Indian Journal of Community Medicine

VIEW POINT
Year
: 2019  |  Volume : 44  |  Issue : 3  |  Page : 188--192

Strengthening public health partnerships in India: Envisioning the role of law enforcement during public health emergencies


Rachit Sharma1, Md Mahbub Hossain2,  
1 The INCLEN Trust International, New Delhi, India
2 Department of Health Promotion and Community Health Sciences, Texas A and M School of Public Health, Texas, USA

Correspondence Address:
Dr. Rachit Sharma
F-1/5, 2nd Floor, Okhla Industrial Area Phase-1, New Delhi - 110 020
India

Abstract

Unique challenges posed by complex public health emergencies have often called for institutions, responsible for restoring health, well-being, and order among affected populations, to realign their operating procedures and work in concordance with each other. To ensure optimal health, the growth of the individuals and societies, and development in a greater sense, it is essential to understand the scope of collaboration between law enforcement agencies and public health institutions during emergencies and their aftermath. To foster such partnerships, policy-level advocacy to overcome challenges posed by existing policies and legislation that limit the autonomy of the law enforcement and public health institutions for making informed decisions would be necessary. Human resources working at different levels should be sensitized about the nature and significance of the kind of collaboration, and they should be allowed to express and clarify their doubts about the same. Evidence-based standard operating procedures should be developed for different cadres of professionals, keeping harmony with the operational diversities. Critical issues such as financing the ventures, coordinating and implementing the protocols and projects, following up the cases and suspects, and examining every scenario using evidence-based scientific and legal methodologies would be crucial for the success of such collaborations.



How to cite this article:
Sharma R, Hossain MM. Strengthening public health partnerships in India: Envisioning the role of law enforcement during public health emergencies.Indian J Community Med 2019;44:188-192


How to cite this URL:
Sharma R, Hossain MM. Strengthening public health partnerships in India: Envisioning the role of law enforcement during public health emergencies. Indian J Community Med [serial online] 2019 [cited 2019 Oct 17 ];44:188-192
Available from: http://www.ijcm.org.in/text.asp?2019/44/3/188/267339


Full Text



 Introduction



There is an old saying-“public health is public wealth” which emerged prominently in European countries during the mid-16th century when most of the nations started to compete with each other to protect their economies in varying market conditions.[1] The rise of new nations across the globe and new classes with the societies gave validation to the discourse of how the collective wealth of health and well-being can be protected at community and state level. In many countries, numerous treaties were adopted to specify the intention of the states to protect the citizens.[2] These treaties were based on different aspects of socioeconomic events such as birth and death, production of food and other consumables, living conditions, the health of special population groups, environmental hazards like flood and drought, man-made crises like war and famine, and so on.[1],[2] With evolving specialization of the working classes and administrative wings, “modern policing” emerged with a conception of protecting lawful rights of the citizens and fostering justice in unwanted situations.[3]

In contrast, “public health” was conceptualized as a domain consisting of experts from different professionals working together to investigate the determinants of health status and diseases with an approach to utilize the same to make desired changes in the health status of the target population.[3] Eminent scholars such as Johann Peter Frank, George Rosen, Auget de Montyon, and Michel Foucault discussed an overlapping field between law enforcement agencies and medical professionals.[1] They named a discipline as “medical police” dedicated to resolving the issues emaciated in the social aspects of health and well-being.[1],[2],[3] In many countries including the United Kingdom, Portugal, France, and Spain, a lot of treatises and institutional efforts have been made to advance medical policing to protect lives and prevent adverse scenario within the sociopolitical paradigms.[1] However, with changing economic determinants within the nations, the idea of medical police did not flourish and sustain in policies and practices, but the essence of a collaborative approach to improving the lives on the citizens was not lost entirely.

In critical situations like natural disasters or violence at individual and community level, law enforcement agencies and public health authorities have been sharing their resources and expertise to work together. This collaboration has benefited both of the institutions and the nations as a whole. Despite limited evidence of such efforts in low- and middle-income countries like India, increasing burden of population health problems and high rate of criminal activities are often reported, which collectively affect the well-being of the population and productivity of the same. To ensure optimal health, the growth of the individuals and nation, and development in a greater sense, it is essential to understand the scope of collaboration between law enforcement agencies and public health institutions during emergencies and their aftermath.

