what are the functions of the international public health services?

Question:

mainly on the international basis or uganda

Answers:
In the main, they are an attempt to bridge the gap between human social structures / lmitations and the reality of epidemiology. Nations, religious arrangments, economic regimes, cultural patterns, linguistic groupings, etc are due to historical developments, resource availability, trade route patterns, etc. None of these has any congruity with disease spread patterns, save perhaps the trade route business.

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historically known background

In the past, disease traveled to some extent along trade routes. A famous example is bubonic plague ("the black plague"), which was once limited to the NE Asian steppes as a disease of small rodents which sometimes affected humans. For the first time in history, the Mongol armies traveled fast enough that an infected human had a good enough chance to spread the bacterium to a new population on the borders of its range. It traveled West with them in stages all the way to Europe where it encountered a large immunologically naive poulation with the well-known, if poorly understood in any detail, result. 30-60% mortality throughout Europe and a depopulation which had serious religious, political, and economic effects for some centuries. In fact, that bacterium's spread has continued via human agency into very recent times. It arrived in North America aboard a ship from China in the 1880s (some researchers think they can even identify the very ship!) and is now epidemic among small rodents and their fleas in much of Western North America. Syphilis most likely originated in the New World and was carried back to Europe by Columbus' crew as it first appears there around 1500 as an acute fulminating disease (think 'flesh-eating bactria', not the chronic infection of today) during a military campaign in northern Italy by the French.
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public health tasks

Public health agencies attempt to intervene in the chain of transmission of disease by developing standards for sanitation, by financing research and development of vaccines and treatments of common diseases (eg, yellow fever in connection with building the Panama Canal), by developing an recommending screening protocols for detecting the contagious who are traveling or shipping internationally, by advocating effective standards of treatment across differing medical regimes, etc. It was a pioneering public health investigation (by Snow) which identified the transmission path of cholera a generation+ before Pasteur and any real understanding of the actual causative agent. Any society taking those results seriously effectively cured its cholera problem forthwith.

International public health agencies attempt to do much the same, bridging national boundaries in an attempt to match the disregard for those boundaries of diseases and their vectors (eg, insects, ticks, .).

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examples of large scale efforts

A gloriously successful example is the eradication of the ghastly disease smallpox from the world (save as samples held in government labs in the US and i Russia). Smallpox was unusually susceptible to attack as it infected only humans, was readily identifiable in a few days after infection, had an effective vaccine (the very first in Western medicine, in fact), and had a short course, after which the victim was either dead (about 30%) or immune to further infection. A joint effort by public health authorities world wide progrssively broke transmission chains and finally isolated and quarantined the last known infected human in Somalia. Polio is a similar disease and an attempt to similarly eradicate it is underway; a couple of years ago, it was confined to a district in Western Africa and looked to be seriously in trouble. Religious political objections, primarily in northern Nigeria, put the campaign back quite a lot, and polio is now significatntly present in several of the contiguous countries.

Not all disease have characteristics which make such attacks possible. HIV/AIDS, for instance, has a long and largely invisible incubation period and continues to be contagious. There is no cure, and it may be that even if there were such a cure, that immune systems could learn to identify the virus to prevent future re-infection. Another is the emergence of disease resistant to existing treatments. Tuberculosis is the classic example of this as it is quite contagious, chronic, and some strains are now quite resistant to all available drugs. It is suspected that failure of public health measures is one of the reasons for the development of these strains, particularly in prisons in the soviet Union and its successors.

Some recent history illustrates both the virtues and disadvantages of the current international public health system, such as it is. The emergence of the previously unknown SARS infection a few years ago was a surprise to all. The international public health community managed to identify and characterize the agent, and to develop workable (if barely) transmission barriers (eg, air travel restrictions, infection tracing, etc). Reluctance of hte Chinese governement to fully cooperate with the international public health community delayed effective response world wide since those outside China were not in a position to understand the existing infection pattern. An outbreak of SARS in Canada (spread by a traveler from East Asia) was largely due to this lack of information.

The current avian flu problem (especially among commercial domestic poultry) is an example of a veterinary international public health issue, and its possible spread to humans of a prospective international public health problem. Whether there will be enough resources allocated to public health, and properly timed, to allow effective action if the H5N1 strain makes the jump to humans will not be clear until the event.

Assorted problems, including internal institutional ones and national rivalries, as well as lack of understanding amongst the responsible parties (eg, politicians) can cause severe difficulties, at the expense of the life and health of many citizens. There are two particularly vivid examples from recent history. Near the beginning of the public health response to the AIDS epidemic, The World Health Organization in Geneva (as UN agency), a Dr Mann managed to gather together a significant and effective team (around 250 staff and a considerable budget), but he and his group ran afoul of institutional rivalry, and he was forced out. Within a year or so, the AIDS effort at WHO had been reduced to a staff of 4. The effect was to delay sensible attempts to control spread of the epidemic and so the infection of a great many who might have not been infected had the WHO effort continued. The second example is in South Africa, where the President has declared that AIDS is not caused by HIV infection, but probably by poverty and other stressors including drug side effects. This politician has no medical or scientific credentials or experience, and so his responsibility is to choose advisors who do. He has failed to do so, despite personal warnings from many and having hosted one of the periodic international AIDS conferences in South Africa. Many South Africans (and others) will become infected and, most likely, die as a result of the essentially politically expedient policy error.

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what are the functions of the international public health services?

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