Health Promotion in Disease Outbreaks and Health Emergencies

Glenn Laverack

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781351605465
• Edition: 1
• Topic: Médecine
• Subtopic: Santé publique, administration et soins

The book is exceptionally timely and will be of interest to many professionals, students and academics. I am not aware of any other book that covers this important topic. Glenn Laverack brings credibility and kudos having direct experience of health emergencies and seen as a leading academic thinker in health promotion.

Dr James Woodall, Reader in Health Promotion, Leeds Beckett University

Using specific examples to illustrate broader concepts, this text provides a solid introduction to health promotion in infectious disease outbreaks.

Ella Watson-Stryker, Health Promotion Manager, Médecins Sans Frontières

This book is timely given the current humanitarian and development scenarios in which health promoters and development communicators must work. There is a dire need for reference materials for practitioners which expand upon theoretical/scientific concepts and principles and provide practical, straightforward guidance to professionals working in the field. The increasing amount of public health emergencies, e.g. SARS, Ebola, Zika etc. require professionals to increase their preparedness to respond in outbreak or disaster situations and this book becomes a useful tool for needed action.

Dr Erma Manoncourt, Vice-President of Membership and Co-Chair Global Working Group on the Social Determinants of Health, IUHPE, Paris, France.

This is the first ever practical guide to the valuable role that health promotion can play in disease outbreaks and health emergencies. Over the past 20 years the number of disease outbreaks has increased alongside a significant role played out by international agencies involved in emergency responses.

The book comprehensively covers the role that health promoters have in this new and exciting field of international work including data collection, communication, community capacity building and engagement and rumour management.

• Part 1 provides a detailed overview of the role of health promotion in disease outbreaks and health emergencies.
• Part 2 directly addresses the role of health promotion in two distinct types of disease outbreaks: person to person and vector borne disease transmission.
• Part 3 covers the role of health promotion in specialist areas of work in disease outbreaks and health emergencies.

Health Promotion in Disease Outbreaks and Health Emergencies is essential reading for health promotion and public health students worldwide, as well as for UN agencies and international NGOs working in this emerging field.

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Health promotion, disease outbreaks and health emergencies

KEY POINTS

• The goal of health promotion in disease outbreaks and health emergencies is to involve and enable people to gain more control to have healthier and safer lives.

• Health promotion can provide a range of educational and skills development activities that are essential to help people to empower themselves during a disease outbreak.

• At the heart of a successful outbreak response is who controls the way in which the disease control programme is designed and implemented.

• In a disease outbreak the situation can change rapidly and budget flexibility is essential.

• Community- and faith-based organisations are an essential partner to a holistic and effective disease outbreak response.

Over the past 20 years the number of international agencies involved in disease outbreak and health emergency responses has increased significantly. In the aftermath of the 2010 earthquake in Haiti, for example, several hundred international non-government organisations were mobilised alongside the United Nations, government, and the private sectors, greatly increasing the complexity of the situation. The growing number of such events has placed pressure on the availability of funding opportunities. At the same time, there has been a realisation that the goal of involving communities has not succeeded, yet such involvement is crucial to the success of a response (Tellier and Roche 2016). The ease of the transmission of diseases between countries is a major issue, and the response in one country cannot be separated from that of another country because connections between people and organisations span geographic and cultural borders (Naidoo and Wills 2009). The outbreak of the Ebola virus disease, for example, was exasperated by the cross-border movement of people as well as by already fragile healthcare systems.

The goal of health promotion in disease outbreaks and health emergencies is to involve and enable people to gain more control to have healthier and safer lives.

HEALTH PROMOTION

Health promotion is a set of principles involving equity and participation and a practice that encompasses communication, capacity building and politically orientated activities. The definition provided in the Ottawa Charter for Health Promotion is still the most universally recognised as ‘a process of enabling people to increase control over, and to improve, their health’ (World Health Organization 1986). Health promotion represents a social and political process that not only embraces actions directed at strengthening the skills and knowledge of individuals, but also action directed towards changing sociocultural, environmental and economic conditions that have an impact on health.

