摘要：The globalization of public health is both real and relevant throughout the United States and to Americans traveling or residing abroad. US public policy responses are evolving, but a crisper and more comprehensive global perspective is needed. I suggest four timely US actions to address today’s competing realities of globalization and economic austerity: raise awareness among clinicians and local health departments; capture and share exemplary disaster management practices across countries; ensure that US global health investments are effective, efficient, and sustainable; and think globally while acting locally to enhance US health security. The reauthorization of the Pandemic and All-Hazards Preparedness Act of 2006 provides an opportunity to more clearly address the global dimensions of domestic preparedness. “Every place on earth is both local and global. We cannot make the United States safe without making the world safe.” —William Foege, MD, MPH, founder of the Task Force for Global Health There is no escaping the global nature of public health these days. The increasing globalization of public health has clear-cut implications for the United States. Current realities mean that infected people and contaminated food and other products from any corner of the world can (and do) reach any place in the United States in just hours. Also, Americans traveling to or residing in other countries can be exposed to diseases, get sick, and bring those diseases back to the United States. Americans can also be caught in the initial impact of natural disasters occurring overseas—for example, the 2004 Asian tsunami, the 2010 Haiti earthquake, and the 2011 earthquake, tsunami, and nuclear disaster in Japan—and the subsequent public health crises that tend to follow these disasters. In the early years following the 2001 terrorist attacks, public health emergency preparedness became a new national security priority and an important focus of public health programming to improve US capabilities to respond effectively to any event with serious public health consequences. The term was conceptualized and defined in early 2007 as the capability of the public health and health care systems, communities, and individuals, to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities. 1 (pS9) This same source also indicated that, As much as possible, [public health emergency preparedness] should be integrated with and expand upon day-to-day public health practices and build upon existing systems, not developed de novo. 1 (pS10) The US Assistant Secretary for Preparedness and Response recently emphasized that public health system preparedness is the foundation for public health emergency preparedness (N. Lurie, MD, MSPH, oral communication, August 2011). Although the term “public health preparedness” has typically been equated with public health emergency preparedness, I use the former term in its broader, systems sense to underscore the importance of basic public health system capabilities as the foundation for scaling up effective public health disaster response and recovery. In the current, global era, the weakest link in public health preparedness anywhere in the world creates vulnerability for other countries, including the United States. Such weaknesses stem from inadequate resources and core public health capacities, poor coordination and accountability, and failure to scale up known effective interventions, among other factors. Public health cooperation across borders is in every country’s health security interest. I have described the health connections between US localities and other countries, areas of progress in addressing US public health preparedness in this new global era, and four actions to incorporate a more explicit global perspective into domestic preparedness. This is especially timely given the pending reauthorization of the Pandemic and All-Hazards Preparedness Act of 2006, which explicitly recognized those global connections, albeit in a scattered, unfocused way.
