases cause sixty per cent of deaths  globally, and are a growing threat in many developing countries. Emergent highly infectious diseases, such as HIV and AIDS, multi-drug-resistant tuberculosis, and avian flu form the third category. Based on case studies, the author develops a framework for change. She argues that political commitment and leadership is key to securing health. Functioning health systems are needed to translate commitment into action, while civil society participation supports  government accountability. Improved commitments and better  governance at global level are essential for national-level improvements. This background paper was written as a contribution to the development of From Poverty to Power: How Active Citizens and Effective States Can Change the World , Oxfam International 2008. It is published in order to share widely the results of commissioned research and programme experience. The views it expresses are those of the author and do not necessarily reflect those of Oxfam International or its affiliate organisations.    Health Risks From Poverty to Power - www.fp2p.org   1 nd their ommunity. dden pidemic outbreaks or other health crises can, and do, destabilise entire societies and economies. strategies, it had spread via humans to 30 countries, infecting over 8,000 people nd killing over 800. n security cannot be left to the state. It is a global responsibility, oth collectively and individually. security approach’ to determine how these health risks can e mitigated to achieve human security. the rate of transmission, the degree of control and the rate at which the extent to which the fabric of the social 1. Introduction - Health Risks from a ‘Human Security’ Perspective At the heart of human security is protecting human life. Sustaining and enhancing health and well being therefore is instrumental to achieving human security. Health can be defined as: ‘…not just the absence of disease, but as “a state of complete physical, mental and social well-being”’. Human Security Now. 1   Any factors that threaten health security, that is, threaten the survival or the safety of daily life; imperil the natural dignity of men and women; expose people to the uncertainty of disease; or subject vulnerable people to sudden deprivation caused by economic downturn, constitutes a breach of human security. The human security perspective is built on the notion that people are the most active participants in determining their well-being. 2  A healthy individual can take responsibility for his/her own livelihood; is capable of being economically productive; and is able to contribute to the society in which they live, supporting peers and taking part in civil actions to protect themselves ac At a higher level, this engenders community integrity, social stability and economic growth. Sue In today’s world, borders cannot withstand globalisation. No country or community is impervious to the threats of global disease, whether it is communicable or non-communicable, a developed nation risk or a poverty-related threat. For example, the Severe Acute Respiratory Syndrome (SARS) epidemic of 1993 emerged from the Guandong Province of China. Within five months, despite stringent containmenta The strong multiplier-effects of globalisation can be positive. Child immunisation protects not just that child, but also others in the neighbourhood. Control of infectious epidemics like SARS means that protecting individuals also protects nations. (See SARS case study)  These global interdependencies in health are being recognised. Humab This paper first considers what constitutes a health risk before defining three major health challenges to human security. It then uses a ’humanb  2. What Constitutes a ‘Health Risk’? Four factors should be considered before declaring a health risk: 1. The scale of the disease burden, now and projected into the future. 2. The urgency for action: control can be asserted. 3. The depth and extent of its impact on society: structure is affected, as well the economic impact. 1  Commission on Human Security (2003) ‘Human Security Now’ Communications Development Incorporated, Washington DC, http://www.humansecurity-chs.org/finalreport/English/FinalReport.pdf, accessed: August 2006 2  Commission on Human Security (2003) ‘Human Security Now’ Communications Development Incorporated, Washington DC, http://www.humansecurity-chs.org/finalreport/English/FinalReport.pdf, accessed: August 2006    4. The degree of interdependencies that will transcend people and places: the threat and rate of is known about them – ither about their composition, the way in which they cross over into humans or how to treat them. t the potential for them to wreak transnational havoc, iarrhoea caused der fingernails. It can easily be prevented by having clean water, per 100,000 live births. 3  Many of these deaths could be voided if there was better access to basic maternal health care. (See case study on Honduras, p. 16). ll, the ombined effect of a loss in earnings as well as the spiralling costs of health care can be devastating. In addition to this funeral, expenses can average a third of an annual wage. 5  Children often suffer as fewer resources are available for their care. Food, education and basic needs are often sacrificed. cross-border transmission, and beyond this, the impact on interdependent societies and economies. 