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At a time when the world faces many new and recurring threats, the ambitious aim of this year's world health report is to show how collective international public health action can build a safer future for humanity.
This is the overall goal of global public health security. For the purposes of this report, global public health security is defined as the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries.
As the events illustrated in this report show, global health security, or the lack of it, may also have an impact on economic or political stability, trade, tourism, access to goods and services and, if they occur repeatedly, on demographic stability. It embraces a wide range of complex and daunting issues, from the international stage to the individual household, including the health consequences of poverty, wars and conflicts, climate change, natural catastrophes and man-made disasters.
All of these are areas of continuing WHO work and will be the topics of forthcoming publications. The 2008 World Health Report, for example, will be concerned with individual health security, concentrating on the role of primary health care and humanitarian action in providing access to the essential prerequisites for health.
This report, however, focuses on specific issues that threaten the collective health of people internationally: infectious disease epidemics, pandemics and other acute health events as defined by the revised International Health Regulations, known as IHR (2005), which came into force in June of this year.
The purpose of these Regulations is to prevent the spread of disease across international borders. They are a vital legislative instrument of global public health security, providing the necessary global framework to prevent, detect, assess and, if necessary, provide a coordinated response to events that may constitute a public health emergency of international concern.
Meeting the requirements in the revised IHR (2005) is a challenge that requires time, commitment and the willingness to change. The Regulations are broader and more demanding than those they replace, with a much greater emphasis on the responsibility of all countries to have in place effective systems for detection and control of public health risks--and to accomplish this by 2012.
A strategic plan has been developed by WHO to guide countries in the implementation of the obligations in the Regulations and to help them overcome the inherent challenges.
GLOBAL PUBLIC HEALTH THREATS IN THE 21ST CENTURY
Today's highly mobile, interdependent and interconnected world provides myriad opportunities for the rapid spread of infectious diseases, and radionuclear and toxic threats, which is why updated and expanded Regulations are necessary. Infectious diseases are now spreading geographically much faster than at any time in history. It is estimated that 2.1 billion airline passengers travelled in 2006; an outbreak or epidemic in any one part of the world is only a few hours away from becoming an imminent threat somewhere else (see Figure 1).
Infectious diseases are not only spreading faster, they appear to be emerging more quickly than ever before. Since the 1970s, newly emerging diseases have been identified at the unprecedented rate of one or more per year. There are now nearly 40 diseases that were unknown a generation ago. In addition, during the last five years, WHO has verified more than 1100 epidemic events worldwide.
The categories and examples given below illustrate the variety and breadth of public health threats confronting people today.
Cholera, yellow fever and epidemic meningococcal diseases made a comeback in the last quarter of the 20th century and call for renewed efforts in surveillance, prevention and control. Severe Acute Respiratory Syndrome (SARS) and avian influenza in humans have triggered major international concern, raised new scientific challenges, caused major human suffering and imposed enormous economic damage. Other emerging viral diseases such as Ebola, Marburg haemorrhagic fever and Nipah virus pose threats to global public health security and also require containment at their source due to their acute nature and resulting illness and mortality. During outbreaks of these diseases, rapid assessment and response, often needing international assistance, has been required to limit local spread. Strengthening of capacity is imperative in the future to assess such new threats.
Gains in many areas of infectious disease control are seriously jeopardized by the spread of antimicrobial resistance, with extensively drug-resistant tuberculosis (XDR-TB) now a cause of great concern. Drug resistance is also evident in diarrhoeal diseases, hospital-acquired infections, malaria, meningitis, respiratory tract infections, and sexually transmitted infections, and is emerging in HIV.
The food chain has undergone considerable and rapid changes over the last 50 years, becoming highly sophisticated and international. Although the safety of food has dramatically improved overall, progress is uneven and foodborne outbreaks from microbial contamination, chemicals and toxins are common in many countries. The trading of contaminated food between countries increases the potential that outbreaks will spread. In addition, the emergence of new foodborne diseases creates considerable concern, such as the recognition of the new variant of Creutzfeldt-Jakob disease (vCJD) associated with bovine spongiform encephalopathy (BSE).
Accidental and deliberate outbreaks
As activities related to infectious disease surveillance and laboratory …