Frederick M. Burkle Jr. 4/2020. “Declining Public Health Protections within Autocratic Regimes: Impact on Global Public Health Security, Infectious Disease Outbreaks, Epidemics, and Pandemics.” Prehospital and Disaster Medicine. Read PublicationAbstract
Public health emergencies of international concern, in the form of infectious disease outbreaks, epidemics, and pandemics, represent an increasing risk to the worldʼs population. Management requires coordinated responses, across many disciplines and nations, and the capacity to muster proper national and global public health education, infrastructure, and prevention measures. Unfortunately, increasing numbers of nations are ruled by autocratic regimes which have characteristically failed to adopt investments in public health infrastructure, education, and prevention measures to keep pace with population growth and density. Autocratic leaders have a direct impact on health security, a direct negative impact on health, and create adverse political and economic conditions that only complicate the crisis further. This is most evident in autocratic regimes where health protections have been seriously and purposely curtailed. All autocratic regimes define public health along economic and political imperatives that are similar across borders and cultures. Autocratic regimes are seriously handicapped by sociopathic narcissistic leaders who are incapable of understanding the health consequences of infectious diseases or the impact on their population. A cross section of autocratic nations currently experiencing the impact of COVID-19 (coronavirus disease 2019) are reviewed to demonstrate the manner where self-serving regimes fail to manage health crises and place the rest of the world at increasing risk. It is time to re-address the pre-SARS (severe acute respiratory syndrome) global agendas calling for stronger strategic capacity, legal authority, support, and institutional status under World Health Organization (WHO) leadership granted by an International Health Regulations Treaty. Treaties remain the most successful means the world has in preventing, preparing for, and controlling epidemics in an increasingly globalized world.
Frederick M. Burkle Jr. 4/2020. “Political Intrusions into the International Health Regulations Treaty and Its Impact on Management of Rapidly Emerging Zoonotic Pandemics: What History Tells Us.” Prehospital and Disaster Medicine. Read PublicationAbstract
For a large number of health care providers world-wide, the coronavirus disease 2019 (COVID-19) pandemic is their first experience in population-based care. In past decades, lower population densities, infectious disease outbreaks, epidemics, and pandemics were rare and driven almost exclusively by natural disasters, predatory animals, and war. In the early 1900s, Sir William Osler first advanced the knowledge of zoonotic diseases that are spread from reservoir animals to human animals. Once rare, they now make up 71% or more of new diseases. Globally, zoonotic spread occurs for many reasons. Because the human population has grown in numbers and density, the spread of these diseases accelerated though rapid unsustainable urbanization, biodiversity loss, and climate change. Furthermore, they are exacerbated by an increasing number of vulnerable populations suffering from chronic deficiencies in food, water, and energy. The World Health Organization (WHO) and its International Health Regulation (IHR) Treaty, organized to manage population-based diseases such as Influenza, severe acute respiratory syndrome (SARS), H1N1, Middle East respiratory syndrome (MERS), HIV, and Ebola, have failed to meet population-based expectations. In part, this is due to influence from powerful political donors, which has become most evident in the current COVID-19 pandemic. The global community can no longer tolerate an ineffectual and passive international response system, nor tolerate the self-serving political interference that authoritarian regimes and others have exercised over the WHO. In a highly integrated globalized world, both the WHO with its IHR Treaty have the potential to become one of the most effective mechanisms for crisis response and risk reduction world-wide. Practitioners and health decision-makers must break their silence and advocate for a stronger treaty, a return of the WHO's singular global authority, and support highly coordinated population-based management. As Osler recognized, his concept of "one medicine, one health" defines what global public health is today.
Amir Khorram-Manesh, Phatthranit Phattharapornjaroen, Luc J Mortelmans, and Frederick M. Burkle Jr. 2/2021. “Current Perspectives and Concerns Facing Hospital Evacuation: The Results of a Pilot Study and Literature Review.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

Objective: To analyze the evacuation preparedness of hospitals within the European Union (EU).

