ABSTRACT
Just as understanding epidemiology is an essential skill for public health practice so too is an understanding of infectious diseases. Epidemiological skills are needed for identifi cation of the source and spread of an infectious disease, as well as for tracking the course of an epidemic. Early public health heroes Pasteur, Jenner and Koch are those who developed germ theory, immunization and antibiotics. And it was the sanitary reformers of nineteenth-century England, such as Chadwick, who understood that the workforce producing the country’s wealth would be more productive if the workers were healthier, and living and working in better conditions with suffi cient income for better diets and able to withstand the ravages of infection. The interrelationship between poverty and disease, and the need to break the vicious cycle that exists between them, remains a cornerstone of public health. In their chapter on the neglected diseases of poverty, Utzinger and colleagues discuss the complexity of the links that exist between poverty and the diseases not commonly perceived as direct threats to industrialized countries despite hundreds of millions of people being affected. Comparatively few deaths are attributable to these neglected tropical diseases, common in low-income countries in Asia, and this low stature makes it diffi cult to seek international attention and funds. Whilst non-communicable diseases (NCDs) are often now the leading public health concern, neglected chronic infectious diseases are still widespread, particularly among people who live in poor or marginalized communities. The remaining, ever widening, inequalities are refl ected by statistics, such as that more than one out of two people in Cambodia, Indonesia and Lao PDR currently live on less than US$2 per day. Lack of access to clean water, poor sanitation and inadequate hygiene behaviour contribute to the sustained transmission of disease and favour the proliferation of vectors and intermediate hosts. Uneven access to health services, low literacy levels and inadequate nutrition (both qualitatively and quantitatively) result in increased vulnerability to infection, and future threats such as climate change may
well impact on these diseases in the future. It is also amongst some of these poorer communities in Asia that new infections, such as H5N1, H7N9 and SARS, have arisen. The lack of attention to the need for robust systems for surveillance and response to new and emerging infectious diseases was amply demonstrated in the 2003 SARS epidemic in Hong Kong. The emergence of the new coronavirus was unexpected and reviews of the systems in place at the time highlighted their inadequacies. The next two chapters describe perspectives from institutions whose role is refl ective of the lessons from SARS in 2003, and of the need for vigilant systems, resilience in response and good communication. In Chapter 13 Tsang writes from experience as Director of the Centre for Health Protection (CHP), established in Hong Kong post-SARS. In his view, governments are a vital source of health information and are key players in health education and promotion activities. In partnership with community groups, government agencies contribute to disease control in many different domains including health research and development, training and capacity building, and monitoring and evaluation of health services. At a supranational level, government agencies form versatile networks to share information, tackle global issues and provide mutual support in disease control. Over the years, the CHP’s role in disease control has undergone a gradual evolution. First, following global trends, more emphasis is being put on intersectoral collaboration and community engagement, whether in the setting of health priorities or in planning or execution of programmes and activities. The CHP is moving away from the role of a dominant, autonomous player to that of a facilitator, coordinator and funder. Risk communication plays a core role in disease control and the credibility of a government agency can be damaged irrevocably by mishandling a single aspect of a disease outbreak, no matter how good its track record.
