Safety of the citizen and society as a function of the health care system
Security and safety are the basic needs of a person and society, which are achieved through access to quality nutrition and living conditions, basic medical care, protection against catastrophes and natural disasters of various natures. The modern world is based on technologically advanced and interconnected societies. This generates new opportunities, but also creates complex and sometimes unexpected problems, which include serious challenges ranging from industrial incidents and terrorist attacks to global epidemics and excessive mortality. These issues concern citizens, occupy high positions in political programs and are a key priority for business. Regardless of their nature – man-made or natural disasters, infectious diseases, or armed conflicts – they all affect the health of each individual citizen, society as a whole and can lead to excessive mortality. Therefore, as a result of unintentional or intentional events, a citizen will suffer.
In modern society, a person cannot independently confront global threats, which is why citizens delegate certain powers to the state to identify risks, assess their condition and manage risks, i.e., reduce the potential negative impact on society’s well-being and citizen welfare.
Risk identification is done by studying the existing and potentially negative health effects of technology. Risk assessment is the analysis of situations and weighing the reasons that may create the conditions for the impact of risk factors on health. Risk management is the planning and organization of activities aimed at reducing the negative impact of factors on health. Such measures may include legislative and regulatory initiatives, the introduction of modern technologies, coordination of players’ work or compensation for potential damage.
To organize the work, the state creates the necessary institutions and gives them the appropriate powers, subject to a balance with basic freedoms. Such a balance can be achieved in the case of an open dialogue with society and its conscious perception of expediency and realism of the proposed measures.
Institutions that ensure the implementation of the above powers to identify, assess, and manage public health risks form a public health system. At the same time, they can be part of the health care system or be part of other industries (Ministries). Such institutions include public health, emergency services, consumer protection, law enforcement agencies (police, border guards, intelligence) and customs.
It is important to ensure coordination of preparedness and risk response at the level of the Cabinet of Ministers of Ukraine or the Verkhovna Rada of Ukraine.
Globalization has a serious impact on modern society and the approaches that the state must take for the safety of its citizens, protection and promotion of health due to the growing number of health threats that freely cross national borders. These threats include primarily infectious diseases, but we should not forget about the import of goods that are harmful to health (such as tobacco, alcohol, or processed foods), which increases the risk of many non-communicable and chronic diseases.
Emerging pandemic threats, such as pandemic influenza, Ebola virus, or COVID 19, are spreading more and more rapidly in today’s globalized world and require constant preparedness.
Climate change is also affecting the global spread of disease. It is no secret that climate change is affecting the emergence and spread of infectious diseases. However, there is growing evidence that rapid climate change will lead to more frequent extreme weather events, such as droughts and hurricanes. It is important to form an understanding of the interaction of climate and other key factors such as globalization, population growth, urbanization, land use and habitat destruction, which play an important role in the emergence or resurgence of certain diseases.
Against the background of the growing dangers of the rapid spread of pandemic infectious diseases, the main efforts of the health care system can be aimed at protecting against risks of biological origin.
We recognize that preparedness to respond to emergencies and disasters is an extremely important state function. A state is prepared that develops, maintains, and uses a realistic preparedness plan, which is combined with routine practices and has the following components: a) planned and coordinated rapid response capabilities; b) accountability and quality improvement; c) professional and staffed human resources.
I. Planned and coordinated rapid response capabilities
- Health risk assessment. High-risk areas, oversight mechanisms and government agencies responsible for hazard identification, monitoring of critical facilities and health indicators that signal potential threats need to be reviewed. Regular, accessible, and clear reports on public health risks should be adapted to the Government, local authorities, and the public.
- Legislative regulation. Issues of legal authority and responsibility need to be constantly identified and addressed to effectively monitor, prevent, or respond to health emergencies. To this end, it is advisable to form a new Law “On Biosafety and Preparedness for Biological Threats”, adapt the Civil Protection Code, and update the relevant departmental bylaws.
- These activities involve the definition and distribution of responsibilities between sectors, at all levels of government and among all stakeholders. Activities should include regular inspections and exercises to ensure the integration and interaction of all participants. Coordination with other structures and agencies is a cornerstone of public safety. The system should be deconcentrated, not decentralized.
- Risk management system. An integrated risk management system is the basic structure that should coordinate the state’s response to various incidents. Typically, such systems require coordination at the level of cross-sectoral structures. For the system to work effectively, it is necessary to develop and test decision-making procedures and practices and the possibility of implementing these decisions at all response levels. It is expedient to review the powers of the State Commission for Technogenic and Ecological Safety and Emergencies and the State Emergency Service of Ukraine.
- Participation of the private sector. Given the need to respond at the level of society as a whole and the importance of communication with various segments of society, it is necessary to educate, involve, and mobilize the public as full and active participants in preparing for health emergencies.