Method: This study consisted of 2 steps. In the first step, a systematic review of the subject matter, according to the PRISMA flow diagram, was performed. Using Scopus (Elsevier, Amsterdam, Netherlands), PubMed (National Library of Medicine, Bethesda, MD), and Gothenburg University´s search engine, 11 questions were extracted from the review and were sent to representatives from 15 European Union (EU)- and non-EU countries.

Results: The findings indicate that there is neither a full preparedness nor a standard guideline for evacuation within the EU or other non-EU countries in this study. A major shortcoming revealed by this study is the lack of awareness of the untoward consequences of medical decision-making during an evacuation. Some countries did not respond to the questions due to the lack of relevant guidelines, instructions, or time.

Conclusion: Hospitals are exposed to internal and external incidents and require an adequate evacuation plan. Despite many publications, reports, and conclusions on successful and unsuccessful evacuation, there is still no common guide for evacuation, and many hospitals lack the proper preparedness. There is a need for a multinational collaboration, specifically within the EU, to establish such an evacuation planning or guideline to be used mutually within the union and the international community.

Frederick M. Burkle Jr., David A. Bradt, Joseph Green, and Benjamin J. Ryan. 10/2020. “Global Public Health Database Support to Population-Based Management of Pandemics and Global Public Health Crises, Part II: The Database.” Prehospital and Disaster Medicine. Read PublicationAbstract

This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.

Frederick M. Burkle Jr., David A. Bradt, and Benjamin J. Ryan. 10/2020. “Global Public Health Database Support to Population-Based Management of Pandemics and Global Public Health Crises, Part I: The Concept.” Prehospital and Disaster Medicine. Read PublicationAbstract
This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.
Patrick Vinck, Phuong Pham, Eric Stover, Andrew Moss, and Marieke Wierda. 2007. Research Note on Attitudes About Peace and Justice in Northern Uganda.Abstract

In light of human rights violations in Northern Uganda, this research note presents preliminary data on Ugandans’ attitudes on peace and justice. The findings reflect the respondents’ desires for truth reconciliation as well as their desires to hold perpetuators of violence accountable for their actions. However, the findings show that justice is not a top priority for Ugandans in comparison to more tangible needs for health, peace, money, and education. A majority of Ugandans in the North are open to the reintegration of former LRA members in society, albeit conditionally on diminished social and political rights for past LRA leaders.

Laurel E. Fletcher, Phuong Pham, Eric Stover, and Patrick Vinck. 6/2006. Rebuilding After Katrina: A Population-Based Study of Labor and Human Rights in New Orleans.Abstract

In August 2005, Hurricane Katrina swept through New Orleans and the surrounding communities, inflicting massive destruction and displacing hundreds of thousands. In the wake of the disaster, the U.S. Department of Homeland Security lifted minimum wage restrictions, thus creating an environment ripe for exploitation of both documented and undocumented workers by their employers. This study presents the experiences of laborers in the construction industry following Hurricane Katrina, and makes recommendations for how federal, state, and local authorities may protect Gulf Coast laborers against exploitation and unfair treatment.

Ismail Lubbad, Allan Hill, and Cari Jo Clark. 6/2006. Population Projections for Socioeconomic Development in the Gaza Strip.Abstract

By all accounts, demographic pressures in the Gaza Strip — in terms of population density, age structure, and growth rate — are extraordinarily high compared to neighboring countries and regions. This population pressure, combined with limited resources and territorial isolation, places immense strain on public services, social and political institutions, and the natural environment. At the same time, insecurity resulting from a deteriorating political context leads to further poverty and unemployment. Together these conditions require both immediate attention and long-term development planning, both of which are, admittedly, difficult in an environment of continuing political uncertainties. Since September 2000, the Gaza population has suffered periods of protracted closure imposed by the Israeli authorities. This has had deleterious consequences on the socioeconomic situation in the Gaza Strip. Currently, 30.3% of the Gazan workforce is unemployed. Concomitantly, poverty is rampant. As of 2004, 37.2% of Gazan families were below the poverty line, 26.0% of whom experienced extreme poverty suggesting that the majority of poor households in Gaza are unable to meet their most basic needs. These challenges to human security are exacerbated by the fact that approximately 64% of the Gaza population are refugees , approximately half of whom still reside in camps.

