Global health: governance and policy development.

Global health policy is now being influenced by an ever-increasing number of nonstate and non-intergovernmental actors to include influential foundations, multinational corporations, multi-sectoral partnerships, and civil society organizations. This article reviews how globalization is a key driver for the ongoing evolution of global health governance. It describes the massive increases in bilateral and multilateral investments in global health and it highlights the current global and US architecture for performing global health programs. The article closes describing some of the challenges and prospects that characterize global health governance today.

Caribbean Public Health Laboratory Surveillance Project: a Department of Defense-sponsored humanitarian mission.

This report describes a Department of Defense humanitarian assistance project to develop and build a regional computer-assisted laboratory-based electronic disease surveillance system in the Caribbean basin. From 1997 through 2000, the project donated 146 computer systems and trained more than 250 personnel from 14 ministries of health to operate this system. This humanitarian mission provided the region with a sustainable and locally maintained and operated surveillance system having a broad and long-term impact on public health. It has improved data gathering, analysis, and reporting at the local, national, and regional level. Benefits to the region include the dissemination through the Internet of increasingly timely and accurate information on the incidence and prevalence of endemic, epidemic, and newly emerging diseases. This serves the Caribbean residents, travelers, and U.S. national interests. The project is a model for cooperative Department of Defense capacity building and training programs in support of partner countries and international public health agencies.

Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: results of an interagency workshop on health indicator surveillance.

A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide. The Department of Defense Global Emerging Infections System sponsored a meeting and workshop in May 2000 in which participants discussed prototype systems and developed recommendations for new surveillance systems. The authors provide a summary of the group's findings, including expectations and recommendations for new surveillance systems. The consensus of the group was that a nationally led effort in developing health indicator surveillance methods is needed to promote effective, innovative systems.

Disease outbreak detection system using syndromic data in the greater Washington DC area.

BACKGROUND: Many infectious disease outbreaks, including those caused by intentional attacks, may first present insidiously as ill-defined syndromes or unexplained deaths. While there is no substitute for the astute healthcare provider or laboratorian alerting the health department of unusual patient presentations, suspicious patterns may be apparent at the community level well before patient-level data raise an alarm. METHODS: Through centralized Department of Defense medical information systems, diagnoses based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are obtained daily from 99 military emergency rooms and primary care clinics across the Washington, DC, region. Similar codes are grouped together in seven diagnostic clusters that represent related presenting signs, symptoms, and diagnoses. Daily monitoring of the data is conducted and evaluated for variation from comparable historic patterns for all seven syndrome groups. Geospatial mapping and trend analysis are performed using geographic information systems software. Data were received on a daily basis beginning in December 1999 and collection continues. The data cut-off date for this manuscript was January 2002. RESULTS: Demographic breakdown of military beneficiaries covered by the surveillance area reveals a broad age, gender, and geographic distribution that is generalizable to the Washington DC region. Ongoing surveillance for the previous 2 years demonstrates expected fluctuations for day-of-the-week and seasonal variations. Detection of several natural disease outbreaks are discussed as well as an analysis of retrospective data from the Centers for Disease Control and Prevention's sentinel physicians-surveillance network during the influenza season that revealed a significantly similar curve to the percentage of patients coded with a respiratory illness in this new surveillance system. DISCUSSION: We believe that this surveillance system can provide early detection of disease outbreaks such as influenza and possibly intentional acts. Early detection should enable officials to quickly focus limited public health resources, decrease subsequent mortality, and improve risk communication. The system is simple, flexible, and, perhaps most critical, acceptable to providers in that it puts no additional requirements on them.

An outbreak of hookworm infection associated with military operations in Grenada

During 1983, a multinational military intervention took place on Grenada. After deployment, troops from several U.S. Army units noted signs and symptoms consistent with soil-transmitted helminthic infection. Of 684 soldiers screened five to seven weeks post-development, over 20 percent reported abdominal pain and/or diarrhea during or after the action. Eosinophilia of at least 10 percent was observed in 119 (22.5 percent) of 529 soldiers evaluated further; eosinophilia of 5-9 percent was documented in another 126 (23.8 percent) of the 529 soldiers. Stool examinations confirmed hookworm infection in 35 soldiers. One case of strongyloidiasis was also documented. Infection was attributed to ground exposure near homes with compromised sanitation. Units that joined the operation after the initial assault phase were at low risk of hookworm infection. (AU)