『国立保健医療科学』 第68巻 第3号、P240-P249 (2019年8月)
特集：公衆衛生と臨床研究へのCDISC 標準導入―疾患横断分析が可能な医療情報の二次利用性の確保へ ＜論壇＞
米国危機管理の変化から我が国に期す改革を考える
加藤聡一郎1,2），山口芳裕2)
1）Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
2）杏林大学医学部救急医学
抄録
日本の健康危機管理領域は，その地政学的宿命から地震や台風の被害を想定した計画が優先して整備されてきた．しかし現代の健康危機管理は，より幅広い事象，ときに複合して発生する危機に対して，災害弱者を含む多種多様な対象を守ることへと拡大している．高次元の情報共有と国内外の連携に基づく高度に体系的な計画が求められるなか，近年のテロ多発や感染症流行を背景に欧米諸国では様々な改革が行われてきた．なかでも関連法令の制定・修正は各国各組織の体制を大きく変えうるものであり，その委細と結果に学ぶ意義は大きい．本稿では，米国における改革の中心を担ったPandemic and All-hazards Preparedness Act (PAHPA)，その再授権法，及びこれらの成果や関連した取組みを記した文献から，健康危機管理の変化と現状，課題について考察した．PAHPAによって米国の健康安全保障に医療と公衆衛生の主導的介入が定められ，その概念や体制は整備・再編された．また，優先課題の設定や評価，課題解決に向けた効率化，サージキャパシティの確保など，細かい項目に対して明確な目標が設定された．PAHPAで扱われた組織間連携，IT活用，目標設定や予算振り分けといった点は本邦においても重要な課題であり，オールハザードを対象とした基本法令は健康危機管理の機能強化を推進し得ると考えられた．
キーワード：健康危機，オールハザード，健康安全保障，IT，クラスターアプローチ
Abstract
Japan has developed specialized procedures for responding to earthquakes and typhoons prior to other events because of its geopolitical status. However, public health emergency preparedness targets have exponentially widened to include various objectives, including management of vulnerable persons, under several types of disaster events, which occasionally occur in combination. Recently, the United States of America (USA) and several European countries have reformed their emergency preparedness to confront the situation of terrorism and health pandemics. These efforts are expected to develop to systematic
plans based on high-level information sharing and inter- and intra-national cooperation. Establishment and amendment of applicable laws have had huge effects on the framework in each country. Therefore, in this article, we review the Pandemic and All-Hazards Preparedness Act (PAHPA), its reauthorization act, and articles reporting related procedures in USA. PAHPA mandated the Department of Health and Human Services in the USA to assume a leading role to strengthen public health emergency preparedness and reform the nationʼs overall health security strategy. The act explicitly describes setting priorities, efficiently solving problems, ensuring surge capacity needs are met, among other activities. These reforms out of the USA suggest that laws related to an all-hazards approach could effectively guide public health emergency preparedness by enhancing cooperation, developing information technology utilization, setting targets, and distributing emergency preparedness budgets.
keywords: Public health emergency, All-hazards, Health security, Information technology (IT), cluster approach
(accepted for publication, 19th June 2019)