 Public Health Emergencies in India



A public health emergency 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.”[4] From the national perspective, numerous hazards have the potential to cause the declaration of a public health emergency, including chemical emergencies (e.g., nerve agents), radiation emergencies (e.g., nuclear leaks and explosions), bioterrorism (e.g., anthrax), natural disasters (e.g., hurricanes, floods, earthquakes, and tsunamis), infectious disease outbreaks and pandemics (e.g., severe acute respiratory syndrome or H1N1 swine flu), and mass casualties resulting from terrorist attacks.[5]

The magnitude, determinants, and impacts of these public health emergencies vary from place to place and time to time. Earlier in India, several incidences of the outbreak of diseases [Table 1] have drawn the attention of national and global institutions which can be used as examples to illustrate the severity of such emergencies in this context. These episodes of public health emergencies necessitate immediate medical support; however, the public health professionals would also adopt additional approaches to identify the sources, mechanisms, and modes of transmission of the outbreak and devise appropriate strategies to stop the outbreak and prevent future incidences. Even if the fatality due to some natural disasters might be comparatively lower, the quality of living of those affected is often compromised to a large extent; which eventually leads to poor health outcomes. Being a geographically diverse country, India has experienced numerous natural disasters in the past. A list of notable natural disasters in India is presented in [Table 2]. In addition to these disasters and outbreaks as described earlier, global crises like the outbreak of newer diseases or conditions can affect the population health in India due to population dynamics. Moreover, the entire world is moving toward a digital revolution where patient data and much confidential information can be manipulated, breaching the medical and legal boundaries, which can result in varying problems in coming days.[17]{Table 1}{Table 2}

 The Need for Collaboration



All the aforementioned public health emergencies may result in closure of public gathering places (such as shopping malls, places of worship, and movie theaters), the dismissal of students from local schools, and the overcrowding of medical facilities and other points of distribution of medication and vaccines that may be specially created for the purpose.[18] Moreover, law enforcement agencies will be expected not only to maintain public order but also to assist public health officials in ensuring compliance with state or local public health orders. Law enforcement representatives will have to work with officials from other community agencies as well, to ensure that their pandemic communication plans complement and support each other. All stakeholders should be informed ahead of time about the risks posed by such a pandemic, how to prepare for one, and how law enforcement's role will change as the situation unfolds.[19] Essentially, all these emergencies would require strategies such as community mobilization, isolation of the cases and/or places, maintenance of logistic support, ensuring the security of the materials and other resources, exploring possible foul play behind the outbreak, and so on. In the context of India, law enforcement agencies can play a critical role to accomplish these goals and facilitate the fundamental strategies to be implemented and thereby the well-being of the population to be achieved.[20] Further, it is necessary to compare different aspects of public health and law enforcement agencies to determine future discourse of how these institutions can contribute individually and collectively. A comparative analysis of the same (discussed in greater detail by Bulter et al.[21]) is presented in [Table 3].{Table 3}

This comparison shows differences between public health authorities and law enforcement agencies; however, it also enumerates the strengths of both kind of institutions which can complement each other during emergencies. For instance, a collaborative information system can minimize the time of interagency reporting and serve as a decision support system.[22] Moreover, critically examined pieces of evidence can lead to ensuring justice, and scientific analysis and documentation of the same would add value to improve the knowledge, policy-making, and practices about similar emergencies in the future. Last but not least, collaborative approaches can bring strengths on the same platform; therefore, minimize the weaknesses by sharing the strengths during complex humanitarian emergencies in India.

 The Way Forward



Despite promising evidence in many developed countries, a collaboration between law enforcement agencies and public health authorities can be challenged by existing policies and legislation which might not provide adequate autonomy to the institutions or the officials for making informed decisions.[21] Crises like this should be addressed by advocating at the policy level showing the magnitude of such public health emergencies. Another challenge would be sharing the resources and optimizing the operational aspects of such collaborations. Human resources working at different levels should be sensitized about the nature and significance of that kind of collaboration, and they should be allowed to express and clarify their doubts about the same.[21],[23] Understanding the responsibilities of partnering agencies can foster empathy and cooperation among the team members.

