Disastrous events and political failures.

Response to the Ebola crisis (ongoing event) has been less than efficient. It has been monitored less than adequately by the international community and has been coordinated poorly in the USA. The event is used as a platform to examine deficiencies in public health infrastructure, the limits of its political and financial support, and how political outcomes can be affected. The need to tease out the political determinants implicit in policy failure and disaster management is argued in this Editorial. Failures mentioned include in the Balkans and in Greece with ongoing austerity. Comments on the real heroes of Ebola on the ground in Africa and the need for a charismatic role for political leaders in public health are also included.

Relationship of locus of control, psychological distress, and trauma exposure in groups impacted by intense political conflict in Egypt.

INTRODUCTION: Social and political instability have become common situations in many parts of the world. Exposure to different types of traumatic circumstances may differentially affect psychological status. OBJECTIVE: The aim of this study was to compare the relationship between personal perceptions of control over the events happening in one's life and psychological distress in two groups who experienced physical trauma but differed as to whether the trauma was a result of political upheaval and violence. Views on the extent to which the state was interested in the individual were also assessed. METHODS: The sample consisted of 120 patients who were injured in the Cairo epicenter and 120 matched controls from the greater Cairo area whose injuries were from other causes. The Brown Locus of Control Scale and the Symptom Checklist-90-Revised (SCL 90-R) were administered approximately three months after the January 2011 start of the demonstrations and subsequent overthrow of the government. RESULTS: The groups did not differ on locus of control. For both groups, externality was associated with greater distress, suggesting a relationship between perceived helplessness in controlling one's life and distress. The Cairo group scored significantly higher than the control group on the SCL 90-R Global Severity Index (GSI) and Positive Symptom Total (PST). Perceptions of state interest in the population were low; overall, 78% viewed the state as having little or no interest in them. Discussion The relationship between exposure intensity and psychological distress is examined. In addition, differences in findings in populations experiencing political chaos compared with other types of disasters are considered. CONCLUSION: Beliefs regarding personal control over one's life circumstances are more closely associated with psychological distress than the circumstances in which the trauma occurred.

Surveying the ashes: experience from the 2007 Peloponnese wildfires six months after the disaster.

INTRODUCTION: Major disasters disrupt the infrastructure of communities and have lasting psychological, economic, and environmental effects on the affected areas. The psychological status and community effects of the devastating 2007 wildfires on the Peloponnese Peninsula of Greece were assessed six months following the disaster. METHODS: Adult inhabitants, 18-65 years of age, living in villages affected by the wildfires were selected randomly and compared with a demographically similar group living in neighboring villages that were unaffected by the fires. Regions were chosen based on the extent of fire damage in that area. There were 409 participants in the fire group, and 391 in the control group. Participants completed a questionnaire that included the SCL-90-R symptom checklist, a subjective perception of health status, and a series of items assessing views about current problems, personal values, and trust in different institutions. RESULTS: The fire group scored significantly higher on psychological distress compared to the control group. Both groups viewed their health status in the previous year as better than at the present time. There were few significant differences between groups in the designation of regional problems, attitudes, and values. In the total sample, 41.6% listed unemployment, and 15.0% listed poverty as the most important problem in their region. The Church was indicated as the most trusted institution by 36.7% of the group and the Government by 13.3%. A total of 30.2% did not have a trusted institution. CONCLUSIONS: The hardiness and resilience of the fire-impacted group was evident. However, an improvement in economic conditions is needed to maintain the health and enhance the quality of life of the population living in the Peloponnese region. This improvement likely would have a positive effect on the attitude of trust in government institutions.

Contributing to Balkan public health: a school for Skopje.

The absence of social well-being and growing vulnerability are alarming for a large portion of people living in the Balkan countries. The Stability Pact is currently targeting the issue of social cohesion, which holds out promise for as yet unrealized development. Both the World Health Organization and the Council of Europe have called attention to the population vulnerability and growing disparity in health status between that region and Europe. Reversal of present trends demands the support of the international community and the strengthening of all public health institutions, human resource training, and population health research. Given the severity of the problem space of population vulnerability, these actions are more than ever indispensable to the health sector of the region. The paper describes an encouraging dialogue for Balkan health conducted by the National School of Public Health in Athens, Greece over the past decade and emphasizes the work of the newly created Public Health in South Eastern Europe (PH-SEE) Network (www.snz.hr/ph-see), which provides new opportunities for engagement in regional public health through Public Health Schools and Institutes. There is a need for public health curricula development and a closer linkage of all Schools with the Association of Schools of Public Health in the European Region. A curriculum for peace and public health is already under development in institutions in Athens, Greece; Mostar, Bosnia and Herzegovina; and Zagreb, Croatia. Soon to be added to the group of regional institutions is the School of Public Health in Skopje. It is a policy response to considerable need in a country showing pre-conflict conditions in the heart of the South Eastern Europe. Within the general framework of public health development, a School of Public Health in Skopje can be of great national benefit. Suggestions are made for its function under an umbrella of interdisciplinarity and autonomy, and the need to steer a path clear of medical dominance. According to a related mission statement, the School is to be implemented as an academic center of excellence and innovation, with the worthy purpose of improving the health of the population, with particular attention to the disadvantaged, underserved, and vulnerable. It can aid policy enactment, capacity building, and vulnerability research, promote the development of new training curricula for human rights and public health, and contribute to regional public health. The implementation of the School has a symbolism attached to it as a Balkan response for the elimination of the causes for political violence.

Severe Acute Respiratory Syndrome (SARS): loud clang of the Leper's bell.

Severe acute respiratory syndrome (SARS) or the "Chinese Chernobyl" emerged against an alarming background of rising infectious disease in poor rural China and to a backdrop of interregional and global polarization of population well-being and vulnerability. SARS has added its own dissonant note to "health disturbance", caused fear and panic and disrupted international commerce. Its emergence should be perceived as a disturbing alarm that underscores the need to strengthen public health and facilitate construction of a human security "umbrella" in the event of future disasters. Although SARS has produced a relatively insignificant level of damage when compared to other threats, its long-term effects on health should not be underestimated, based on its unexpected appearance and still unknown properties. This essay presents a qualitative flowchart that follows SARS from its origin in China to the accumulation of global damage. Two future scenarios were formulated, covering a worse-case outcome and containment outcome, which currently appears to be the case. In the event of the worst-case scenario it is doubtful whether any health service in Europe could cope. In either case, the development of a European Union Center for Disease Control is mandatory.