A call for more research and planning to deal with the public health challenges of mega-events

We live in the era of mass gatherings – and it’s not only the Olympics crowds that bring this to mind.

More than 5 million people are thought to have recently attended the 2012 UEFA European Football Championships, held across Poland and the Ukraine.

In October, about 3 million people from 183 countries are expected to gather in the city of Mecca, Saudi Arabia, for the annual Hajj pilgrimage.

The size of these crowds pales by comparison with a forthcoming event in India, the 2013 Kumbh Mela, which is predicted to attract around 70 million Hindu pilgrims to the city of Allahabad next January/February.

How well equipped are global and local public health planners to deal with such events?

These and related issues are explored further in the latest “must read” article recommended below by the JournalWatch service of The Public Health Advocacy Institute WA.

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 Mass gatherings and global health security

Dr Melissa Stoneham writes:

With an estimated 8,000 athletes and millions of visitors from all over the world having gathered in London for the 2012 Olympic Games, it is timely to highlight August’s “must read” journal article, titled “Mass gatherings medicine and global health security”, and published recently in The Lancet by Abdullah Al Rabeeah and colleagues.

Mass gatherings present special challenges for public health that need to be prepared for and managed.

With unusual population increases, high crowd density, international visitors, temporary catering and accommodation facilities, the health risks at mass gatherings are diverse, and include infectious disease outbreaks, non-communicable diseases, injuries, environmental effects (such as stampedes and heat-related illnesses), trauma and terrorist attacks.

However, Rabeeah identifies that there is no existing global consensus or evidence base regarding the most effective public health measures that are required to be in place within the host country.

The authors suggest this lack of policy increases the risks for such events including the introduction, transmission, and amplification of infectious diseases and other injuries.

The article recognises that mass gatherings present major opportunities to obtain consensus for developing optimum recommendations for global health security.

Australia’s recent performance in the area of mass gatherings and public health is good, with few major outbreaks of food poisoning or communicable disease at events.

Even at the 2000 Sydney Olympics, officials advised there were only around 5% more presentations to Sydney emergency departments than in comparable periods in other years.

Australia has however, experienced a number of incidents at music festivals with two examples appearing below.

During the 2001 Big Day Out festival in Sydney, a young girl was crushed in a mosh pit during a performance by the band Limp Bizkit. She was revived and rushed to hospital, but died of a heart attack five days later.

More recently at the Soundwaves Festival 2011 held in Sydney, which featured big-name international acts such as Iron Maiden and Slash, an RTA report revealed traffic control was so poor at the event, pedestrians were forced to walk down M4 off-ramps.

So how did London prepare for mass gatherings expected at the 2012 games?

The UK’s Health Protection Agency advised they put in place a world-class system to monitor and respond rapidly to any outbreaks of infectious diseases or environmental hazards.

These included laboratory tests to detect gastrointestinal illnesses within 24 hours rather than several days, enhanced syndromic surveillance to include services more likely to be used by international visitors, including emergency departments, walk-in-centres and out-of-hours GP services, and a new system in intensive care units and high dependency units in several UK hospitals to detect potentially new and emerging infections2.

However globally, the topic of public health and mass gatherings remains a concern.

A meeting of some of the world’s leading experts in the health and medical issues around global mass gatherings and major sporting events was held at the London School of Hygiene & Tropical Medicine (LSHTM) in May, to explore relevant issues and engage in a public panel discussion.

With the number of public events in Australia and many other countries increasing, it may very well be time for the global consensus on the most effective public health measures for mass gatherings to be developed, as advocated by Rabeeah and colleagues.

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About JournalWatch

The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.

The Journals reviewed include:

• Australian & New Zealand Journal of Public Health (ANZJPH)
• Journal of Public Health Policy (JPHP)
• Health Promotion Journal of Australia (HPJA)
• Medical Journal of Australia (MJA)
• Lancet
• Environmental Health Perspectives (EHP)
• Tobacco Control (TC)
• American Journal of Public Health (AMJPH)
• Health Promotion International (HPI)
• American Journal of Preventive Medicine (AJPM)

These reviews are then emailed to all JournalWatch subscribers and are placed on the PHAIWA website. To subscribe to Journal Watch go to http://www.phaiwa.org.au/index.php/other-projects-mainmenu-146/journalwatch

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PHAIWA is an independent public health voice based within Curtin University, with a range of funding partners. The Institute aims to raise the public profile and understanding of public health, develop local networks and create a statewide umbrella organisation capable of influencing public health policy and political agendas. Visit our website at www.phaiwa.org.au

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