Some months ago, a simple, yet powerful campaign known as ‘This is Public Health’
The campaign had the aim to brand public health and raise awareness of how public
health affects individuals, families, communities and populations. It was a call to
place public health under the spotlight. This campaign was strongly endorsed by the
European Public Health Association. The need to refocus on public health was partly
a response to the emerging evidence on the erosion of public health services subjected
to budget cuts in several countries as part of the implementation of austerity measures.
It was also a clarion call by the public health community, reinforcing earlier concerns
about a growing health gap within and between countries and a need for a renewed commitment
to the principles of the Ottawa Charter
to make progress in achieving the Sustainable Development Goals.
Fast forward to early 2020 and public health was truly caught in the eye of the storm
as the harsh reality of the COVID-19 pandemic rapidly swept worldwide. This pandemic
has an enormous impact on the health and wellbeing of entire communities, over-stretching
even the best health services and crippling powerful economies.
What is beginning to emerge rather clearly is that countries which were better equipped
from a classical epidemiological disease control perspective and had the mechanisms
to surge their capacity to test, isolate, contact trace and quarantine, were better
able to manage the epidemic particularly at the cluster stage. Yet, in practically
every country’s public health services were overwhelmed and traditional approaches
to outbreak control could not cope with the high intensity of transmission. All countries
resorted to greater or lesser extents to the implementation of non-pharmacologic interventions
in an attempt to break transmission chains. Strong public health leadership embedded
at the heart of policy making was critical to garner support for, and institute appropriate
non-pharmacologic interventions in a timely manner in a quest to delay and ‘flatten’
the epidemic curve.
As countries enter the Transition Phase of the pandemic, a skilled public health workforce
supported by effective digital technology and capable of fulfilling a comprehensive
real-time effective surveillance function is a clear pre-requisite to safe shifting
of physical distancing restrictions. Strong and integrated management of the public
health services, primary care services and management of hospitals and long-term care
facilities is critical to manage this delicate phase. COVID-19 has underscored the
importance of tight collaboration between the public health and clinical health care
services. In a time of crisis, pre-existing networks based on trust and common understanding
of the roles of the respective functions is a critical factor for success. Yet this
alone will not suffice unless we are able to obtain the full support of people in
society to adhere to a gradual and incremental loosening up of physical distancing
measures. We need to leverage behavioural insights as part of the solution.
COVID-19 has made a strong case for anyone asking the question ‘Why should we strengthen
public health services?’. Yet the rationale for investing in public health services
actually goes far beyond strengthening preparedness to counter the next COVID-19 wave
or the next unknown infectious health threat.
COVID-19 has highlighted health inequities. Persons with pre-existing chronic diseases
often associated with lower socio-economic status were more likely to suffer serious
complications or die from COVID-19. The mental, social and economic impacts linked
to being under extended periods of ‘cocooning’ (Cocooning is a term being used in
the context of COVID-19 to refer to measures being put in place to safeguard the elderly
and other vulnerable persons by keeping them indoors and physically distant from other
members of society.) should also be considered.
The 10 Essential Public Health Operations described in the European Action Plan for
Strengthening Public Health Capacities and Services
adopted by the WHO Regional Committee for the European Region in 2012 still provide
a robust framework for the functions that public health services seek to cover. It
is however timely to revisit the bigger picture, learn lessons from COVID-19 and use
this experience to answer questions, such as ‘Where should public health services
be anchored to be most effective? How can we build better bridges between public health
services and clinical services, particularly primary care? How can we modernise public
health services to exploit digital technology in a way that respects privacy and ethics?
Finally, how can we ensure that we harness the effective and efficient practices put
in place to deal with the COVID-19 crisis and how do we recover stronger and better?’
These are important issues which will be considered within the European Programme
that is being developed for the WHO Regional Office for Europe in the coming years.
Action on the wider determinants of health and bridging between the health services
and the broader political, economic and social agenda is a key component of a highly
performing public health service and needs to be bolstered going forward.
Conflicts of interest: N.A.-M. is Past President of the European Public Health Association
and a Senior Advisor to the Regional Director WHO Europe. H.H.P.K. is the Regional
Director of the WHO Regional Office for Europe.