Lynne Hudson, Siobhan McNally, Sera Bonds, Leilani Johnson, Jennyfer Dulyx, Courtney Hilbert, Simran Bains, and Rachel Bedenbaugh. 2010. Picking Up the Pieces: Women's Health Needs Assessment, Fond Parisien, Haiti.Abstract

Circle of Health International (COHI) conducted this Women's Health Needs Assessment to identify the specific and immediate needs of women, and to provide evidence-based recommendations for short and long-term women's health programming in the Fond Parisien area. These recommendations are based on the results of surveys conducted with 64 women living in the American Refugee Committee (ARC) camp in Fond Parisien. This document highlights the present and future needs of the women living in this IDP camp, and provides specific recommendations to address the unique health needs of women within this population.

HPCR. 1/2002. Internal Displacement in Afghanistan: New Challenges.Abstract

The ongoing military action in Afghanistan is deepening what was already a severe humanitarian crisis. Further displacement of civilians will have a profound impact upon the ability of the country and its people to recover. The movement of civilian populations in search of security, as a result of conflict, or food, as a result of drought, has characterized the long conflict in Afghanistan. The continuing flight of civilians from urban areas, in the face of aerial attacks, compounds a humanitarian situation that was already grave, due to a long and devastating drought in many parts of the country. Over the coming winter, more than a million internally displaced persons (IDPs) will require emergency assistance simply to survive. Apart from the immediate impact on the livelihoods of the displaced and their hosts, forced movement affects social relations and traditions within affected communities. It is important to take stock of these changes, and related shifts in community- or tribal-level politics that might occur during displacement, in efforts to support the recovery of vulnerable communities. This policy brief aims to provide a concise point of reference for those planning responses to the complex range of issues resulting from displacement. It includes a number of active links to the most relevant and reliable information sources. It concludes with a range of operational recommendations for international organizations, governments and NGOs working on this issue.

6/2018. “An Innovative Global Diplomacy Public Health Student Program – Lessons from the Field in a Post-Conflict Medellin, Colombia”.Abstract

For over fifty years, Colombia has been embroiled in conflict, displacing nearly seven million people, second only to Syria for the highest number of internally displaced persons (IDPs) in the world. Most are displaced to urban environments into dense informal settlements with inadequate water, sanitation, shelter and power infrastructure. The city of Medellín, has become home to over 200,000 IDPs in informal agglomerations. Medellín’s transformation to a city of progress and innovation through the promotion of “social urbanism” is an example of how collaboration between city institutions and government sectors can address issues of poverty, violence, equality, engagement, and reintegration of displaced populations in Colombia.

The Post-Conflict Colombia Public Health Project is a collaborative academic exchange program aimed at bringing together public health students from the United States and Colombia for the purpose of understanding between the people of both countries. The project aims to educate students while also providing direct service and fostering long-term cross-cultural relationships and sustainable projects. Seminars, skill building workshops, cultural experiences, and community engagement are used to build professional competencies and inform policy recommendations for future projects. Despite the limited research on the educational impact of short-term global emersion programs, small scale evaluations point to an increase in learners’ cross-cultural adaptability. The believed benefit to students’ professional and personal development must be balanced with ethical considerations including preparedness of students, health and safety risks, cultural sensitivity, and issues of sustainability. In order to address these concerns, programs should be developed collaboratively through bi-directional participatory relationships, incorporating both education and direct service components, and promoting local capacity building and long-term sustainability.

Our course pairs 16 carefully selected graduate-level public health and medical students from Harvard and Universidad de Antioquia, who will serve as both student and citizen ambassadors, to come together and share about their culture, values, and experiences through the lens of diplomacy and dialogue to make a meaningful impact in the people and country of Colombia. The course examines the social development model of Medellín and its impact on advances in peace, social equity, and health. Beyond the theoretical concepts, students will learn to apply them to the Granizal community in order to create practical solutions that are sustainable, scalable, innovative, and measurable.