Furthermore, maintaining the quality of services and minimizing delays or errors should be a priority. Therefore, evidence-based standard operating procedures (SOPs) should be developed for different cadres of professionals, keeping harmony with the operational diversities.[24] These SOPs should be designed based on the context-specific data focusing on the preparedness toward the emergencies. Moreover, different kind of emergencies should be evaluated thoroughly to make the SOPs resilient to emerging problems. More importantly, timely monitoring and learning exercises can promote accountability at individual and institutional levels and facilitate future improvisation initiatives. Furthermore, the health of those working together to make lives better requires cautious attention.[21] People from both institutions should understand the medical and legal aspects of an emergency and protect themselves from potential harms. For instance, if we consider a pandemic flu outbreak as a potential scenario, the pandemic will affect how the local law enforcement agencies operate. It is predicted by some experts that the percentage of employees affected in some way during a flu pandemic (e.g., exposed, infected, or unable to work because of responsibilities toward sick family members) will range from 10% to 40%, and as a result, departments will lose staff members.[25] Agencies will need to activate their internal emergency operations' plans, prioritizing and shifting resources to the most critical operations. Calls for service will likely increase dramatically; however, with fewer officers available to work, response time will suffer, and services will be reduced. Problems like this are often ignored which results in mortalities and morbidities that could be prevented with timely interventions.

