Babić, S., Gačić, J., Nikolić, M., Cvetković, V., & Rašeta, D. (2017). Global Health Risks and Healthcare System Responses in Emergencies. First International Conference on Environmental Safety and Health at Work, Proceedings, Zrenjanin, 16. November, 2017.

GLOBALNI RIZICI PO ZDRAVLJE I ODGOVOR ZDRAVSTVENOG SISTEMA U VANREDNIM SITUACIJAMA

GLOBAL HEALTH RISKS AND HEALTH CARE SYSTEM RESPONSE IN EMERGENCIES

Prof. dr Slađana Jović Babić, Prof.dr Jasmina Gačić, Prof. dr Maja Nikolić, Doc. dr Vladimir Cvetković, Danica Rašeta,

Fakultet bezbednosti,Univerzitet u Beogradu

ABSTRACT

The area of study, research and practice that emphasizes the importance of improving health and achieving equity in health care for the entire human population is defined, in modern terms, as ‘’global health’’. For the most part, this term replaced the one previously used – ‘’international health’’ and focuses on worldwide health improvement, reduction of disparities in access to healthcare and protection in the face of global threats that show no regard to national borders. When it comes to planning, leading and coordinating global health initiatives in response to these threats, the World Health Organization (WHO) is the most important international body. Other agencies that stand out are UNICEF, World Food Programme and the World Bank.

Public health security encompasses the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that put the collective health of world populations at risk, and lack of global health security has a negative impact on all aspects of society.New global health threats in the 21st century are pandemicsof infectious diseases, bioterrorism, biological and chemical weapons, foodborne diseases, natural disasters and chemical or radio nuclear events, as well as the health consequences of wars, conflicts, climate change and migrations during last decade.

When it comes to emergency situations, they often foster the development of epidemics or pandemicsof infectious diseases as theydrastically disturb the social and ecological balance in the affected areas, and can lead to deterioration of sanitary and epidemiological situation.As soon as an emergency occures, quick risk assessment is necessary, followed by defining the needs for assistance in personnel, material resources, medicines, hospital facilities and transportation means, and, if necessary, international assistance is requested. The most common health problems in emergencies are injuries, emotional stress, infectious disease outbreaks and an increase in the number of patients with endemic diseases already present.At this time, in addition to healthcare, psychosocial support to citizens is of great importance. In general, emergency situations require special organization of health protection systems for public health protection.

All events that might potentially become a public health emergency of international concern (PHEIC) are covered by the International Health Regulations (IHR) which represent a framework for prevention and control of global health threats, coordinated by the WHO. The IHR play an important role in global collaboration to mitigate threats to public health and public security and are legally binding for all 196 parties to the agreement. The Global Outbreak Alert and Response Network (GOARN) is organized within WHO, and is responsible for monitoring of specific diseases which appear for the first time (emerging diseases) or reoccurring diseases with a large epidemic potential (reemerging diseases). GOARN together with WHO are responsible for timely informing of the population about the occurrence of infectious diseases.

The IHR goals should have been met until 2016, but it is estimated that only about a third of all the countries in the world currently possess the ability to assess, detect and respond to public health emergencies. Fortunately, global programs are prepared and run by world leaders in epidemiology, surveillance, informatics, management, laboratory systems, and other essential disciplines. Partnerships between countries and ministries of health lead to improved quantity and quality of

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1. KONFERENCIJA SA MEĐUNARODNIM UČEŠĆEM – “EKOLOŠKA BEZBEDNOST I ZAŠTITA NA RADU”

critical public health services, better global health and public security.

SAŽETAK

Oblast studija, istraživanja i prakse koja ističe važnost unapređenja zdravlja i dostizanja jednakosti u pristupu zdravstvenoj zaštiti celokupne populacije u svetu, definiše se danas, kao ’globalno zdravlje’’. Ovaj termin najčešće zamenjuje stariji pojam – ’međunarodno zdravlje’’ i fokusira se na unapređenje zdravlja širom sveta, smanjenje nejednakosti u mogućnosti pristupa zdravstvenoj zaštiti i zaštiti od globalnih pretnji koje ne poznaju granice. Kada se govori o planiranju, rukovođenju i koordinaciji globalnih zdravstvenih inicijativa kao odgovora na ove pretnje, Svetska zdravstvena organizacija (WHO) ovde igra najvažniju ulogu. Pored nje, važnu ulogu imaju i UNICEF, Svetski program za hranu i Svetska banka.