A unique aspect of disease outbreaks and health emergencies is that the situation can change quickly and also the speed at which activities are delivered can be a deciding factor in preventing the transmission of an infection. In a disease outbreak, health promoters are practitioners who incorporate some aspect of communication and community engagement in their everyday work. These workers include medical personnel, health educators, community mobilisers, social workers, trainers and managers. Health promoters play a key role to quickly deliver approaches that government and non-government agencies alike can utilise as a part of any response. Health promotion is also a core responsibility for government services in many countries and can be quickly integrated in a disease outbreak response by providing local expertise and a basic infrastructure for the delivery of a range of communications and other activities. The role of the health promoter also includes data collection, communication, community capacity building and engagement, rumour and resistance management, stigma recognition, survivor support and provision of social support to families and communities.

Behaviour change communication, Communication for Development (C4D) and hygiene promotion interventions help to prevent person-to-person disease transmission by targeting specific knowledge and skills, such as hand-washing with soap. In controlling vector-borne diseases, health promotion uses health education messaging so that people know how best to protect themselves and their communities. The purpose is to motivate people to change high-risk behaviours by giving them improved skills and self-confidence. The focus on individual responsibility must avoid ‘victim-blaming’, that is, making people feel guilty about their state of health even though certain risk factors are outside of their control, such as not having access to a bed net to protect themselves against mosquitoes. The role of health education departments at the national level is to design learning materials and provide training, instruction and skills development. The guiding principle is to help people to make informed choices to modify their behaviours and to avoid risks.

Health promotion can provide a range of educational and skills development activities that are essential to help people to empower themselves during a disease outbreak.

DISEASE OUTBREAKS AND HEALTH EMERGENCIES

Endemic refers to the usual prevalence of a disease in a population within a geographic area. An outbreak refers to an increase, often sudden, in the number of cases of a disease above the endemic level in the population. An outbreak can occur within a restricted geographic area or it may extend over a much broader area for a prolonged period. A single case of a disease not normally present in the population can also constitute an outbreak, for example, as for the poliovirus, and must be reported and investigated. A disease outbreak may result from a recent increase in the amount or virulence of the disease, a recent introduction of the disease into a setting where it has not been before, an enhanced mode of transmission so that more susceptible persons are exposed, a change in the susceptibility of the host response to the disease, and/or factors that increase host exposure or involve a new means of entry into the population (Kelsey et al. 1986).

BOX 1.1: The International Health Regulations

The International Health Regulations (IHR) were enforced on 15 June 2007 with the purpose and scope to ‘prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade’ (World Health Organization 2016f, article 2). The IHR help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. The IHR are an international legal instrument that is binding on 196 countries that have agreed to build their capacities to detect, assess and report public health events. The IHR are not limited to specific diseases and also apply to new and emerging public health risks to have long-lasting relevance to international responses. However, there are four communicable diseases that require notification in all circumstances: (1) any laboratory-confirmed case of a recent human infection caused by an influenza A virus with the potential to cause a pandemic; (2) a case of poliomyelitis due to wild-type poliovirus in a stool specimen collected from the suspected case or from a close contact of the suspected case; (3) a case of severe acute respiratory syndrome (SARS) from an individual with laboratory confirmation of infection with the coronavirus (CoV) who either fulfils the clinical case definition of SARS or has worked in a laboratory working with live SARS-CoV or storing clinical specimens infected with SARS-CoV; (4) any confirmed case of smallpox (World Health Organization 2016c).

A pandemic is an outbreak that occurs on a scale crossing international boundaries, usually affecting a large number of people (Porta 2014). The severe acute respiratory syndrome (SARS) virus, for example, killed 800 people in the Asia-Pacific region in 2002 and was contained by using rigorous sanitation procedures and barrier nursing techniques such as latex gloves, face masks and disposable gowns when in contact with infected patients (Doherty 2013). An emergency is a state that demands a response as an extraordinary measure. A ‘state of emergency’ is declared and lifted by those in authority and is dependent on the scale, timing, unpredictability and capabilities of existing services to respond. All emergencies have a health aspect that can be caused by natural disasters, civil emergencies, disease outbreaks and the release of hazardous materials into the environment. A health emergency specially occurs when the consequences have the potential to overwhelm the capabilities of the health system to contain the problem (Nelson et al. 2007). Disease outbreaks and health emergencies are closely connected, and this book uses the term ‘disease outbreaks’ to cover both contexts.

