Cent Eur J Public Health 2017, 25(3):171-176

Public Health Crisis: The Need for Primary Prevention in Failed and Fragile States

John Quinn¹, Preslava Stoeva², Tomáš Zelený³, Toozy Nanda¹, Alžběta Tomanová¹, Vladimír Bencko³

¹ Prague Centre for Global Health, Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic

² MSc Global Health Policy (DL), London School of Hygiene and Tropical Medicine, London, United Kingdom

³ Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic

Objective: A new 'normal' in global affairs may be erupting from large global powers to that of non-state actors and proxies committing violence through scaled conflict in a post-Westphalian world generating significant global health policy challenges. Health security of populations are multifactorial and indirectly proportional to war, conflict and disaster. Preventing conflict and avoiding the health vacuum that occurs in war and violence may be best practices for policy makers. This paper considers an approach of applying clinical primary prevention principles to global health policy.

Methods: Brief policy review of current standards and practices in health security in fragile and failed states and prevention; and definitions discussion. A short case study series are presented with best practices, with risk and outcome review.

Results: The global balance of power and order may be shifting through geopolitical transference and inadequate action by major global power brokers. Health security in at risk nation-states may be decreasing as a result.

Conclusion: Small scale conflict with large-scale violence threatens health security and may experience increased incidence and prevalence in fragile and failed states. Preventative policy to resuscitate fragile and failed states and prevent further external and internal shocks may support health and promote a positive feedback loop of further state stability and increased health security. Public health policy shift to mitigate state failure and public health crisis in war and conflict through the basis of primary prevention may provide best practices and maximize health security for at risk populations.

Keywords: fragile and failed states, infectious disease, non-communicable disease, primary prevention, evidenced based policy, health security

Received: December 10, 2015; Revised: August 16, 2016; Published: October 10, 2017  Show citation