HSS 3110 L8 (1) PDF - Epidemiology and Conflict

EPIDEMIOLOGY HSS 3110 Lecture 8 WEEK 8 Conflict as a determinant of health Conflict, mass migration, and global health Conflict and EIDs Lab 8 Heath research in the context of conflict Q&A War is the antithesis of public health - Barry S. Levy Conflict as a determinant of health can also mean interp...

EPIDEMIOLOGY HSS 3110 Lecture 8 WEEK 8 Conflict as a determinant of health Conflict, mass migration, and global health Conflict and EIDs Lab 8 Heath research in the context of conflict Q&A War is the antithesis of public health - Barry S. Levy Conflict as a determinant of health can also mean interpersonal conflicts among pts and HCP but we are talking art ARMED conflict affects how we interact w/ society social determinant/aftermath of social determinants most under explored areas in epi; hard to study — no data American Public Health Association (APHA) affirms war as one of the most important, and increasingly significant, determinants affecting population health. Red Cross - objectives are to make sure health infrastructures aren’t affected by war Conflict can significantly impact global health, but the documentation of its impact on the distribution of social determinants of health is limited. Mortality surveys conducted by the International Rescue Committee (IRC) between 2000 and 2004 in the Democratic Republic of Congo (DRC) revealed the humanitarian impact of war and conflict. Data coming from African countries recently These surveys estimated that 3.9 million people had died since 1998, making the DRC's conflict one of the deadliest crises since World War II. Less than 10 percent of deaths were attributed to violence, with Non-violent aftermath of the war the majority caused by preventable and treatable health conditions indirectly related to conflict, such as malaria, diarrhea, respiratory infections, and malnutrition. diseases can re-emerge since infrastructure is destroyed — no real healthcare in the country to control spread of diseases pubmed search for articles on war/conflict (((("Health" OR "Healthcare" OR "Public Health" OR "Epidemiology" OR "Health Outcomes" OR "Morbidity" OR "Mortality")))) AND (("War" OR "Conflict" OR "Military Conflict" OR "Armed Conflict" OR "Civil War" OR "Insurgency" OR "Combat")) So many articles being published on these issues Attacks on health and healthcare in some countries, restricting flow of medicines, etc, In February 2001, the Carter Center and the United States Institute of Peace (USIP), along with CARE, Emory University, and the Centers for Disease Control and Prevention (CDC), sponsored a meeting on "Violence and Health." The meeting aimed to assess the impact of violent conflict on public health and provide guidance to public health training Conflict epidemiology programs on enhancing the effectiveness of public health professionals in conflict settings. Compiling or estimating the number of deaths caused during wars and violent conflicts is a contentious topic, with historians offering various estimates. War is identified as a significant contributor to illness and death, prompting some public health professionals to advocate for the inclusion of "war epidemiology" as a more prominent component within the field of public health. Conflict epidemiology offers a methodological approach to more accurately estimate mortality rates during ongoing wars and conflicts. Short-Term Impacts: Impacts of war on public health Physical and psychological harm Violations of human rights Eroding human rights Destruction of public health infrastructures Supply chain interruption in healthcare Caused by other factors like climate change, food insecurity, etc. Displacement and refugee health Biggest challenge Disrupted supply chains in healthcare Spread of infectious diseases Destroying clean water infrastructure short-living, but when they start to happen it’s on a mass scale — preventive mechs (surveillance systems, etc.) food systems being destroyed —> create risks of food insecurity · long-Term Impacts: Impacts of war on public health esp in children (PEM - protein energy malnutrition and Marusmus and kwashiorkor) —> can’t grow up healthy physically & mentally — create generation of disabled which affects all other factors such as economy, education system, health infrastructure, etc. —> cycle of poverty, crime and unemployment Malnutrition and food insecurity Impaired access to clean water and sanitation Disruption of health services Mental health Environmental health risks Bioterrorism Deaths in armed conflicts, 2022 Study at country level — ecological study Also includes internal conflicts happening for decades in African countries highest infectious diseases and maternal and mortality and low quality health infrastructure www Disruption of healthcare systems, including hospitals, clinics, and public Conflict and Emerging Infectious Diseases might go to forest to escape conflict (lots of microbes, etc.) food insecurity —> rely on unconventional food when getting close with animals deadly pathogens can be transmitted mostly about habitat and food and water issues health infrastructure. This can hinder the detection, surveillance, and response to infectious diseases, allowing them to spread more rapidly. Forced displacement leads to overcrowding in refugee camps or informal settlements, and this facilitates the transmission of infectious diseases such as respiratory infections, diarrheal diseases, and vectorborne diseases. Conflict can disrupt ongoing disease control programs e.g. vaccination campaigns which can lead to gaps in immunity and increased susceptibility to infectious diseases. Water, sanitation and hygiene Destruction of WASH infrastructure leads to unsafe water supplies and poor sanitation practices, and increases the risk of waterborne and foodborne diseases. Conflict can disrupt ecosystems and lead to the displacement of animal populations, potentially bringing humans into closer contact with wildlife, and thereby facilitating the transmission of zoonotic Conflict and Emerging Infectious Diseases diseases from animals to humans. Restricted access to healthcare services makes it difficult for individuals to seek treatment, which can result in delayed diagnosis and treatment, ncreased morbidity and mortality. Chronic food shortages and malnutrition can weaken immune systems and make individuals more susceptible to infectious diseases. 1. Years of war in Sierra Leone weakened health systems, leading to a nosocomial Lassa fever outbreak in 2004 at Kenema District Hospital. 