Disease prevention

Disease prevention deals with individuals and populations exhibiting identifiable risk factors, often associated with different risk behaviours (World Health Organization 1998) to prevent the occurrence of a disease and to reduce its consequences once established. Health promotion is concerned with the primary, secondary and tertiary stages of disease prevention. Primary prevention is directed towards preventing the initial onset of ill health by, for example, the detection of risk factors and appropriate health messages. Secondary prevention seeks to change unhealthy behaviour or to shorten the period of ill health and its progression (e.g. educational and motivational strategies to increase the use of hand-washing). Tertiary prevention seeks to limit the effects of a condition and enhance a person’s quality of life (e.g. effective rehabilitation therapy) (Naidoo and Wills 2009).

Communicable disease, also called infectious and transmissible disease, comprises clinically evident illnesses resulting from pathogenic agents in an individual or population group and can include viruses, bacteria, fungi and protozoa. A communicable disease is transmitted from a source, such as from one person to another or from a vector to a person. Identifying the means of transmission is important in helping people to understand how to prevent the disease outbreak and focuses on controlling or eliminating the cause of transmission, the vector or high-risk behaviours. Sometimes, this identification can be done using a physical method (e.g. a bed net to prevent being bitten by a mosquito) or a vaccine to reduce the effect of the disease (e.g. for cholera). Surveillance is particularly important because of the infectious nature and the rapid spread of communicable diseases. Information that is used for surveillance comes from various sources, including reported cases of communicable diseases, hospital admissions, laboratory reports, population surveys, reports of absence from school or work, and reported causes of death (Public Health Agency of Canada 2013).

Screening is designed to identify disease, thus enabling prevention, management and treatment to reduce mortality. Mass screening covers a whole population or a subgroup, irrespective of the risk status of the individual. High-risk or selective screening is conducted among individuals of a risk population. The selection of screening tests for an individual depends on age, sex, family history and risk factors for certain diseases. Screening can show positive for those without a disease, called a false positive, or negative for people who have the condition, called a false negative. Over-diagnosis can also make screening seem successful by finding abnormalities, even though they are sometimes harmless, and are counted as ‘lives saved’ rather than as healthy people with a manageable condition (Raffle and Muir Gray 2007). Health promotion plays an important preventive role in the screening process including education and counselling interventions and behaviour change to combat, for example, the spread of sexually transmitted diseases through condom use or ensuring a drug regime is completed such as to combat the transmission of tuberculosis.

Drug resistance is the reduction in the effectiveness of a treatment because of the resistance by some pathogens. The development of antibiotic resistance, for example, derives from some drugs targeting only specific bacterial proteins, and therefore any mutation in these proteins interferes with its destructive effect. It has been the lack of a committed strategy by governments and the pharmaceutical industries that has allowed organisms to develop resistance at a rate that has been faster than new drug development can occur. Drug resistance can sometimes be minimised by using a combination of multiple drugs, for example, in the treatment of tuberculosis (National Research Council 2003).

BOX 1.2: Drug resistance and tuberculosis

XDR-TB is an abbreviation for extensively drug-resistant (XDR) tuberculosis (TB) that is resistant to at least four of the core anti-TB drugs. Multidrug-resistant (MDR-TB) and XDR-TB both take substantially longer to treat than ordinary drug-susceptible TB and require the use of second-line anti-TB drugs, which are more expensive and have more side effects. Three countries carry the major burden of MDR-TB—India, China and the Russian Federation— together accounting for nearly half of all cases globally. The risk of spread of MDR-TB and XDR-TB increases where there is a high concentration of TB bacteria, such as can occur in overcrowded l...

Table of contents

• Title Page
• Copyright Page
• Table of Contents
• List of boxes
• List of figures
• Preface
• Acknowledgements
• 1 Health promotion, disease outbreaks and health emergencies
• 2 Collecting information effectively and quickly
• 3 The public communication approach
• 4 The risk communication approach
• 5 Engaging with communities
• 6 The global Ebola virus disease response
• 7 Health promotion and person-to-person disease outbreaks
• 8 Health promotion and vector-borne disease outbreaks
• 9 Addressing rumour, resistance and security issues
• 10 The post-outbreak and emergency response
• Glossary
• References
• Index