Cross-sector interventions for better health security
Asian countries need to leverage investments in sectors beyond health to ward off pandemics.
Asia-Pacific is highly susceptible to disease outbreaks of pandemic potential. In the past century, the most severe of the flu pandemics killed between 50 million and 100 million people, possibly driven by increased mobility during World War I. Several other flu epidemics and pandemics have followed, and many originated in Asia. It is virtually certain that within the next few decades, the region will experience another influenza pandemic.
The reasons why this part of the world faces increased risk from emerging infectious diseases are complex.
The region is home to dynamic systems in which biological, social, ecological and technological processes are interconnected in ways that enable microbes to exploit new ecological niches. The processes include population growth and movement, urbanization, changes in food production, agriculture and land use, water and sanitation and the effect on health systems through generations of drug resistance.
To make matters worse, Asia is highly vulnerable to natural disasters, which can have rapid or slow onset, with serious health, social, and economic consequences. Beyond deaths and injuries, disasters can have a significant impact on public health via increased risk of disease transmission.
In the wake of a disaster, the most vulnerable populations are often displaced, with limited access to safe water and sanitation. To exacerbate the situation, they are often malnourished, are not immunized for preventable diseases such as measles, and have limited access to basic health services.
The above scenario demands that countries invest in capacities for increased health security, both within the health sector and across other sectors.
The most obvious cross-sectoral engagement—adopting the “One Health” approach, which recognizes that the health of humans is connected to the health of animals and the environment. Beyond that, though, there are some key areas of engagement we can scale up on.
First comes infrastructure. Improved transportation has a direct impact on timely geographical access for improved surveillance, reduced travel time for increased health seeking behavior, accelerates early detection and better response mechanisms by facilitating swift supply of commodities and personnel.
On the other hand, in a rapidly modernizing world, increases in efficiency, speed and reach of modern transport networks can also put people at increased risk from disease transmission.
Second, slums are ideal locations for insects and rodents to proliferate, resulting in high prevalence of vector-borne diseases and geohelminthiases. Inadequate water supply, sanitation, and waste management exacerbate the problem.
It is expected that by 2050 the urban population in Asia-Pacific will reach 3.2 billion. This presents both an opportunity to engage as well as a potential risk if not addressed through improved urban planning, increased investments in housing and better water and sanitation facilities.
Third, vulnerable groups —particularly older persons and children—are at a severe disadvantage during times of emergency both from infectious diseases and natural disasters. There is growing evidence that older people are particularly susceptible to infectious diseases for a variety of reasons, including immunosenescence (the progressive deterioration of immune functions with age) and frailty.
Apart from the sheer size of its population, Asia-Pacific is also in the midst of a historic demographic transition. More and better social protection programs can help reduce financial constraints to health care access. Social protection programs can likewise support assisted mobility as these population groups often can’t move independently.
Finally, there is an inherent relationship between food production, biodiversity, nutrition, climate change and the environment. This needs to be understood, respected, and leveraged for improved health security.
Recognizing that ADB’s strength lies in regional engagement, we have been committed to employing regional mechanisms to bolster health security across our developing member countries. For the past decade, we have been supporting member countries to develop regional, multi-country, and cross-border responses for increased health security by building resilient, efficient and responsive health systems.
But not all countries are equally vulnerable, or resilient. It is therefore imperative that we support an increased effort to leverage investments in other sectors that can have a positive impact on health security.