Public health is the backbone of the medical fraternity

Many will ask why public health? What makes the public health professional so necessary and relevant today?

The answer is simple: Firstly it is important to acknowledge that the discipline of public health is the backbone of the medical fraternity.

It addresses present and future broad issues that concern the well-being of individuals, families, communities, populations and societies.

Thus the public health professional is vital in ensuring the maintenance and improvement of the health and well-being of the community through the use of population health knowledge and skills.

Interdisciplinary and inter-sectoral partnerships as well as measurements of the health needs of populations will lead the public health professional to the development of strategies for improving health and well-being of the citizens he or she serves, through implementation of the principles of either: health promotion, disease prevention or health protection.

The public health professional is key in demonstrating skills of public policy development as well as design, implementation and evaluation of health programmes through the application of a broad range of experience.

Public health professionals are team players; they work with colleagues in other medical and social science disciplines as well as across sectors such as education, housing, sport, politics.

They are trained in research methods and have particular skills in interpretation and translation of research findings for public health policy and clinical intervention.

Their training in health management and behavioural sciences enables them to contribute to key public health functions within state and non-governmental services geared at equitable access to health services.

It is an open secret that public health has progressed in leaps and bounds through the years. Yes we have come long way from the days of epidemic prone disease threats such as the plague and cholera.

However, the Sustainable Development Goals that ended in 2015 highlight the unfinished agenda of public health that includes: acute epidemic diseases, escalating epidemic non-communicable diseases, mental health disorders and inequality in health provision across the world.

The new development goals that came into effect in the beginning of 2016 are broad and ambitious. They rely on the integration of social, economic and environmental factors.

Globalisation is shrinking the world and with it new threats are emerging. In ensuring that the third Sustainable Development Goal which reads: “Ensure healthy lives and promote well-being for all at all ages” is realised, a new breed of public health professional is needed.

The founding father of epidemiology and public health, John Snow highlighted in his research on cholera, the collision between science, politics and culture. Snow demonstrated that this discipline requires answers to who, what, where and how in the quest of improving health systems and health outcomes.

When I was 16 years of age, a life time ago I attended a youth concert at my church. A pastor from Australia, by the name of Mel Fletcher had been invited to preside over the festivities.

There are words he spoke that day which to this day are my mantra and probably the reason that public health has a hold on me: “Make big footprints in the sands of time.”

Some public health scholars believe that the answer lies not only in ensuring that the Sustainable Development Goals are met but also in going back to 1978 Alma Ata Declaration where health for all was pronounced. This brings us to the chatter of the day: universal health coverage.

Society at large is acknowledging that health is indeed a basic human right to be enjoyed by all irrespective of social standing. Just spending more on healthcare is not a solution, as evident in the American Health care system which spends 18% of gross domestic product but delivers life expectancy rates at the lower end of Organisation for Economic Cooperation and Development economies.

Universal health coverage is labelled differently depending on country of origin: in South Africa we refer to the all elusive National Health Insurance which has been in pilot phase since 2011 and is expected to pilot for 14 years while funding models are being debated, while our British counterparts have been at it for more than 70 years with the National Health Service.

One will find it hard to argue with the former director of the World Health Organisation, Dr Margaret Chan Fung, who praised universal health coverage by saying: “I regard universal health coverage as the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.”

Others believe that answer lies in the fourth industrial revolution. It is said that by the year 2050, Earth will be inhabited by 9.7 billion people. This will put unprecedented stress on healthcare resources. And technology through automation, mobile computing and artificial intelligence is said to be a possible long lasting, stronger and better solution to public health challenges.

The MEC of health, Dr Gwen Ramokgopa, in an address on the challenges facing the department of health in August last year cited the lack of patient safety, unstandardised quality of care, shortage of human and financial resources and the high cost of medical litigation.

While these challenges were acknowledged she also indicated that there are pockets of excellence in the department which attends to more than 23 million patients each year.

She spoke of the men and women across the health system who help the department to transform itself by being involved in activities that improve the lives of individuals and communities, i.e: change agents. When one looks at the characteristics of such individuals, I’m reminded of public health professionals.

These are the roles of change agents as outlined by Heather Stagl:

1. Investigate: Change agents are observant and analytical. Remember the sciences of epidemiology, biostatistics and demography. Evidence is your secret weapon.

2. Advocate: Change agents are vocal and persistent. The Principles of health promotion from the Ottawa Charter call for you to be a voice for the voiceless.

3. Encourage: Change agents listen and encourage. Health seeking behaviour models emphasise the importance of understanding facilitators and inhibitors that are cues to health action.

4. Facilitate: Change agents are helpful and creative. Most health systems operate in resource constraint settings; the ideal is but a dream. The public health professional needs to be flexible and solution driven in such settings especially when servicing developing countries.

5. Mediate: Change agents are peacemakers. The prerequisites and prospects for health cannot be ensured by the health sector alone, needs government and non-governmental agents, Professional and social groups as well as health personnel as a collective to have shared responsibility to mediate between differing interests in society for the pursuit of health.

6. Advise: Change agents are confident and knowledgeable. Share knowledge that is factual. Follow the ethical principles of research, whether it be action research within the service setting or formal research for academia.

7. Manage: Change agents ensure there are goals, targets, they are determined and conscientious. There is a saying attributed to Benjamin Franklin that reads: that if one fails to plan, one plans to fail. Planning, implementation followed by monitoring and evaluation are crucial skills in public health.

• Dr Ntsakis J Maluleke is a public health medicine specialist. This is an edited version of a speech she gave at the launch of the post-graduate diploma in public health at Monash South Africa on May 24 2018