Post on 12-Jan-2016
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StandardizationBegun in the 19th CenturyInternational Sanitary Conferences60 year processdiseases, vector control & standardsInternational Sanitary Regulations 1951
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International Health RegulationsReplaced International Sanitary Regulationspurposeensure maximum security against international spread of disease with a minimum interference on world traffic
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Article 84Migrants, nomads seasonal workers or persons taking part in periodic mass congregations, and any ship, in particular small boats for international coastal traffic, train, road vehicle or other means of transport carrying them, may be subjected to additional health measures conforming with the laws and regulations of each State concerned and with any agreement conclude between such States.
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Challenges Post arrival follow upnot a part of classic quarantinemore relevant in todays worldcostlymajor gap
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Traditional Approaches to Migration Health Immigration Medical AssessmentInfectious Diseases Quarantine Health
Fitness for EstablishmentImmigration Health
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Photo: US National Library of Medicine
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Traditional FocusBorder or FrontierPrimarily of interest to large receiving countriesLimited to arrival phaseLittle concern for integration into health systemsHomogenous populations
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ApplicationOften applied under immigration legislationreference to national quarantine systemnational differences as opposed to international situationmovement from high to low prevalence areas
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Immigration Health Screeningreflects national concernsgreat variabilityrelated to social policyemployabilityindependenceeugenicscontagious diseases
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Why this is not already apparent to many Historic Canadian focus is inadmissibility screening focus limited to exclusion (few)limited attention on long term impacts of arrivals (TB good example)limited attention to forward looking issues of those who arrive
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Policy is designed for Homogeneous Populations - Migrants VaryWhile the unifying factor may be being foreign born, other characteristics can be markedly different:HistoryEconomic statusEducationLegal statusLocal environmentAll of these characteristics can affect health outcomes
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Pressures on the ParagidmPopulation flowsGlobalizationNew prevalence gapsEvolution of travel
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Reduction of Interest in International Disease Control and RegulationLimited revision and modernization of legislationnational : quarantineinternational: IHRsRetention of antiquated regulatory instrumentswrong tools for the wrong place at the wrong time
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The Lessons of History may not be Relevant
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Reduction of the Impact of Infectious DiseasePharmacology (a drug for every bug)Improved control and reduction of disease prevalencein the developed worldLowered appreciation of threatDecreased appreciation of importance of Public Health
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Evolution : DemographyMore people on the move for more reasonsdisplacementpost (natural / man made)More destinationsMore originsDifferent ages
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Demographics@ 175 million persons live and often work outside of their country of citizenship@ 1- 2 more million migrate permanently every year @ 1 million others seek political asylumAdded to this are some 24 million refugees and millions of internally displaced individuals
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DemographicsOlder and youngerBringing with them the health parameters of where they leftHealth care professionals may not be ready for previously geographically isolated diseases (SSD, Trypanosomiasis)
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New Factors ContinuedSocial Increasing conflict/social/political unrestInternally and externally displacedGlobalized economyExchange of commerce and labour and merchandiseDietary patterns, pharmaceutical use globalContinued population pressuresSustained economic disparity
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Geo-Biologic Boundariesconsequences of travel speed and availabilityincubation period less than journeyvectors in conveyanceshumanity as a vectorparasiticvaccine preventable
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Prevalence Gapsmovement from local level to prevalence at destinationimplication for diseases that have mandated public health responsecosts and resource utilizationBioSafety IV diseasesmanaging small risks
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New Factors ContinuedSpeed of Travelincubation period greater than travel timeFrontier focus requires reassessment
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Forgotten Risk Groupsdescendants of migrantswho return to region of originconcept that citizenship provides public health protectiontravel medicine is generically applied to passport not riskchildren return to high risk environmentprophylaxis may not be taken
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Risks of Rare or Uncommon Low Incidence Diseases In developed countries, certain groups of migrants can be expected to become high risk groups for diseases and illnesses controlled or eliminated in native-borne populations,
Craig AS, Reed GW, Mohon RT, Quick ML, Swarner OW, Moore WL, Schaffner W Pediatr Neonatal tetanus in the United States: a sentinel event in the foreign-born. Infect Dis J 1997 Oct;16(10):955-959
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Distribution of reported TB cases by origin in Canada : 1980 - 2001Foreign bornCanadian born non-aboriginalCanadian born Aboriginall
Chart2
49.414.135.3
4814.837.1
4715.637.4
44.119.836
4615.638.4
43.91640.2
42.817.339.9
36.519.544
37.217.145.8
32.720.147.1
34.118.847.1
33.216.850
27.818.453.8
28.618.552.8
23.619.257.2
22.517.959
19.915.862.7
20.214.364.3
19.215.564.3
17.917.463.7
18.115.465
15.9718.162.4
Cdn-born Non-Aboriginal
Cdn-born Aboriginal
Foreign-born
Percent ofCases
Sheet1
Cdn-born Non-AboriginalCdn-born AboriginalForeign-born
198049.414.135.3
19814814.837.1
19824715.637.4
198344.119.836
19844615.638.4
198543.91640.2
198642.817.339.9
198736.519.544
198837.217.145.8
198932.720.147.1
199034.118.847.1
199133.216.850
199227.818.453.8
199328.618.552.8
199423.619.257.2
199522.517.959
199619.915.862.7
199720.214.364.3
199819.215.564.3
199917.917.463.7
200018.115.465
200115.9718.162.4
Sheet2
Sheet3
1http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1048001686696_114///?hub=Canada1March 18 BBC http://news.bbc.co.uk/2/hi/health/2859825.stm
1As well as monitoring of more specific trends