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• Public health education integral to structural health system change
  CARLOS SANTOS-BURGOA
  Published on: 9 April 2021

• Published on: 9 April 2021

  Public health education integral to structural health system change

  • CARLOS SANTOS-BURGOA, Professor Milken Institute School of Public Health, George Washington University

  Dear Editor:

  Ghaffar, Rashid, Wanyenze, and Hyder invite to the dialogue and debate on the revision for public health education (PHE) as a topic of global importance. They do it from a diverse perspective including the developed and developing economies, and the challenges of practice.
  I want to contribute based on the lessons learned from my experience during a previous pandemic, and my concern on the lack of full realization of the potential of public health methods and knowledge to manage this current crisis.

  Since the Influenza A(H1N1) 2009 pandemic, we realized that its management called for work with the economic, educational, agriculture and nutrition, labor, housing, transportation, tourism, and it can be achieved only with established platforms for this collaboration (1). The epidemic demanded for a differentiated care of the poor and those with cultural barriers, the pregnant, of those living with obesity or chronic co-morbidities. That it required massive behavioral change – only possible though effective health promotion functions -, and the assurance of safe settings, medical care (2), and products. That the local action had global implications. It was clear since then the central role of well-organized local public health service delivery, the place for effectively containing the spread. And we saw the importance to constrain the politicizing of the epidemic, by having rigorous, rapid, and fearless exercise of the public health authority....

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  Dear Editor:

  Ghaffar, Rashid, Wanyenze, and Hyder invite to the dialogue and debate on the revision for public health education (PHE) as a topic of global importance. They do it from a diverse perspective including the developed and developing economies, and the challenges of practice.
  I want to contribute based on the lessons learned from my experience during a previous pandemic, and my concern on the lack of full realization of the potential of public health methods and knowledge to manage this current crisis.

  Since the Influenza A(H1N1) 2009 pandemic, we realized that its management called for work with the economic, educational, agriculture and nutrition, labor, housing, transportation, tourism, and it can be achieved only with established platforms for this collaboration (1). The epidemic demanded for a differentiated care of the poor and those with cultural barriers, the pregnant, of those living with obesity or chronic co-morbidities. That it required massive behavioral change – only possible though effective health promotion functions -, and the assurance of safe settings, medical care (2), and products. That the local action had global implications. It was clear since then the central role of well-organized local public health service delivery, the place for effectively containing the spread. And we saw the importance to constrain the politicizing of the epidemic, by having rigorous, rapid, and fearless exercise of the public health authority.

  Still, these elements did not remain embedded in the health systems (3): for the COVID-19 pandemic, we had to go through the process again. That was not reflected in the International Health Regulations (4) and their very limited biomedical scope, the exercise of health authority (5), nor from the accreditation of essential public health services. The PHE graduate programs did not incorporate it either. And we can count the cost of that in the millions of lives lost from COVID-19, avoidable non-COVID mortality, long-term COVID-19 disease burden, and trillions of dollars in human capital lost, besides the Gross World Product lost.

  We must frame investment in PHE within a virtuous cycle in the institutional capacity building, integrated with the research enterprise in schools of public health, that assemble practitioners to systematize the lessons learnt from public health practice and make curriculum pertinent. And with the trained workforce, to make structural durable changes in the health system.

  With these elements I would like not only to support the “four areas for consideration by schools of public health for the development”, but to propose other four. The first one is Health Regulation for Health Protection (6) at the local, subnational, national, and global levels; the approval and registration of vaccines and medical treatments is the most visible, but also relates to safe disinfectants, meeting paces, workplaces, etc. a function that has failed globally. The second area is Public Health in Social Structures, its integration outside the health system, tackling the social and commercial determinants of health, getting public and private actors the capacity to be agents for health, advancing towards the redefinition of the scope of action of health authorities, and defining the roles of public health practice in other sectors. The third area is Crisis Management. Public health professionals should be readied to address difficult times urgent delivery of services, decision making under pressure, as medical professionals are to care for patients at emergency rooms. They should be able to talk to its audience and to listen to them, be capable communicators, and able to gather the societal resources to deal with the common problem, to plan and advocate for it. And the fourth is Public Health Law, as the way to structure the organized social response, protect human rights, and support a rigorous exercise of the health authority.

  The strategy should be a transformation on the perspective of the role of public health in society, and how we see the future role of our graduates in leading a response realizing the potential of public health. The opportunity is there for LMICs countries, but the whole world claims for it.

  References.
  1. PAHO/Ministry of Health of Mexico. Influenza A(H1N1): Health Promotion Actions, sharing our experience. Publication. México, 2009 https://www.paho.org/mex/index.php?option=com_docman&view=download&alias...

  2. Rubinson, L., Mutter, R., Viboud, C., Hupert, N., Uyeki, T., Creanga, A., Finelli, L., Iwashyna, T. J., Carr, B., Merchant, R., Katikineni, D., Vaughn, F., Clancy, C., & Lurie, N. (2013). Impact of the fall 2009 influenza A(H1N1)pdm09 pandemic on US hospitals. Medical care, 51(3), 259–265. https://doi.org/10.1097/MLR.0b013e31827da8ea

  3. Cascini F, Hoxhaj I, Zaçe D, Ferranti M, Di Pietro ML, Boccia S, Ricciardi W. How health systems approached respiratory viral pandemics over time: a systematic review. BMJ Glob Health. 2020 Dec;5(12):e003677. doi: 10.1136/bmjgh-2020-003677.
  4. Cameron EE, Nuzzo JB, Bell JA. Global Health Security Index. Building Collective Action and Accountability October 2019. Johns Hopkins Health Security Center/Nuclear Threat Initiative. https://www.ghsindex.org/wp-content/uploads/2020/04/2019-Global-Health-S...

  5. KPMG. Government and institution measures in response to COVID-19Update 49. Downloaded April 1, 2021. https://home.kpmg/xx/en/home/insights/2020/04/government-response-global...

  6. National Academies of Sciences, Engineering, and Medicine 2020. Stronger Food and Drug Regulatory Systems Abroad. Washington, DC: The National Academies Press. https://doi.org/10.17226/25651

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  Conflict of Interest:
  None declared.

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