Transcript Confederation of Health Care Systems Israel – 2008

Confederation of Health Care
Systems
Israel – 2008
Lori Post
Yale University
School of Medicine
By the Year 2020
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The next pandemic
will have concluded
The UN will send a
mandate to the
World Health
Organization
The WHO will
generate a resolution
to prevent another
pandemic
WHO Request for Proposals
1.
2.
3.
Why did it happen?
Damage – Mortality, Morbidity, Cost
What could we have done?
Why?
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Every ~100 years, avian flu sweeps
through the world
Large human population without
immunity
Densely populated
Asymptomatic during transmission
Global population exposure
Cytokine storms
Damage
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TBD
Flu Pandemic
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Phase 1: No new influenza virus subtypes have been detected
in humans.
Phase 2: No new influenza virus subtypes have been detected
in humans, but an animal variant threatens human disease.
Pandemic alert period:
Phase 3: Human infection with a new subtype but no humanto-human spread.
Phase 4: Small cluster with limited localized human-to-human
transmission
Phase 5: Larger cluster but human-to-human spread still
localized.
Pandemic period:
Phase 6: Increased and sustained transmission in general
population.
Public Health Surveillance
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Ongoing, systematic collection, analysis,
and interpretation of data (e.g., regarding
agent/hazard, risk factor, exposure,
health event) essential to the planning,
implementation, and evaluation of public
health practice, closely integrated with
the timely dissemination of these data to
those responsible for prevention and
control.
Early Surveillance
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1854
John Snow
Began with a cholera outbreak in London
No technology
First example of data collection and
spatial display of health issue
Broad Street Water Pump clusters
Solution
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Data collection and display
Break the chain of transmission
Public Health Resolution –
REMOVE the HANDLE
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Technology sufficient in 1854 but not in
2018
Risk and Protective Factors for
Infectious or Contagious Disease
1800s
1900s
2000s
Positive
Population
Rural
ICT
Negative
Transmission
Transmission
ICT
Knowledge
Knowledge
Population
Movement
Population
Movement
Rural
Small Population
Knowledge
Movement
Urban
Large Population
1918 Flu Pandemic
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~100 Million People Died
2 x number killed in WWWI
Epicenter in Spain
2015 Flu
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Epicenter in rural Asia
Disparate information and control measures
Surveillance – passive, confederation, disparate
Poor use of Information Communication Technology
Slow response
Global transmission before identification
Population movement (1000s flights out of Asia every
day)
Healthy population affected
The technology to prevent the pandemic of 2015 was
developed in 1995
What could we have done?
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Standardized data collection and aggregation
Active Universal Health Surveillance System
Early Identification
Public Health Information Dissemination
Containment until vaccine developed (2nd and
3rd Waves)
Stockpiles of life sustaining medicines
Global solution beyond political boundaries
Borders and Health Care
Systems
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3077 county health care systems
Complicated passive system in US: County to
State to CDC to WHO
The next avian flu will begin where there is little
to no surveillance
Universal Health Care could be used for
primary, secondary, tertiary prevention for
number of public health and social issues