 Conclusion



Effective and efficient collaboration is the key to optimize the usage of resources as well as competencies and achieve the mutual goals and objectives of law enforcement and public health.[21],[23] Global evidence suggests to strengthen the bonds between two agencies and engage in building the capacities for emergencies before they strike the lives of millions.[1],[21] Critical issues such as financing the ventures, coordinating and implementing the protocols and projects, following up the cases and suspects, and examining every scenario using evidence-based scientific and legal methodologies are crucial for the success of such collaborations.[26] Last but not the least, strong leadership with a shared vision can initiate and sustain such collaborations between law enforcement and public health-yielding greater impacts on population health, through managing public health emergencies in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Mantovani R. What were the medical police? Hist Ciênc Saúde Manguinhos 2017;25:409-27. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-59702018000200409&lng=pt&tlng=pt. [Last accessed on 2019 Mar 14].
2Carroll PE. Medical police and the history of public health. Med Hist 2002;46:461-94.
3King LS. From medical police to social medicine: Essays on the history of health care. J Am Med Assoc 1975;231:85. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama. 1975.03240130065038. [Last accessed on 2019 Mar 14].
4Gostin LO, Sapsin JW, Teret SP, Burris S, Mair JS, Hodge JG Jr., et al. The model state emergency health powers act: Planning for and response to bioterrorism and naturally occurring infectious diseases. JAMA 2002;288:622-8.
5Arnold JL. Disaster medicine in the 21st century: Future hazards, vulnerabilities, and risk. Prehosp Disaster Med 2002;17:3-11.
6MoHFW-GoI. Seasonal Influenza (H1N1): Integrated Disease Surveillance Programme (IDSP). MoHFW-GoI; 2019. Available from: http://www.idsp.nic.in/index4.php?lang=1&level=0&linkid=453&lid=3906. [Last accessed on 2019 Mar 14].
7GoK. Nipah Details Kerala; 2019. Available from: http://dhs.kerala.gov.in/docs/transfer/addlph/adph_18062018v.pdf. [Last accessed on 2019 Mar 14].
8NDMA-GoI. Disaster Data and Statistics – National Disaster Management Authority. NDMA-GoI; 2019. https://ndma.gov.in/en/disaster-data-statistics.html. [Last accessed on 2019 Mar 14].
9The Times of India. Hudhud Killed 46 in Andhra Pradesh, 21 Lakh Families Hit. The Times of India; 2014. Available from: https://timesofindia.indiatimes.com/india/Hudhud-killed-46-in-Andhra-Pradesh-21-lakh-families-hit/articleshow/44932425.cms. [Last accessed on 2019 Mar 14].
10Press Trust of India. Jammu and Kashmir 2014 Floods Death Toll: 300 People Died, 25 Injured In J and K Floods Last Year, Says Government. Press Trust of India; 2015. Available from: https://www.india.com/news/india/jammu-and-kashmir-2014-floods-death- toll-300-people-died-25-injured-in-j-k-floods-last-year-says- government-332422/. [Last accessed on 2019 Mar 14].
11The Hindu. Heatwave Deaths High in State. The Hindu; 2018. Available from: https://www.thehindu.com/todays-paper/tp-national/tp-andhrapradesh/heatwave-deaths-high-in-state/article23019525.ece#!. [Last accessed on 2019 Mar 14].
12The Economic Times. Unprecedented Rains, Floods Battered Tamil Nadu in 2015. The Economic Times; 2015. Available from; https://economictimes.indiatimes.com/news/politics-and-nation/unprecedented-rains-floods-battered-tamil-nadu-in-2015/articleshow/50364364.cms. [Last accessed on 2019 Mar 14].
13The Wall Street Journal. Western Indian State Tries to Cope With Record Heat Wave. The Wall Street Journal; 2016. Available from: https://www.wsj.com/articles/western-indian-state-tries- to-cope-with-record-heat-wave-1463846290. [Last accessed on 2019 Mar 14].
14Business Standard. Bihar Flood Situation Improves, Death Toll 514. Business Standard; 2017. Available from: https://www.business-standard.com/article/news-ians/bihar-flood-situation-improves-death-toll-514-117082801273_1.html. [Last accessed on 2019 Mar 14].
15The Indian Express. Kerala Floods: Death toll Rises to 483, Says CM Pinarayi Vijayan 2018. Available from: http://www.newindianexpress.com/states/kerala/2018/aug/30/kerala-floods- death-toll-rises-to-483-says-cm-pinarayi-vijayan- 1864968.html. [Last accessed on 2019 Mar 14].
16The Hindu. Over 100 Killed in Dust Storm in U.P. Rajasthan: The Hindu; 2018. Available from: https://www.thehindu.com/news/national/other-states/over-100-killed-in-dust-storm-in-up-rajasthan/article23763743.ece. [Last accessed on 2019 Mar 14].
17Fernández-Alemán JL, Señor IC, Lozoya PÁ, Toval A. Security and privacy in electronic health records: A systematic literature review. J Biomed Inform 2013;46:541-62.
18Sanberg EL, Mcfadden SM. Law Enforcement Preparedness for Public Health Emergencies: An Executive Summary of the Resources Series Communication and Public Health Emergencies: A Guide for Law Enforcement Benchmarks for Developing a Law Enforcement Pandemic Flu Plan A Guide to Occupational Health and Safety for Law Enforcement Executives; 2010. Available from: http://www.policeforum.org/assets/docs/Free_Online_Documents/Public_Health/lawenforcement preparedness for public health emergencies-anexecutive summaryoftheresourcesseries 2010.pdf. [Last accessed on 2019 Mar 14].
19World Health Organization. Pandemic Influenza Risk Management WHO Guidance. World Health Organization; 2017. Available from: http://www.who.int/influenza/preparedness/pandemic/PIRM_update_052017.pdf. [Last accessed on 2019 Mar 14].
20JHCCP. Social and Behavior Change Communication for Emergency Preparedness Implementation Kit. JHCCP; 2016. Available from: http://www.healthcommcapacity.org. [Last accessed on 2019 Mar 14].
21Butler JC, Cohen ML, Friedman CR, Scripp RM, Watz CG. Collaboration between public health and law enforcement: New paradigms and partnerships for bioterrorism planning and response. Emerg Infect Dis 2002;8:1152-6.
22Khan AS, Fleischauer A, Casani J, Groseclose SL. The next public health revolution: Public health information fusion and social networks. Am J Public Health 2010;100:1237-42.
23Richards EP. Collaboration between public health and law enforcement: The constitutional challenge. Emerg Infect Dis 2002;8:1157-9.
24World Health Organization. Standard Operating Procedures For Coordinating Public Health Event Preparedness and Response in the WHO African Region. World Health Organization; 2014. Available from: http://www.who.int/hac/techguidance/tools/standard_operating_procedures_african_region_en_2014.pdf. [Last accessed on 2019 Mar 14].
25OSHA-US. Guidance on Preparing Workplaces for An Influenza Pandemic. OSHA-US; 2007. Available from: https://www.osha.gov/Publications/influenza_pandemic.html. [Last accessed on 2019 Mar 14].
26Smith CB, Battin MP, Jacobson JA, Francis LP, Botkin JR, Asplund EP, et al. Are there characteristics of infectious diseases that raise special ethical issues? Dev World Bioeth 2004;4:1-6.