Public Health Ethics - Global Cases, Practice, and Context, 2016a

8 International Collaboration for Global Public Health
275
Dubai Residency Training Program and Public Health Consultant
Dubai Health Authority
Dubai , United Arab Emirates
e-mail: hussainh569@gmail.com
Kasturi Sen
Global Public Health, Wolfson College (Common Room)
University of Oxford
Oxford , UK
This case is presented for instructional purposes only. The ideas and opinions
expressed are the authors’ own. The case is not meant to reflect the official position,
views, or policies of the editors, the editors’ host institutions, or the authors’ host
institutions .
8.10.1 Background
During the last century, public health practices have greatly improved the health of
individuals and societies in the Middle East and North Africa (MENA) region
through successful interventional programs like expanded immunization for children
and universal salt iodization programs. The major challenge for public health
in the twenty-first century is to simultaneously maintain and upgrade the infrastructure
created to improve peoples’ lives.
Currently, the MENA region faces multiple challenges to its public health achievements,
one of which is the impact of sanctions being used against MENA countries to
influence political behavior. Sanctions—defined as mostly economic but also political
and military penalties introduced to alter political/military threats and behavior—are
employed by the United States and other countries to discourage the proliferation of
weapons of mass destruction and ballistic missiles, bolster human rights , end terrorism
, thwart drug trafficking, discourage armed aggression, promote market access,
protect the environment, and replace governments (Haass 1998 ). Sanctions often
involve economic measures , such as restricting or eliminating foreign assistance ,
freezing countries’ assets, imposing export and import limitations, and revoking mostfavored-nation
trade status (World Health Organization 2003 ).
Empirical evidence indicates that sanctions have profound long- and short-term
public health impact on the health of citizens in the affected countries, with the greatest
harm affecting the elderly, women, and children (Garfield 1999 ; Ali and Shah
2000 ). This impact goes far beyond problems with medical supplies or other healthspecific
resources. Public health services depend on a safe water supply, a functioning
sanitation system, and a reliable power infrastructure; on availability of equipment
such as ambulances , X-ray machines, and refrigerators for storing vaccines ; on the
public having resources to access health care (e.g., transportation, financial resources);
and on human resources, the trained staff who use the equipment.