2. The Marburg hemorrhagic fever outbreak in Angola (2004-2005) occurred in the context of ongoing conflict, being the first in an African urban setting with a high fatality rate. 3. Poor infection control practices in conflict-affected healthcare facilities have enabled outbreaks of viral hemorrhagic fevers, including Ebola, in countries like the Democratic Republic of Congo (DRC) and Sudan. Geography of EIDs south east Asia and Africa is where they are most concentrated Conflict and Emerging Infectious Diseases www Commentary article Conflict and Emerging Infectious Diseases www Does conflict affect the spread of HIV? yes — makes it worse — fuelled by conflict risk factors: unsafe sex, using drugs — hard to control in wars Baseline Health Status, Risks, and Determinants: mortality rates, morbidity patterns, water quality, sanitation facilities, presence of disease vectors, and access to essential resources like food and shelter. Heath research in the context of conflict/disaster /mass migration Hard to do studies in conflict —> don’t have time possible that internet of things can collect data Availability, Quality, and Utilization of Health Services: examining the availability and quality of healthcare services within conflict-affected areas, assess the extent to which the population can access and utilize these services, identifying gaps and barriers that may hinder healthcare delivery. Access to Healthcare: factors such as geographical distance, transportation barriers, security concerns, and affordability. Population Dynamics and Conflict Changes: tracking changes in the population, including migration patterns and displacement trends. Pregnant woman need the most access to care, as well as those experiencing life threatening conditions telemedicine is a life saving technology can also provide guidance to midwives on teleconference for safe childbirth - specialist guide the process need more maternal health focused protocols water purification tablets invented — recommended that refugees get 50 L of water everyday but they get around 15 only Changes in health-seeking behavior of patients also doctors don’t wanna stay there to provide care (feeling unsafe in hospitals) Also destruction of roads, etc. can impact access to healthcare during crisis Destruction of infrastructure (water, electricity) Safety issues for healthcare workers, leading to Healthcare access leaving posts due to safety concerns Disruption of essential healthcare services Closure of healthcare facilities Displacement of communities Lack of transportation Restrictions on movement Psychological impacts leading to unmet need for healthcare Some countries have forced conscription meaning ppl have to go to the military and these ppl may be taking care of others in their families Healthcare access those who care for patients can provide valuable data www Maternal healthcare other emergencies overshadowed those of pregnant mothers Domestic violence Woman are most common victims www hungry ppl are angry ppl food insecurity —> angry ppl (stronger direction) war —> food insecurity water insecurity also key driver of cross-border conflicts (countries who share water share wars) — becoming an object of struggle and a commodity for conflict water insecurity drives food insecurity many articles on the emergence of conflict after a recession A bi-directional relationship! Armed conflicts can lead to severe food shortages, destruction of infrastructure, and displacement of populations, leaving them vulnerable to food insecurity. Scholars argue that food insecurity can also contribute to violent political Food security conflicts (e.g. the French Revolution and the Arab Spring uprisings). Hunger and extreme food insecurity are highlighted in the SDGs, with conflicts and climate change-associated weather events being identified as significant contributors to rising global malnutrition rates since 2015. Throughout history, warfare has seen deliberate military tactics aimed at starving enemy populations, resulting in mass starvation. On May 24, 2018, the UN Security Council passed a resolution condemning the use of food insecurity and starvation as tactics of war, marking the first time the issue was addressed at such a level. www Food security Famine deaths during WWII If We Don’t Feed People, We Feed Conflict. António Guterres How many ppl died of hunger rather than the war itself Done when there are too many studies Mental health www Globally, we are experiencing unprecedented levels of displacement, with over 65 million people currently displaced. At the end of 2022, of the 108.4 million forcibly displaced people, an estimated 43.3 million (40%) are children below 18 years of age. Conflict, mass migration, and global health climate refugees how do we understand the source of migration, displacement and conflict (circle — all impact each other) point of no return in term of climate change (driving food insecurity, water shortages, etc. that worsen health outcomes) conflict creates unequal distribution of resources — inequality common risk factors that emerge from lectures are inequality inequality is so pervasive in healthcare context health is global - it is a shared global concern — this is why we do ecological studies climate change —single indicator that affects all aspects of our health, living and existence of species — data shows this is the case all aspects of healthcare being studied in context of climate change Between 2018 and 2022, an average of 385,000 children were born as refugees per year. LMICs host 75% of the world’s refugees and other people in need of international protection. Modern conflicts are often protracted, leading to new health needs and challenges among displaced populations. In addition to well-known consequences such as increased mortality, malnutrition, and spread of infectious diseases, many displaced people require longer-term care for chronic conditions. Conflict and displacement strain existing healthcare and social services, particularly in developing countries where 86% of refugees and displaced people are hosted. Conflict and climate both drive refuggee crisis lead to a lack of resources and ppl will move to where they can get those resources (habitat, water, healthcare access) www Conflict, mass migration, and global health More than doubled from 2012 to 2022 Internally displaced, refugees and asylum seekers. How does climate change fuel armed conflict? Why is mass displacement happening?. To prevent, use human rights based approach and empowering communities approach organizations give support based on their own understanding rather than the experiences of the victims fund services for free in countries w/ conflict have to have data + research to make decisions Persecution Conflict. Violence. Human rights violations. There's nothing natural about human displacement. Global patterns of inequality that lead to migration are rooted in specific social, political, and economic conditions; they reproduce by specific structures, policies, and institutions; and to gloss over the root causes of population movements is an injustice to the people affected by them.(PM) Events disrupting public order. Disasters Food scarcity. Inflation. Climate crisis www class reading www