The Future of Public Health

We now come to the conclusion of this introductory course on global health. Global public health has now a very large mandate in the context of sustainable development. It has grown from the foundations of public health, which itself is not relatively new. Even prior to the 20th Century, public health was deemed to be very important. Many of the important investments in public health, whether in the form of water, sanitation, or healthy nutrition, came about in the centuries preceding what we call as modernity. However in the 20th Century, marked advances in science and technology enabled us not only to understand the links between health and disease much better in terms of what causes disease and how best to protect it, but also to organize health systems around dealing with disease and promoting health. When we look at how the scientific knowledge has helped, we must also recognize that to some extent it started fragmenting our approach to public health. Epidemiology has been a remarkable science which advanced the understanding of the factors that cause disease, whether it is an infectious agent or smoking. However it is in the very nature of epidemiology that we start looking for independent associations which can be attributed to that particular risk factor over and above anything else. And therefore, necessarily we start becoming reductionist in our approach. But we also need to position that reductionist knowledge in a much more holistic context and that is where public health comes in. We have previously separated out different knowledge and practice domains like epidemiology, health economics, behavioral sciences and also to some extent management principles. But now we need to integrate all of them into the discipline of public health and to some extent we have succeeded in doing that in the 21st Century. But we now need to position it in the context of global public health, because global public health has now become a common concern for all of humanity whereas public  health previously did look at what was happening in different parts of the world but confined its actions mostly to national or regional contexts. But when we recognize that the determinants of health now act across geographical boundaries and cause common challenges that have to be faced by the world as a whole, then global public health becomes a very necessary unifying platform and here we need to integrate all of our knowledge in order to address these challenges. So while epidemiology for example provided a very necessary insight into what caused disease, public health provided a better perspective on how a complex system should be addressed, so from linear thinking to complex thinking, a complex system approach, we started having a transition. But global public health now brings in much more dynamics into the picture. It brings in the whole global economic profile of development and distribution of the products of that development. It talks about equity as an underlying value. It shows how economic inequities within countries and across countries can accelerate health inequities. It also shows how global cooperation can advance the common objective of reducing health inequities and protecting people against the spread of disease. So we now need to look at how global health has evolved from public health, how global health is now looking at the determinants of health transition across countries, the varied measure of these determinants, but how they act in concert in order to determine whether countries are going to face a huge burden of disease in one form or the other or whether they can actually telescope the transition by averting much of the disease that could have otherwise occurred. We now have a better understanding of some of the specific problems related to maternal and child health including child under nutrition. We also have a better understanding of the spread of infectious diseases as well as the methods for their control. We recognize the big threat posed by non-communicable diseases, and how these are happening in the context of health transition which again has multiple determinants and driving forces. We have seen how health systems have to be better organized in order to respond to this combination of challenges and how when we talk about health systems we are not only talking about financial protection or health workforce or access to essential drugs and technologies in isolation but we are talking about all of them and again as a combination. And where we now look at the health systems as a platform for universal health coverage, this becomes even more important to look at how universal health coverage can deliver a variety of services needed by the people while providing them adequate financial protection. This again becomes very important in the context of economic development and reducing health inequities which can be perpetuated by ill health which affects the poor people predominantly. So the interrelationship between poverty and ill health is again brought into focus not only in the area of public health at the national level, but in terms of global public health as well. So all of these complex interactions become very integral to our understanding of global health and become the basis for our action. When we really look at how we need to respond to some of these global public health challenges we further realize that we are require an all-of-society approach which brings in multi-sectoral action in order to advance global health by dealing with the multiple determinants which have impact upon health. Those within the health sector as well as those outside of the health sector, whether it’s trade, whether it is urban development, whether it’s agriculture and food systems, all of these will now have to be studied and also motivated to become better aligned to public health objectives. And this is where global public health has to now become positioned in the framework of sustainable development because we cannot really think of sustainable development without having healthy people. But we also can’t think of having sustainable development without a healthy planet and interestingly, we cannot think of healthy people without a healthy planet because environmental degradation will certainly undermine the health of the people and even imperil their very existence. So bringing together all of these elements under the framework of sustainable development is very critical not just because the United Nations wants to call them Sustainable Development Goals but because these are very important goals for humanity itself. But while all of this happens we have to contend with a huge number of social forces and decide how they can actually be driven in favor of public health. We recognize that there are different models of economic development based on ideologies, there are the free market model, there has been the state controlled model, there are people who are looking at blending some of these systems in a mixed economic system as well as in a mixed health system. While all of these debates go on, we must really recognize what works best in favor of global public health. And therefore, we need a vigorous debate on ideas but we also need to embody those debates and a set of fundamental values and global public health actually brings forth global solidarity and partnership as those values. And of course the very underlying value of public health anyway is equity. So when we are really trying to promote equity in all dimensions but use solidarity as one of the motivating forces for moving us toward that ideal of equity, then global public health becomes a very important unifying factor across the world. And therefore, irrespective of some of the ideological struggles that are inevitable, and are likely to take place even in the 21^st Century, we must overcome the struggle of these competing and conflicting ideas and ensure that we have a common blending of values which will triumph over these kind of sectarian ideological battles and those values will have to reflect a commitment to global solidarity, because without that solidarity, we will not be really looking at all of humanity as one family where the concerns and problems of one section will have to be addressed by the whole family together. We must recognize that as we move towards the implementation of the Sustainable Development Goals, health is absolutely pivotal for the economic, social and environmental development and protection. And then we must also ensure that health in turn benefits from equitable development in other sectors. For all of this to happen, the Sustainable Development Solutions Network is providing a unifying platform for looking at sustainable development in all dimensions from all directions. Health and global public health are important components of the mandate of the Sustainable Development Solutions Network. We hope that after this introductory course in global health has set you in motion, you will now become important contributors to global public health and to sustainable development. Therefore, this is not the end of the course. This is the beginning of our partnership to work together for global public health and for sustainable development which are a global public good, and which are important not only for this generation, but for generations to come.

Pedro Pereira Leite

Researcher and professor. He had his PhD. on museology in 2011, with the title “Muss-amb-ike Homeland: The commitment on musicological process”, that was published in 2011. In 2012 he finishes a Post-PhD Research on "Biographical Glances: The intersubjectivity poetry on museology, at Lusófona University (Lisbon). Presently he is working in his Post PhD. Research about: “Global Heritages" with the aims to build a network on local cognizance and memory manager has a tool to build the will of action in 3 different communities, linked by past communed heritages.” He works at CES. He participates on different Research network, presented papers in national and international conferences, and had published books on research subjects.

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