Page 12 - Smart public health emergency management and ICT implementations - A U4SSC deliverable on city platforms

include both immediate and long-term ones in addition to the enormous societal and economic
costs.

The risk to community well-being underpins the importance of understanding this historic and
complex relationship between epidemics, public health and city resilience. Such studies are rooted
in the 19 century, when urbanization rates increased along with a corresponding deterioration
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in environmental conditions of the working class and areas that became hotbeds of diseases.
High population concentrations, coupled with poor infrastructure, including the lack of clean
water and sewage systems, encouraged the rise and transmission of diseases from the individual-
level to entire cities and beyond. Tackling these conditions were instrumental in transforming the
public’s role in the control of the outbreaks, focusing on the citizenry’s health and emphasizing the
importance of the physical urban infrastructure. Furthermore, the failures of isolation and quarantine
in combating certain diseases were countered by advances in scientific understanding of the
causes as well as transmission and prevention of many contemporary outbreaks. Such progress
constituted a major step in the evolution of modern public health before the early 20 century.
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This is best evinced in the following definition from that period: public health is “the science and
art of preventing disease, prolonging life and improving quality of life through organized efforts and
informed choices of society, organizations, public and private, communities and individuals ”. This
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definition has consequently expanded the focus of public health to include the physical, social and
psychological well-being of an entire community without diminishing the central component of
its purpose – and that controlling and preventing disease can only be initiated by epidemiologists
and in laboratories .
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The complex array of factors that can lead to new viruses emerging and causing an epidemic
makes an emergency very much part of the make-up of public health. It is defined as an occurrence
or imminent threat of an illness or health condition caused by bioterrorism, epidemic or pandemic
disease, or a novel and highly fatal infectious agent or biological toxin that poses a substantial risk of
a significant number of human facilities or incidents or permanent or long-term disability . It is also
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defined as a state of affairs in which the health of a substantial portion of a community’s members
is either compromised or in imminent danger because of the inability of existing mechanisms for
safeguarding the public’s health to cope with an emergent health threat . These definitions show
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that an emergency can arise from natural factors (e.g., drought, earthquake etc.), human activity
(war, poor sanitation, overcrowded areas, bioterrorism etc.) and illness (bacteria and viruses).

The declaration of a public health emergency permits a government to modify public liberties,
suspend constitutional rights, reallocate resources, and implement surveillance. This is often
considered a necessary public health function. In general, this term has a broad scope. Its French
roots – sur (over) and veiller (to watch) – signifies the close and continuous observation of one or
more persons for the purpose of direction, supervision and control. When applied as part of public
health measures, however, surveillance is the ongoing systematic collection, analysis, interpretation
and dissemination of health data for the planning, implementation and evaluation of public health
action 17,18 . It does not constitute a new approach to tackling the spread of infections. In fact, public
health surveillance dates back to the first recorded epidemic by Hippocrates who coined the term

2 U4SSC: Smart public health emergency management and ICT implementations