The 7th Meeting of SEAPHEIN

“Challenges in Public Health and Expanded Role of Public Health Professionals”

Dr Samlee Plianbangchang
Regional Director, WHO South-East Asia

10–12 October 2013, Colombo, Sri Lanka

Prof. Sarath Amunugama, Honorable Vice Chancellor of University of Kelaniya, Sri Lanka; Dr Phitaya Charupoonphol, President SEAPHEIN, and Dean, Mahidol University, Faculty of Public Health; Prof Rajitha Wickremasinghe, President-Elect of SEAPHEIN and Professor of Public Health, Medical Faculty, University of Kelaniya, Sri Lanka; Dr. Firdosi Mehta, WHO Representative to Sri Lanka; Distinguished Public Health Professional Colleagues; Honourable guests; Ladies and gentlemen:

At the outset, I thank the President of the South-East Asia Public Health Education Institutions Network for inviting me to deliver the keynote address at this august assembly. I will try to restrict myself to the context of the theme, but I have a little dilemma about the theme. The theme in the programme is mentioned as “Leadership Role of SEAPHEIN in Strengthening Public Health Education for the 21st Century” and in the invitation, it is indicated as “Challenges in Public Health and Expanded Role of Public Health Professionals”. Anyway, I will try to cover both the themes.

Ladies and gentlemen;

Nowadays, there is indeed a multitude of public health challenges – challenges that are multifactorial, stemming primarily from environmental and ecological changes. The factors underlying public health challenges are determined by several domains – domains that are not only physical, but also biological, social, cultural, economic and political.

Colleagues;

Advancement in public health and medical sciences underlie an important public health challenge. This advancement contributes significantly to longevity of life, which, however, may be accompanied by morbidity and disability in varying degrees.

As a consequence, we are having more elderly with chronic noncommunicable diseases – elderly who need long term or even lifelong care and treatment. This is a result of demographic and epidemiologic changes, changes that contribute to the overload of national health care systems. Medical facilities, in particular, are overloaded. For the care and treatment of the elderly, more facilities including medicines and medical devices are required. These requirements for medical interventions of chronic noncommunicable diseases in the elderly populations contribute significantly to the increasing health care cost. Furthermore, with inadequate emphasis on health promotion or disease prevention by national health care systems, people in general will get sick more often and more severely and come to health care facilities for treatment. This is really a big contributor to the increasing trend of health care cost.

Another important point in this connection is that the elderly populations, if not properly managed, will become socially and economically dependent on others. Therefore, we, the public health professionals, should try to ensure that our elderly populations are healthy, so that they are not so dependent and instead, they are still socially and economically independent and productive.

Colleagues;

Primary health care-based public health programmes can help reduce the load of medical facilities through intensifying actions on health promotion and health protection of general population. PHC-based public health interventions can play an important role in contributing to the containment of increasing health care cost – cost that is of critical concern of all governments today, in both developing and developed countries. Public health professionals indeed have an important role to play in the containment of such a cost.

Public health programmes can ultimately help in reducing the social and economic dependency of elderly populations on the government welfare systems. PHC-based public health programmes, through primary prevention, can help reduce or prevent general morbidity and disability in the population of all age groups and the programmes can help make early interventions possible during the period of secondary prevention.

On another issue – environmental degradation and ecological imbalance – that are due mainly to development activities, especially the in economic sector, it has been proven that these phenomena indeed contribute to the prevailing emerging infectious diseases through the wide and uncontrolled use of chemicals. During the past four decades, more than 40 new pathogens have been discovered.

Among others, we are now facing daunting epidemics of influenza, such as: novel coronavirus in the Middle East; and H7N9 influenza in China. We also call it another bird flu. H5N1, bird flu that we already got used to is still endemic in the South-East Asia Region for a decade. H1N1, swine flu, that caused a “pandemic” in 2009, is now in the group of seasonal flu. Swine flu is still causing outbreaks sporadically here and there worldwide, but with only mild consequence and the outbreaks are only within limited areas. Emerging infectious diseases will become important public health threats more and more in future. We have to be better prepared for it.

Population migration that links to poverty brings about, among other things, international spread of infectious diseases, such as malaria, TB, and HIV/STI and so on. Health of migrants or in a broad context – migration and health – is another challenge in public health today. The issue is difficult to tackle due to its multisectoral complexity.

And yet, we have to be better prepared to face the adverse health impact of climate change. Strong public health interventions through robust health systems are needed for mitigation of such impact. Climate change accentuates natural disasters in both frequency and magnitude. We have heavier rain, severe floods, and devastating hurricane and cyclones. Air temperature is unpredictable worldwide; extremely hot, and extremely cold.

The average world temperature is rising. Certain vector-borne diseases, including malaria and dengue fever, can affect the areas of higher altitude, especially in mountainous countries. Snow and glaciers are melting, causing flood first, then drought, in the mountainous areas. Sea-level is rising, due to melting of ice in the poles; low land countries are losing their land areas. All these phenomena impact human health, one way or the other. The poor are worst affected by the impact of climate change, not only in terms of their health, but also in terms of social and economic aspects of their life. It is the duty of public health professionals to ensure robust public health programmes to effectively mitigate the adverse health impacts of climate change.

