WFPHA World Congress on Public Health Istanbul, Turkey

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• WFPHA World Congress on Public Health Istanbul,
  Turkey
• April 28, 2009
• Health and Human Security
• Expanding the Role of
• Public Health
• by
• Dr. Paula Gutlove
• Institute for Resource and Security Studies
• Cambridge, Massachusetts

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Human Security

• Addresses the security of people, not the
  security of nations
• Recognises humanitys global interdependence and
  mutual vulnerability
• Provides a new framework for addressing
  humanitarian concerns
• Creates new opportunities to expand the scope of
  public health

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Causes of Insecurity

• Economic inequality
• Poverty
• Political grievances
• Nationalism
• Environmental degradation
• Weakening of international institutions

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Evolution of the Concept of Human Security

• Common Security 1980s, Cold War, OSCE, IPPNW
• United Nations Development Programme, 1994
• economic security
• food security
• health security
• environmental security
• personal security
• community security
• political security

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Value Added by a Human-Security Approach

• Provide a compelling objective for humanitarian
  work
• Stimulate contingency planning
• Emphasise global interdependence
• Mobilise additional resources and new
  partnerships
• Address interacting threats in multiple domains
• Stimulate comprehensive threat assessment and
  programme planning

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Public Health A Crucial Domain of Human Security

• Mobilise new resources
• Catalyse new partnerships that recognise global
  interdependence
• Link programmes that address related objectives
  and thereby enhance the effectiveness of both
  strands of effort

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Health as a Bridge to Peace Contexts and
Actions

• Human Security
• Social Reconstruction
• Community Reconciliation
• Conflict Management
• Integrated Action

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The IRSS Health Bridges for Peace program

• Institutional base IRSS, ICMP
• Philosophy utilizes a shared concern for public
  health to bridge conflict divides
• Programs public health, social reconstruction,
  conflict management, policy engagement, education
• Participants health practitioners,
  administrators, social workers, decision makers,
  academics

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Range of IRSSs HBP Programs

• Intra-national, community-level intervention
• Bosnia, community reconstruction
• Ingushetia, refugee assistance
• Iraq, teacher training
• Inter-national intervention
• Medical Network for Social Reconstruction
• International Partnership for Psychosocial
  Healing
• Iran-USA Health Diplomacy
• Policy engagement
• Health and Human Security in the Middle East
• Health Bridge for Peace WHO Strategy

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Medical Network for Social Reconstruction in the
Former Yugoslavia

• Structure
• Health professionals from all sides of conflict,
• coordinated through a contact group
• Operating Principles
• Violent conflict is the ultimate threat to public
  health
• the health community has a unique role
• Programs
• Conferences, training, local assistance,
  research,
• evaluation, publications, international outreach

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Psychosocial Healing

• Definition
• Integrate psychological healing of the individual
  with social healing of the community
• Principles
• Psychosocial healing and peacebuilding both
  involve developing and repairing human
  relationships
• Post-trauma stress can be a normal reaction to
  abnormal events
• Trauma healing is a social process

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Stages of Psychosocial Healing

• A Healing Relationship
• Requires support person, group or network
• Safety
• From unpredictable danger toward reliable
  security
• Acknowledgement
• From dissociated trauma to acknowledged memory
• Reconnection
• From isolation, helplessness and stigmatization
  to meaningful social connections and empowerment

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Psychosocial Healing Programs

• Training and training of trainers
• Identification and activation of health
  professionals
• Volunteer action
• Training and empowering volunteers
• Community integration
• Integration of vulnerable groups
• Help to helpers
• Assistance for stress, burnout and indirect
  trauma

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• MNSR Conference participants arrive in Gracanica,
  Bosnia, from Serbia, Kosovo, Bosnia, Croatia,
  Slovenia, Montenegro, Macedonia and Chechnya, May
  2000

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Training in psychosocial healing in Gracanica,
Bosnia with local physicians, teachers, nurse,
psychologists, and others
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Gracanica, Bosnia
Local teacher explains to Bosnian visitor the
school-based social reconstruction program
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Gracanica, Bosnia
A group effort to rebuild a roof
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Gracanica, Bosnia
A group effort to plant a garden
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Gracanica, Bosnia
Young adults from Gracanica restored the school
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Gracanica, Bosnia
Young adults from Gracanica restored the school
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Gracanica, Bosnia
Teen volunteers supervise Saturday sports games
next to the school
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Gracanica, Bosnia
Teen volunteers supervise Saturday sports games
next to the school
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Photographs from a Conference and Training
Program in Gracanica, Bosnia
The Medical Network assembles to plant a tree--a
symbol of hope for the future
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Lessons from Training Programs

• Employ new and creative skills
• Tailor programs to needs of trainees
• Build mutual-support networks
• Gains can reach beyond initial focus

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International Partnership for Psychosocial
Healing

• Formed June 2004, in Kranska Gora, Slovenia
• Who More than 100 health and education
  professionals from 16 countries
• Declaration Healing from violence is possible
  but difficult, complicated and costly
• Request That the international community support
  programs to heal the psychological and social
  wounds of war

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Photographs from a Conference and Training
Program in Gracanica, Bosnia
 Alija from Jablanica, Ksenija from Belgrade,
Anica from Ljubljana, and Moussa from Grozny,
with Hamdija from Gracanica in the background.
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US-Iran Health Diplomacy Building a Cooperative
Network of Health Scientists Linking the US and
Iran

• Initiated November 2005
• Functions on 2 levels
• Intrinsic value of health research, education
• Model for confidence building
• Health provides a unique opportunity for
  interaction

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Achievements to date

• Videoconferences linking Harvard School of Public
  Health and Isfahan University of Medical Sciences
• Visits of Iranian physicians to USA, addressing
  heart disease, HIV AIDS, Chemical weapons effects
  and rehabilitation
• Visits of US health scientists to Iran, community
  engagement in cardiovascular disease prevention,
  sustainable cities

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• US and Iranian health scientists meet at Tabriz
  Medical University

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Exercise equipment in a public park in Tehran
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Lessons from Health Bridge Programs (1)

• Necessary preconditions include some degree of
  security and external support
• Local programs are best guided by a broadly
  representative group of indigenous personnel
• Embed a program in a structure that has the
  potential for long-term sustainability
• Offer international assistance in the spirit of
  partnership

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Lessons from Health Bridge Programs (2)

• Establish effective channels for communication
  and information exchange
• Build links with other actors and other sectors
• Evaluate programs in a manner that is empowering
  and instructive
• Share lessons learned

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Pursuing Public Health within a Human-Security
Framework

• Policy development
• Specific program opportunities
• Research, training and technical collaboration
• Outreach and promotion

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Iraqi physician leads Kosovar, Bosnia and
Macedonian colleagues in dance