Bezbednost javnog zdravlja obuhvata aktivnosti, kako proaktivne tako i reaktivne, neophodne za smanjenje ranjivosti na događaje koji izlažu riziku kolektivno zdravlje stanovništva širom sveta, a nedostatak iste na globalnom nivou ima negativan uticaj na sve aspekte društva. Nove globalne zdravstvene pretnje u 21. veku su pandemije zaraznih bolesti, bioterorizam, biološko i hemijsko oružje, bolesti prenosive hranom, prirodne katastrofe, hemijski ili radio-nuklearni incidenti kao i zdravstvene posledice ratova, konfikata, klimatskih promena i migracija tokom poslednje decenije. Vanredne situacije često predstavljaju plodno tlo za razvoj epidemija ili pandemija zaraznih bolesti, budući da drastično remete društvenu i ekološku ravnotežu u pogođenim područjima i mogu dovesti do pogoršanja sanitarne i epidemiološke situacije. Odmah po nastupanju vanredne situacije, potrebna je brza procena rizika, praćena definisanjem neophodne dodatne pomoći u vidu osoblja, materijalnih resursa, lekova, bolničkih kapaciteta i prevoznih sredstava i, u krajnjem slučaju traži se i međunarodna pomoć. Zdravstveni problemi koji se najčešće javljaju u vanrednim situacijama su povrede, psihološki problemi izazvani emotivnim stresom, širenje zaraznih bolesti i povećanje broja pacijenata sa endemičnim bolestima koje su već odranije bile prisutne na tom području. U tom periodu, pored zdravstvene zaštite, od velikog je značaja i psihosocijalna podrška građanima. Vanredne situacije zahtevaju posebnu organizaciju sistema zdravstvene zaštite u cilju što bolje zaštite javnog zdravlja.

Svi događaji koji potencijalno mogu izazvati ugrožavanje javnog zdravlja na međunarodnom planu (Public health emergency of international concern, PHEIC) obuhvaćeni su Međunarodnim zdravstvenim pravilnikom (International Health Regulations, IHR) koji predstavlja okvir za prevenciju i kontrolu pretnji globalnom zdravlju i koji koordiniše Svetska zdravstvena organizacija (WHO). IHR igra važnu ulogu u globalnoj saradnji koja za cilj ima smanjenje pretnji javnom zdravlju i bezbednosti, i pravno je obavezujući za svih 196 zemalja potpisnica. Globalna mreža za obaveštavanje i odgovor na izbijanje bolesti (Global Outbreak Alert and Response Network, GOARN) organizovana je u okviru Svetske zdravstvene organizacije i odgovorna je za monitoring određenih bolesti koje se javljaju po prvi put, ili bolesti koje se iznova javljaju uz veliku mogućnost prelaska u epidemiju. GOARN i WHO zajedno odgovorne su za blagovremeno informisanje populacije o pojavljivanju zaraznih bolesti.

Ciljevi IHR trebalo je da budu ispunjeni do 2016., ali je procenjeno da danas tek trećina svih zemalja sveta raspolaže mogućnostima da proceni, identifikuje i odgovori na vanredne situacije u oblasti javnog zdravlja. Globalne preventivne programe pripremaju i vode najbolji svetski stručnjaci u oblasti epidemiologije, nadzora, informatike, menadžmenta, laboratorijskih sistema i drugih relevantnih disciplina. Partnerstva među zemljama i ministarstvima zdravlja vode unapređenju kvaliteta i kvantiteta neophodnih kritičnih struktura javnog zdravlja, boljem globalnom zdravlju i javnoj bezbednosti.