A Major Public Health Shakeup The World Needs To Beat TB/HIV/Malaria By 2030

Structural preparedness and readiness are part of the ecosystem needed to ensure child, adolescent, youth, adult and senior quality living, good health and wellbeing.

Major changes are afoot and they have to address climate-change; the variables influencing disease progression; following up people from a life span point of view that deliberately addresses children, adolescents, youth, adults and seniors’ (CAYAS) issues; Pandemic Preparedness and Response Policy; and climate, food, energy, debt and political crises.

But these are not given the much-needed attention.

Beyond devising a new and agile ecosystem, Public health needs to undergo a leadership transition, with important implications for an uplifting relationship between the Global North and Global South.

Public health has to ensure the long-term relevance based on “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals,” (Gatseva et Al, 2011).

Public health as a service is modelled on national health infrastructure influenced or distorted by a partisan leadership appointment system in the case of the UK, Portugal, Spain, the US and France.

In the case of the former colonies, Public health follows a pattern left by the colonisers and a structure maintained by aid from donors.

Public health agencies are captive to interests other than those of the people the agencies are supposed to benefit in most cases.

Public health should not be defined narrowly but it should rather include the organized efforts and informed choices of society, organizations, public and private, communities and individuals, e.g., adaptation and integration in communities, road networks, housing estates, school systems, social amenities, work place, community organisation, social-cultural-political dispensations, population size and the geography of a given region.

Public health is about ecosystems, of which medical interventions constitute only 10–20 percent of modifiable factors affecting health. The other 80 to 90 percent are sometimes broadly called the Social Determinants of Health (SDoH): health-related practices, socioeconomic factors, and environmental factors (Magnan, 2017).

Strategic public health is a continuum between clinical reasoning and population-level logic of public health that addresses the tensions brought about due to use or under use of existing services; competing interests; efforts and choices of society; public and private organisations; communities; and individuals which impact or are impacted by disease progression and climate changes

Households with bed-bound or bedridden breadwinners in case of TB/HIV/AIDS/ Malaria where those households have no health insurance coverage and formal livelihoods are lost, there are tendencies of selling off household resources and eventual dependence on natural resources.

Due to shame, stigma and discrimination, there are several examples for households with bed-bound members to shift to other areas where they perceive less stigma, shame and discrimination.

Climate-induced human migration from flooding, droughts, and extreme weather events also?increase crowding, which in turn exposes many to disease transmission and decreases outcomes for those already living with the virus or infections (Lieber et Al, 2021).

Climate-related events affect public health aspirations and vice-versa. Humans and naturally occurring processes have a hand in greenhouse-gas emissions which drive climate change.

Climate change contributes to weather changes including extreme weather; affects settlement patterns; agricultural production; is linked to intense rainstorms, flash floods, rising temperatures which provide contexts for the spread of disease-causing fungi, bacteria and parasites; increased respiratory, cardiovascular disease, sensory-nerve systems, injuries and premature deaths related to extreme weather events, changes in the distribution of food- and water-borne illnesses and other infectious diseases; and threats to mental health. Connecting service provision to resilient ecosystems is likely to translate into more effective leadership on health service provision, development, including the climate trends that threaten it.

How can public health be positioned to effectively be the vehicle to end TB, HIV and Malaria by 2030, support good health, wellbeing and prosperity?

For starters, the possible expansion of the public health agenda should include integrated service delivery, resilient and sustainable systems, structures, climate-change countermeasures, addressing people and community-centred issues, economic development, climate, housing, energy, food, debt crises, climate resilience, mitigation, and post-disaster reconstruction.

Vulnerability or livelihood insecurity emerges when poor people as individuals or social units have to face harmful threats or shocks with inadequate capacity to respond effectively. People face escalating levels of risk, uncertainty and consequently vulnerability as a result of multiple interacting stressors, including political insecurity, persecution, TB, Malaria, HIV/AIDS, poverty, food insecurity, weak governance, climate change and land degradation, (Shackleton et Al, 2011).