3. Three Major Health Risks The health risks that pose a serious threat to the human security of this planet can be categorised into three  groups. First, ‘traditional’ poverty-related threats cause the greatest burden. Secondly, non-communicable diseases such as cancer, coronary heart disease, strokes and diabetes were considered to be a greater threat in the developed world, as opposed to the developing world. But as HIV and AIDS was left unrecognised and largely ignored for long enough for it to get a foothold (which, 25 years later, it has not yet relinquished), so non-communicable diseases are the sleeping monsters of the twenty-first century in the developing world. Thirdly, ‘new’ infectious diseases, such as SARS, could be a catastrophic threat to human survival. Increasingly, these diseases are animal-borne, ransmitted across species to humans and are highly contagious. Very little teThis, coupled with globalisation, means thaleaving humanitarian and economic disaster in their wake, is extremely high. ‘Traditional’ poverty-related threats The global share of avoidable deaths is disproportionately high in poor countries. Poor people are ore susceptible to environmental health threats such as water-borne infections like dmby the lack of clean drinking water and sanitation, and asthma and respiratory infections caused by air pollution. These are compounded by hunger and malnutrition. Deaths caused by these infectious diseases, avoidable with basic treatment, constitute a major breach of human security. The leading causes of childhood mortality are acute respiratory infections and diarrhoeal disease. Pneumonia poses the most serious threat in children, even though it can be treated with affordable antibiotics. Diarrhoea is caused by ingesting bacteria spread through water, food, hands, eating and rinking utensils, flies, and dirt undand as illustrated in the case study on Egypt (p. 15), adopting healthy behaviour and treating it extremely cost-effectively with Oral Rehydration Therapy. Malnutrition often accompanies these leading causes of childhood death. Women and children are especially vulnerable. In developed countries in 2000, 13 mothers died per 100,000 live births due to complications during pregnancy or during childbirth. In sub-Saharan Africa, this figure escalates to 940 mothers dyingaThe risk of children becoming orphans is heightened, as they are 3.9 times more likely to die in the two years following their mother’s death. 4  Poor people are least able to absorb the effects of ill-health. When a family member becomes ic   3  UNICEF Statistics, End-decade Database (2006) ‘Maternal Mortality’, http://www.childinfo.org/areas/maternalmortality/countrydata.php, accessed August 2006 4  UNICEF (2006) ‘Africa’s Orphaned and Vulnerable Generations; Children affected by AIDS’, UICEF, UNAIDS and PEPFAR, http://www.unicef.org/publications/index_35314.html, accessed October 2006 5  UNICEF (2006) ‘Africa’s Orphaned and Vulnerable Generations; Children affected by AIDS’, UICEF, UNAIDS and PEPFAR, http://www.unicef.org/publications/index_35314.html, accessed October 2006 Health Risks From Poverty to Power - www.fp2p.org   2    Non-communicable diseases – a human security threat in developing countries According to the World Health Organisation, 6  60 per cent of all deaths are due to chronic (non-communicable) disease. This is more than double the number of deaths from all infectious diseases including HIV and AIDS, tuberculosis, malaria, maternal and perinatal conditions and nutritional deficiencies combined. Of these, 80 per cent occur in low or middle-income countries, in men and women equally. In absolute terms, this translated into 28 million deaths in 2005. In comparison, 2.8 million people died due to AIDS in 2005. WHO Global Deaths by Cause HIV/AIDS8%TB5%Cardiovascular diseases50%Cancer 21%Diabetes3%Malaria2%Chronic Respiratory Disease11%   Source: ‘Preventing Chronic Diseases’, WHO (2005) The WHO has predicted 338 million deaths from chronic diseases in the next 10 years, with 310 million taking place in poor countries. (There have been 40 million AIDS deaths in the last 25 years.) This will have grave economic consequences. It is estimated that China will forego $558 billion in National Income in the next ten years. The Russian Federation will face a 5.5 per cent decrease in GDP. An enormous hurdle in the fight against the devastating impact of chronic disease is the unappreciated cause of poverty. Poor people are more likely to have an unhealthy diet, be physically inactive and smoke more. Exacerbating this is their increased exposure to the risk of maternal deprivation, increased risk of unhealthy behaviour, unhealthy living conditions and limited access to good quality healthcare. They are more likely to suffer the double burden of poverty and disease arising from the high cost of treatment and the loss of income. Tobacco use is the leading cause of preventable deaths in adults and therefore one of the biggest security threats to the world’s health. If current trends hold, it could kill 1 billion people this century, 10 times more than in the 20 th  century. 7  It contributes to half of all cancer deaths, 8  lung cancer being one of the most common diseases caused by smoking. It is also the major cause of cardiovascular disease including strokes and heart attacks. A study in India showed that it accounts for about half the country’s tuberculosis deaths and could be increasing the spread of infection. 9  Passive smoking impairs the ability of children to breathe normally, and around pregnant women can contribute to sudden infant death syndrome and babies being born with a below normal birth weight. Further, 6  World Health Organisation (2005) ‘Preventing Chronic Diseases: a vital investment’, World Health Organisation, Switzerland: Geneva 7  CNN (2006) ‘Tobacco could kill 1 billion this century of current trends hold’, http://www.cnn.com/2006/HEALTH/07/10/tobacco.cancer.ap/index.html 8  Peto, R.A., J. Lopez, M. Boreham et al (1992) ‘Mortality from Tobacco in Developed Countries: Indirect Estimates from National Vital Statistics’, The Lancet, 339: 1268-78 9  Gajalakshmi, C.K., P. Jha, K. Ranson, and S.Nguyen, (2000) ‘Global Patterns of Smoking and Smoking Attributable to Mortality Patterns’, in ‘Tobacco Control in Developing Countries’, ed. P. Jha and F.J. Chaloupka. Oxford: Oxford University Press Health Risks From Poverty to Power - www.fp2p.org   3
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