How bad is the environment for our health?
The Bulletin interview with Kerstin Leitner.
Q: Why are you handling this? Isn’t this an administrative task?
A: No. There is clearly an administrative and managerial task involved, but we are looking at a sophisticated assessment of technical needs. For example, just because you have a major DOTS programme does not mean you need a tuberculosis expert in that office. If a country has institutions capable of delivering a DOTS programme for tuberculosis effectively you don’t need to spend money on a DOTS expert. You may be better off providing a multidisciplinary team to monitor progress of that national programme.
Q: What are you doing to help countries with inadequate health legislation?
A: We are in the process of formulating model legislation which countries can adapt to help them achieve the Millennium Development Goals. Many countries revise public health legislation and many never do. There are some former colonies whose health legislation probably dates back to colonial times. It doesn’t mean this is obsolete, most likely not, but sometimes it needs to be brought up to date. Furthermore, we have collected existing legislation from many countries, so we can provide Member States with examples of existing laws.
Q: What simple, cost-effective interventions could make environments substantially healthier and food much safer?
A: There’s one — and it’s something that often gets short shrift when there is an outbreak of infectious disease — and that’s hygiene. Hygiene can carry us a long way. Hygiene is written into the WHO constitution. We have developed the Five Keys to Safer Food, consisting of five very simple principles of hygiene. I don’t know if it takes care of 30% or 50% of health-related problems, but it’s a big step and something that can be done easily.
Q: What are you doing to improve hygiene standards?
A: Probably not enough. With regard to avian flu, in particular on small farms, there could be room for us — under the heading of occupational health — to develop guidance on hygiene standards and methods to handle poultry. We have been much more focused on the virus that causes it, and this is important work, but most people who died were at these small farms.
Q: When people are faced with a daily struggle for survival are ethics a luxury they can ill afford?
A: In public health, ethics are particularly important when you work under constraints. We developed a set of ethical guidelines for the ‘3 by 5’ campaign, to get HIV/AIDS treatment to one in two poor people who need it. For example, a doctor or a nurse in a rural clinic has one HIV/AIDS treatment left. In comes a poor farmer and in comes the local teacher. Whom do you treat? Without ethical guidance medical personnel are exposed to the pulls and pushes of the situation. The teacher may be more important to the community but may get treatment by other means. If the farmer dies, a whole family will be thrown into destitution. We have also discussed the ethical dimensions of organ and tissue transplant over the last two years as well as transplantation tourism. Ethics are not a luxury, it’s quite the opposite. It’s in situations where you have very limited choices that you need to know how to make the right decision.