Colleagues;

We are yet to be more successful in pursuing our ideal in health that is “Health For All”. Health For All is our aspirational goal which needs to be always kept in mind in our endeavours in health development, so that our health development efforts will always be geared towards better health, better quality of life of all people. The social goal of Health For All, as resolved by the Thirtieth World Health Assembly in 1977 calls for the attainment by all people of the level of health that can permit them to lead a socially and economically productive and satisfied life with minimal dependency on others, socially or economically.

The Health For All goal calls for equity and social justice in health for all people. It calls for narrowing or even closing the gap between “haves” and “have-nots” in health. Health is not interpreted only in physical and biological terms, but health is strongly determined by social, economic and political factors. As we all understand, health systems based on primary health care approach is the key to Health For All.

All countries are now embarking on universal health coverage (UHC) as an integral component of their national health care systems. UHC is to ensure equitable access by all people to quality health care in a comprehensive and well balanced manner, the balance between promotive, preventive, curative and rehabilitative care. Also, UHC calls for equitable access to essential medicines and essential medical devices.

UHC is considered to be an important prerequisite for the attainment of Health For All if it is developed and implemented as an integral part of national health systems based on primary health care approach. To be successful, interventions in UHC must also be public health-based, implemented through multisectoral and multidisciplinary approaches emphasizing actions at community and grass-roots levels. UHC through public health interventions must recognize the critical importance of community-based health workforce as the key to success.

Community-based health workers (CBHW) are the vanguards of community health work. CBHWs contribute very significantly to reaching the hard-to-reach or the unreached. They help in narrowing the gap between “haves” and “have-nots” in health. These workers are in the forefront as change agents, who educate and empower people in the community to be able to take effective care of their own health and the health of their communities.

Development and production of community health workers (CHWs) is indeed cost-efficient and cost-effective. CHWs are particularly dedicated and committed to serving people in rural and remote areas. They are not migrating from their areas of work or from their own countries. However, it should be kept in mind that CHWs cannot work without back-up support from public health professionals and public health specialists.

In the strict sense, a CHW is a part of the public health workforce who is working particularly in the community, at the peripheral and grass-roots levels. To be effective, community health work needs functional referral systems to which people in the community can be referred to benefit from specialized services in medical institutions, where medical specialists are working. The public health professionals can contribute productively to the achievement of UHC and to the attainment of Health For All goal.

Ladies and gentlemen;

Because health has gone much farther beyond the health sector, public health professionals need to go out and work with other sectors, in diverse disciplines. Public health work should be an integral component of all development policies and programmes in all sectors whose development activities have a bearing on health.

This is the connotation of “Health in All Policies”, whereby all development sectors must have awareness of, and be concerned with the impact of their development work on the health of the people. They must have effective measures to protect people’s health from such impact and such measures must be built into their sectoral development programmes.

Other sectors need expert advice and guidance from public health professionals. The staff of other sectors need training in health from public health institutions. Public health institutions provide education and training services not only to the staff of the health sector, but also to the staff of other sectors on matters relating to health.

These are some of the public health challenges that we are facing today. To work successfully amidst these challenges, the role of public health professionals must be expanded. Public health professionals have to work efficiently and effectively in the multidisciplinary and multisectoral environment whereby communication, coordination, management and planning capability are their important assets. Since health is very much multisectoral, Politics and health cannot be separated from each other – the same as health and foreign policies, which have existed side by side for decades.

Even more so, when we move towards the Post-2015 development agenda whereby health will become more central to sustainable development at any levels. Post-2015 or post-MDG development agenda is being debated at the United Nations General Assembly. Hopefully, there would be another political declaration for global action on this agenda. The central concern of this development agenda will be Poverty Eradication before any other development strategies can be effectively implemented.

Public health professionals should always be multisectorally-minded and able to work effectively in the multistake holders and multiple partners milieu. To be effective, public health professionals should be politically and diplomatically proficient, without being politicians or diplomats, since at times, they have to play their professional role on the political and diplomatic platform. Public health professionals will have the principal responsibility of advocating and striving for the rightful place of public health in the post-2015 development agenda. This indeed needs political and diplomatic skills.

As far as national health development is concerned, I strongly encourage organizations such as SEAPHEIN to join hands with all the like-minded people and to convince all others in furthering the cause of public health at all levels of health development in countries by promoting, protecting and maintaining the health of all peoples. This is in order to ensure that our countries can really achieve healthier populations – populations that are the prerequisite for national progress towards wealth and prosperity.

With the prevailing situations that ignite the expansion of our role as public health professionals, it is an opportune time for our public health education and training to be reviewed to ensure that our curricula and programmes can effectively meet the expectations of people in light of the current public health challenges.

SEAPHEIN has an important role to play in strengthening public health education, i.e, to revisit public health education and training programmes and reorient them in light of the current global health challenges and in light of the expanded role of public health professionals. There is a need to follow up on teaching of public health in medical schools at undergraduate level.

Following up on the regional meeting on teaching of public health in medical schools at undergraduate level in December 2009, another meeting is planned during December 2013 in Bangkok to review progress made in this area, which is expected to result in the development of an orientation package for teachers in public health in medical schools. The WHO Collaborating Centre on Medical Education at Chulalongkorn University in Thailand will be closely involved with the organization of this follow-up meeting. It is important to promote better understanding of public health work between medical and public health communities and to promote their closer collaboration and cooperation.

SEAPHEIN needs to continue advocacy of the important role of public health in ensuring health of the populations that contributes in a big way to human capital, to effectively drive the national development machinery towards social and economic progress.

With these words, I wish you, all success and all the best in your noble career in public health. For now, I wish you all a successful meeting.

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