国際保健学
International Health Studies
解説:池田光穂
国際保健学(International Health Studies)とは、1945年の国際連合憲章の後にうまれた国民国家を基本単位とする国際的協調の枠組み――国際レジームと呼びます――にもとづい て、公衆衛生学を基軸にしたローカルレベルでの治療や予防の実践行為から、世界的レベルでの保健医療施策の策定にまで広がる現象の解明と問題解決のために 寄与するための学問群のことです。国際保健協力学と言われることもあります。
国際保健学(=国際公衆衛生学)と他の医療人類学の分野の関係の位置付け
2020年頭に中国で発生 したCOVID-19は同年の前半には早々とパンデミック宣言がWHOになされた。同年8月上旬の時点で、中国は制圧に成功、他方、中国の政策を批判する アメリカ合衆国やブラジルは最悪の蔓延国になってしまった。これらの蔓延の原因は、政府と大統領の責任であることは言うまでもない。
ランセットのエディトリアルは、7月25日号( VOLUME 396, ISSUE 10246, P213)で"COVID-19 and China: lessons and the way forward"と題して、中国での成功を次のように分析している。私個人はfacebook でこのようにつぶやいている:「ナチのT4以前の段階における健康政策のように全体主義政策はパンデミック級の疾病対策にはよいというランセットの提灯エディトリアル。なんか複雑だ 」
China has largely controlled
COVID-19. A country of 1.4 billion people and a size similar to Europe
or the USA now reports only clusters of cases rather than widespread
community transmission. China has been widely criticised for its role
and responsibilities during the pandemic because of censorship,
transparency, and human rights concerns. But the rest of the world can
still learn from China's successes in bringing its outbreak under
control. |
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China's response shows the
importance of domestic research and public health capacity. Huge
investments have left China much better prepared for COVID-19 than for
severe acute respiratory syndrome (SARS). When SARS broke out in 2002,
China was unprepared initially, especially as the pathogen was unknown.
When COVID-19 emerged in December, 2019, Chinese scientists were
quickly able to identify the virus and shared genomic sequencing data
internationally on Jan 11, 2020. By the end of January, doctors from
mainland China and Hong Kong had characterised the clinical features of
patients with COVID-19, person-to-person transmission, genomic
characteristics, and epidemiology, warning the world about the threat
of COVID-19 with research papers published in The Lancet. China has
also been at the forefront of vaccine research, with promising results
of early trials of a recombinant adenovirus type-5-vectored COVID-19
vaccine developed in China published in The Lancet in May and July.
Such research was done incredibly fast and rigorously through close
cooperation within China at a time of national emergency. For other
countries, particularly low-income and middle-income countries, China's
experience shows the importance of investing in national health and
research systems to enhance laboratory capacity as well as workforce.
They are fundamental to a quick and effective national response to
health emergencies and to global health security. |
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A second lesson is that a robust
foundation of research cannot guarantee effective control without
strong top-level political commitment to use science to tackle the
outbreak decisively. Governments and their leaders must respect
science, understand its value, and act on it in a way that is best for
society. China's National Health Commission sent three groups of
national infectious disease experts to Wuhan at the beginning of the
outbreak to investigate the risks and transmission of COVID-19, and
their recommendations informed the decision to lockdown Wuhan on Jan
23. When Chen Wang, president of the Chinese Academy of Medical
Sciences, and colleagues saw the need for Fangcang shelter hospitals,
the government was quick to respond. |
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Third, achieving rapid and
effective implementation of control measures for COVID-19 requires
broad community engagement. Community solidarity has been unprecedented
during the COVID-19 outbreak in China. Control measures that could
sacrifice individual freedom, like mandatory mask-wearing in public
areas, were accepted readily by the public. Millions of China's
community workers have “built the first line of defense against
COVID-19”, according to Xinhua News Agency, in their work to provide
essential health checks and support for people with fever, severe
diseases, pregnant women, and those quarantined at home. There are
tensions between freedom and security that each country has to reckon
with, and some of China's approaches to surveillance, for example,
would not be acceptable elsewhere. But China's experiences show the
importance of community solidarity and what it can achieve. |
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So, there are lessons for health
to learn from China. But how will Chinese and global health communities
work together in the future? China's Foreign Minister Wang Yi has said
that globalisation needs to be more inclusive and beneficial to all,
that multilateralism must be safeguarded and promoted even more firmly,
and that global governance needs to be reformed and improved where it
is most lacking. The health community is waiting to see if China will
become a multilateral leader in global health, what role it wants in
international global health security, and whether it will aspire to
fill the vacuum in global health left by the USA. |
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China is facing legitimate
questions in many areas of its domestic and foreign policy, but when it
comes to COVID-19, scapegoating China for the pandemic is not a
constructive response. “Now is the time for global leaders to decide:
will we succumb to chaos, division and inequality? Or will we right the
wrongs of the past and move forward together, for the good of all?”, as
UN Secretary-General António Guterres asked in his 2020 Nelson Mandela
Annual Lecture. Tackling a global health emergency like a pandemic
requires open collaboration. The lack of global solidarity to address
COVID-19 amid geopolitical instability is a threat to us all. |
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