December 2018 | Issue 39
Fighting the good fight

EsabelleYam (Custom).jpg By Esabelle Yam, Manager, LKCMedicine Centre for Global Health

From the Age of Exploration in the 15th century — when many new lands were discovered and the beginning of globalisation as we know it came into play — to the modern time, the evolution of public health has been guided by the growth in scientific knowledge, social reform and increasing recognition of the importance of organised efforts to maintain good health and prevent diseases.

The first public health effort in modern medicine could be traced back to the 17th and 18th centuries when isolation and quarantine measures were used to contain contagious diseases. The next century beckoned in the "Great Sanitary Awakening" when filth was associated with low socioeconomic status and disease, and sanitation was gained recognition as a means to keep diseases away. This period marked the transition from sporadic and reactive efforts, to calculated and preventative public health programmes, and more importantly, an expansion of the sphere of responsibility to include the public and citizens in the management of health.

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The 19th century saw another significant milestone in the discovery of agents responsible for contagious diseases such as yellow fever, tuberculosis, malaria and this gave rise to the germ theory of diseases which eventually displaced the miasma theory — the dominating theory that attributes diseases to bad air in the centuries before. The next two centuries constituted the golden age for modern medicine, including the discovery of penicillin, eradication of smallpox, growth of primary healthcare and the establishment of local and international institutions such as the World Health Organization in leading and directing resources in the health sector.

Along with the institutionalisation of healthcare and establishment of international health agencies, the boundaries between countries become increasingly porous with globalisation, increasing ease of travel and connectivity. Terms such as "international health" and "global health" became almost synonymous with public health today. Much debate has been conducted in journal articles and forums about the difference between these terms. Nonetheless, they represent the same principles and agenda to promote good health with an understanding of health as a public good, undertake multidisciplinary approaches for mainly preventative purposes, and focus on population health.

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With the increased use of antimicrobials, especially as a first line of defence, the microbial world has naturally evolved under pressure, which has led to the current Antimicrobial Resistance (AMR) crisis where highly infectious diseases affecting the world recently have been untreatable. In recognition of this crisis, the World Health Organization launched the Global Antimicrobial Resistance Surveillance System on 22 October, 2015 and published the first report the following year.

Asia, in particular South-east Asia has been identified as a hotspot for the AMR crisis, but could also be where contribution to a global solution could arise.

As a young medical school training doctors and conducting research that will redefine medicine and transform healthcare, LKCMedicine recently organised the Antimicrobial Resistance (AMR) in the Asia-Pacific & Its impact on Singapore symposium from 13 to 14 November 2018, to stage a multi-sectoral effort to address the challenges of AMR.

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The event was graced by Guest-of-Honour A/Prof Benjamin Ong, Director of Medical Services, Ministry of Health (MOH), and delivered by a panel of distinguished speakers and panellists from Timor-Leste, Papua New Guinea, Cambodia, Indonesia, Thailand, Myanmar, US and the UK. It was a joint effort by the LKCMedicine Centre for Global Health, National University of Singapore Saw Swee Hock School of Public Health, National Centre for Infectious Diseases, Singapore-MIT Alliance for Research and Technology, DSO National Laboratories, and supported by MOH and Pfizer.

Symposium participants engaged with topics on not only surveillance, but also socioeconomic aspects and innovations in this field. They gained a better understanding of the complexities of AMR and a heightened awareness of the importance of a coordinated global effort. LKCMedicine Professor of Infectious Diseases and Lead for Global Health and Vaccinology Annelies Wilder-Smith, Associate Professor of Human and Microbial Genetics Eric Yap and Associate Professor of Infectious Disease and PhD Programme Lead for Global Health Awareness Attachment Yeo Tsin Wen were recognised for their efforts in the organisation of the symposium, and for their vision in bringing together Singapore and the Asia Pacific to advance the efforts in combating AMR.

It is essential that LKCMedicine students learn about the evolution of public health to gain a deeper understanding of the responsibility of the medical profession to society, the micro and macro forces that shaped and continue to influence the ability to provide good health to the populations and approach health holistically from different angles. Through Overseas Community Involvement Projects (OCIPs) initiated, driven and executed by the students, they gain an appreciation of public health efforts in countries such as Sri Lanka, India, East Timor, Cambodia, Nepal, Philippines and Indonesia. 

LKCMedicine research and faculty members actively participate in these OCIPs and undertake public and global health research that span the health spectrum, from primary healthcare to health-system strengthening, infectious diseases to non-communicable diseases, and molecular epidemiology to population health sciences. These projects are conducted locally and abroad in clinics, hospitals, laboratories and field sites, and involve multidisciplinary teams of clinicians, scientists, epidemiologists, bioinformaticians, clinical trial coordinators, economists, and sociologists.

Many challenges still lie ahead: we are also faced with an ageing population, rising incidence of chronic diseases, increasing budget constraints and growing health inequity. As a medical school emphasising research and education, LKCMedicine has the responsibility and capability to contribute to the betterment of health through initiatives in global health and public health projects through engaging our medical students and research communities in these efforts.  After all, the world is the classroom. 

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