Ruger Jennifer Prah
Associate Professor at Yale University Schools of Medicine, Public Health and Law (Adjunct) and Graduate School of Arts and Sciences.
Glob Health Gov. 2010 Spring;3(2):1-20. Epub 2010 Apr 1.
The threat of global infectious agents has the potential to cripple national and global economies, as the outbreaks of SARS, Avian Flu, H1N1, and XDR-TB have demonstrated. This article offers a Root Cause Analysis (RCA) of one public health case study - the Speaker case of XDR-TB - pinpointing the underlying causal relationships associated with this global health incident and proposing recommendations for preventing its recurrence. An RCA approach identifies corrective actions directed at the root causes of the problem and advances them as necessary to eliminate global contagion with its major international public health risks. To my knowledge, this is the first root cause analysis of a global health problem. The reform this article proposes would be to add a standardized procedure akin to the informed consent process in clinical ethics, but within a shared health governance framework. This approach, addressing infectious agents at their origins or source, is potentially a more effective strategy to reduce uncertainty and avert global health threats.
正如非典、禽流感、甲型H1N1流感和广泛耐药结核病的爆发所表明的那样，全球传染病原体的威胁有可能使国家和全球经济陷入瘫痪。本文对一个公共卫生案例研究——广泛耐药结核病的议长案例进行了根本原因分析（RCA），找出了与这一全球卫生事件相关的潜在因果关系，并提出了预防其再次发生的建议。根本原因分析方法确定针对问题根源的纠正措施，并在必要时推进这些措施，以消除具有重大国际公共卫生风险的全球传染病。据我所知，这是对一个全球卫生问题的首次根本原因分析。本文提出的改革措施是在共享卫生治理框架内增加一个类似于临床伦理中知情同意程序的标准化程序。这种在传染病原体起源或源头解决问题的方法，可能是一种更有效的策略，以减少不确定性并避免全球卫生威胁。
