1. It is a point of important debate to ask the question, “Is public health as we know it in a state of collapse?” This is a worthwhile debate that is informed by the archaeological and sociological literature on societal collapse. It may be argued that public health has struggled to maintain relevance in the 21st century, perhaps as a byproduct of its success.

2. WHO and its Members States (including the United States) lack an effective strategic and tactical intelligence apparatus that is coupled to response decision points. This has been pointed out to them for over two decades now, and the bureaucracy has failed to respond. This article points out examples of Ebola and SARS, however there are quite a few others like HIV/AIDS, the influenza pandemics (including the 2009 H1N1 pandemic), MERS, Zika, and the current antimicrobial resistance disaster. Pursuant to the above point, public health is simply unable to keep up with the complexity of risk presented by these kinds of crises.

3. For those of us involved in the Ebola response, it is convenient to reflect retrospectively on what happened. There remain several key issues that contributed to the perception that public health failed in how this particular crisis was managed. The first is non-ambiguous- there was an intelligence failure associated with this crisis. And it reflected a similar pattern of failure seen with so many other infectious disease crises associated with national security implications. The second (and this is critically important) was the very real concern this virus may have mutated. Prudence suggested a need to slow down the unpredictable flow of returning travelers from this region until this concern could be properly assessed. It is common to see public health disregard these type of concerns and treat the situation as a traditional outbreak involving a traditionally understood pathogen. Another example of this was what happened in Haiti with Nepalese cholera- public health moved forward with the assumption of traditional response to a traditional cholera epidemic versus consideration of a virgin soil epidemic involving an exotic pathogen capable of generating a disaster.

4. It may be strongly argued that public health have themselves to blame for promoting hyperbole. This cannot be ignored: the frequent use of the phrase “pandemic potential” when discussing novel (to human recognition) avian influenza viruses or the arrival of Zika to South America. Subsequent use of visuals on CNN showing half the United States at risk of epidemic transmission of Zika were not considered credible by those of us experienced in assessing arboviral transmission risk. Use of the Ebola forecast models (forecasting over a million cases in West Africa) in Time Magazine subsequently discredited CDC’s threat assessment abilities – a discrediting before the entire world. The comparison of Zika to HIV/AIDS on CNN is another example. The point is, public health itself has allowed itself to lose the ability to have balanced perspective and context when expressing itself to the world’s public.

5. Lastly, it goes without saying that public health may arguably considered “political health”. Public health institutions are funded through political mechanisms and often answer to political leadership. This is in direct conflict with the very mission of public health- to provide unbiased, scientifically sound engagement to protect the public.

In summary, there are several other sides to this discussion that require balanced consideration when discussing the existential issue of whether public health is functioning in a relevant manner in this world… And what we do about it moving forward.

James M Wilson V, MD FAAP
Director, Nevada Medical Intelligence Center
University of Nevada-Reno

2- Why our article, is not available in pubmed and google scholar?

Please dissolve these problems, emergency

Best Regard

CO detectors/alarms (similar to commercially available smoke detectors) have been a tremendous advancement in the early detection of CO and the prevention of CO toxicity. The authors fully endorse the use of CO detectors (all the time, including in conditions of disasters). In addition, nearly all currently available CO detectors have a battery backup for use in temporary electrical service interruptions. In this particular manuscript we chose to focus on the intervention as described above. This is no way meant to be in place of CO detectors, but rather as an additional prevention effort.

Why It Is Not Possible To Get Prepared For Disasters in Turkey

Year after year Turkey experiences many natural disasters. Unfortunately, instead of decreasing with experience, causalties are increasing. The same mistakes are made over and over again( Such as hospitals and schools collapsing first in earthquakes, such as obstinately constructing houses in river beds, such as chaos following even minor disasters etc). Why don’t we take any lessons from disasters?

1. Most of the citizens are uneducated, and poor. They do not care much about future disasters becouse they have to live day to day. They have immediate worries and problems. Every day the people are continuously faced with minor disasters such as hunger, accidents, infectious diseases, street violance. An earthquake that might strike within 10-20 years does not carry much weight.
2. The uneducated and poor people do not have resources ( material, psychological, time, strength ) to make any preparations such as buying safe but more expensive houses, retrofitting dangerous houses, making a family disaster plan or making unstructural mitigation at home.
3. Moreover, poor people do not value their lives so dearly. Life and death are common and interwoven in daily life. Raising a family is difficult They might have to trade off poor quality but cheap housing to safe but a little more expensive housing. In cities they mostly live in unplanned, unhealthy slum areas or in adobe and stone houses in rural areas that collapse even after a heavy rain. 4. A feeling of helplessness grows in people in face of uncontrollable forces of nature, especially in societies technically insufficient.. Moreover, it is not psychologically feasible to live in constant fear and stress. To be able to cope with life and retain sanity under such conditions, denial and forgetfulness are commonly utilized mechanisms.
5. Wild and unleashed capitalism which is practised in the country does not care much about disaster preparation. On the contrary, building bad houses in alluvionus ground or in floodplains and then rebuilding them after disasters is more profitable. Therefore neither the private sector nor the government is much enthusiastic about reducing.disaster risks
6 The political leaders that the poor and uneducated elect are not the ones that represent the people but those that represent the rich and powerful. Therefore government ministers and mayors of towns do not care to make any public preparations in cities as well ( Such as retrofitting bridges, museums and historical sites, educating and training citizens, building durable infrastructure, making emergency plans etc.). The public resources are spent to benefit the favored and the already rich.The administrators also close their eyes to contractors that choose improper building sites, build unsafe houses, to factories and workshops which do not take any measures to protect their workers. Similarly, no one is tried and punished for corruption or mismanagement even when thousands unnecessarily die after disasters, or when workers die of silly accidents or easily preventable causes at workplaces.
7. The government has privatised every common public utility from harbors to communication, from health to education. Even supervision activities are private. For example construction of private and public buildings are supervised by private companies and they are paid for their services by the contractor. Big construction companies have set up their own supervision companies to supervise their own constructions. Many of these buildings collapse without an earthquake. Everything in the country is organised on the basis of profit.
8. On top of all these there is a culture of negligence in individuals which is a byproduct of years of alieniation, exploitation, belief of fate, of experiencing many disasters.
It is apparent that the economic system, capitalism , which breeds exploitation and greed is the main factor behind the ignorance of disaster risks. Therefore, the only correct and effective thing to do is to replace this system and its extension imperialism by a system which assures power sharing, equal distribution of resources, respect to human rights and to all living things and peace, within and among nations, achieving a universal well-being. Any intervention less than that will sooner or later end up with disappoinment, as frequently experienced. Those in power will find a way to modify it to serve their own interest.