As other disciplines move away from curricula limited to rote learning and fact-based content, public health and policy education will also benefit from incorporating experiential and competency-based learning with an emphasis on skill building in leadership, management, policy-making, and research.5 The Institute of Medicine’s 2003 report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, recommends eight content areas as essential to graduate level public health education programs: informatics, genomics, communication, cultural competence, community-based participatory research, global health, policy and law, and public health ethics.6 The report further acknowledges the importance of developing international relationships between academic institutions, community organizations, and health agencies for collaboration in interdisciplinary and community-based research, learning, and service. Health disparities, issues of social justice, and public health threats from infectious disease are less and less confined by political and geographic boundaries. The future generation of leaders in public health and policy must be able to bridge nations and cultures through diplomacy and be equipped to develop innovative strategies and partnerships across professional disciplines and on a global scale.

While several public health approaches have been documented in the literature, we describe a model for a multi-institutional and cross-cultural collaboration based on The Post-Conflict Colombia Public Health Project, a three-week intensive course developed in partnership between the Harvard Humanitarian Initiative, the Open Hands Initiative, and the University of Antioquia. While this model is a public health course focusing on Colombia, the concepts and educational strategies can be applied across academic disciplines and to other countries and communities.


Allan G. Hill, Cari Jo Clark, Ismail Lubbad, and Claude Bruderlein. 10/2006. “Hope and Despair over Health in Gaza.” BMJ, 333.Abstract

The Israeli re-invasion of Gaza this July has redrawn the world’s attention to the dire straits of the population living in the Gaza Strip. There, within an area the size of the Isle of Wight, 1.4 million people live without free access to the outside world. Contrary to international hopes, the Israeli decision to withdraw from Gaza in September 2005 has led to increasingly tight control over the movement of goods and people. The destruction of the Gaza power station in addition to the damage to bridges, roads, and other infrastructure can only worsen the plight of Gazans in the coming months.

Theresa Stichick and Claude Bruderlein. 5/2001. “Children Facing Insecurity: New Strategy of Survival in a Global Era”.Abstract

This paper explores the nature of children’s security within the context of modern threats from globalization and new forms of warfare. It analyzes the sources of insecurity faced by children and the survival strategies they and their families employ as a result. Through a number of case-studies, it questions the usefulness of assistance programs that focus on the physical needs of children in isolation of their social and communal environment. As children are in a constant state of development, protecting their security requires more than support against physical harm. The paper argues that four dimensions of security are important for the protection of children in times of war: physiological necessities, safety, communal relationships and opportunities for personal development. Efforts to promote children’s security must involve analysis of these core dimensions and treat the coping strategies of children and their families as a roadmap for protection. The focus of this paper is children affected by war but the analysis also applies to children at risk in other circumstances, from street children, to those living in extreme poverty. Children’s security is particularly at risk in those countries under economic embargo, afflicted by armed conflict or by extreme poverty. Today’s threats take place in the context of wars sustained by the import of small arms and light weapons and are often fought over the control of valuable resources – oil, minerals, timber, gems - whose major markets are in the North. The dislocation caused by these wars fragments families and isolates children. While few of these threats are new, their impact on the life and security of children has increased with the globalization of trade, migration and communication. Civilians, especially children and their families, have been forced to develop new coping mechanisms for their changed situations. Children can no longer be viewed merely as the victims of war. They have taken on new roles as heads of households, child combatants, student leaders and actors in peace building. This paper explores how globalization affects the security of children, particularly in conflict areas. It presents a framework to structure the core dimensions of children’s security and discusses how the survival strategies employed by families and children when protections fail may be used as a signal for improving security conditions for children. The paper was produced for the Human Security Network meeting in Amman, 11-12 May 2001, with a contribution from the Canadian Department for Foreign Affairs and International Trade.