- Strengthening the epidemiological service. The monitoring system should be constantly improved to maintain the appropriate level of collection of information necessary for the timely detection and investigation of potential hazards, environmental, radiological, toxicological, and infectious in nature. The system of routine collection of statistics (passive monitoring) should be complemented by other forms of monitoring, including surveys, sentinel surveillance, syndromic surveillance, and event-based surveillance. For the proper functioning of the epidemiological service, it is necessary to use the capabilities of modern information technology, including but not limited to geographic information systems, cloud technologies, 5G technologies, radical interoperability and open platforms, artificial intelligence, big data analytics.
- Development of laboratory network. Investigation of potential hazards is not possible without proper support and improvement of the laboratory diagnostic system. High-tech laboratory hubs (4-5 per country) with mobile response teams should be equipped with modern equipment and techniques, including genome sequencing and culture technologies. The development of rapid diagnostic capabilities should provide early screening for the possibility of taking immediate action.
- Mitigation strategies. Emergency response may include the introduction of restrictive measures (isolation, quarantine, social distancing). Planning and improving strategies to mitigate such situations at the community, regional, and national levels should be part of the response preparation. Such measures should include planning the possibility of providing mass medical services.
- Public information and communication. Providing prompt, accurate, and reliable information to the public prevents panic, fear, and social discontent. The formation of clear, concise, and concise messages about dangers and response measures prevents epidemics of misinformation and mystification. Communication should be carried out through all available channels, which should be identified and prepared in advance.
II. Accountability and quality improvement
- System performance check. Planning activities will be ineffective without implementing decisions. To this end, it is necessary to practice such solutions using real public health measures, to revise and improve standards and response procedures, which must be complemented by appropriate training and exercises.
- Performance management. Implementing an efficiency management system will allow us to get better results from the system, teams, and individuals by introducing appropriate goals, standards, and competency requirements. The benefits of performance management extend to enhancing broad cross-sectoral involvement in decision-making and risk calculation, ensuring the visibility of accurate and relevant information.
- Financial support. Any response system cannot exist without adequate funding. Financial support should include the development, review and improvement of mechanisms and procedures for the replenishment, accounting, use, tracking of financial resources, and ensuring their proper and timely replenishment and reimbursement.
- Inventory and supply management. Responding to health emergencies requires the identification of critical resources, replenishment mechanisms and the ability to deliver these resources throughout the supply chain.
III. Professional human resources
- Training of medical personnel. Determining the need for relevant specialists and the formation of the state order to perform the functions of the state should be carried out regularly, considering the latest trends in technology and scientific knowledge. Control over the actual use of human resources for their intended purpose.
- Mobilization of medical workers and volunteers. Emergency response may require the simultaneous involvement of many health workers and volunteers who must have the appropriate training and skills. To accomplish this task, appropriate mobilization plans must be developed at the national and regional levels. Mobilization readiness should be a prerequisite for entering the profession. The personnel potential of the response system is not included and is not regulated by the legislation on medical self-government.
- Leaders. Responding to emergencies requires not only medical knowledge but also the skills to mobilize resources, engage communities, develop interagency relationships, and communicate with the public. To this end, teams should be formed, which include specialists with appropriate competencies and skills.
We recognize that ensuring the priority of the public good requires a revision of the social contract between the state and citizens and the definition of an exclusive list of situations in which the powers of the state can be applied in full. Including:
- prevention of the spread of pandemic infectious diseases (infectious diseases subject to registration),
- supervision and response to the appearance of new infectious agents (new and re-emergent infection)
- natural disasters, accidents, and catastrophes of natural or man-made origin
- terrorist attacks and hostilities
- safety and biosecurity when working with hazardous substances and/or pathogens of infectious diseases
With economic growth and the effective implementation of an appropriate level of security, other measures can be considered to meet the needs of citizens in a welfare state. In this case, the personal good should be satisfied only after the satisfaction of the public good.
The development of institutional capacity for security coordination should focus on
- collection of information and analytics (a centralized system of monitoring certain signal indicators and the formation of security levels in real time). This structure should include a small number of think tanks equipped with modern equipment and resources. The structure of such centers should include a strong laboratory service and mobile response teams.
- fulfillment of the state’s powers to supervise compliance with legislation and established norms (inspection) – a central executive body, which will include supervision over compliance with sanitary legislation and factors affecting public health, from environmental indicators and food to pharmaceutical and cosmetic products.
- research and development (R&D) – the development of highly specialized centers that increase the unique expertise in certain areas (such as chemical, radiological hazards, man-made and natural disasters) and provide consulting and methodological assistance to other health care facilities. Such centers must have the resources to respond within the first 3 days of an emergency.
The globalized world also requires strong cooperation and interaction with key international partners. The review of international initiatives and the development of Ukraine’s active participation in them should be ensured by delegating powers to the relevant central authorities.