Reimagining Public Health Inside View 17/02/2021 • Jose Luis Castro Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) The pandemic has revealed that health must be woven into all aspects of society – from our workplaces to schools, businesses as well as the government. The COVID-19 pandemic has revealed the profound dangers of having social, economic and health care systems that marginalize public health. To go forward, we must start by looking back. We must build a stronger foundation with better systems that can prevent future pandemics and also weave health into all aspects of society, from our workplaces to our schools to our businesses to every action of government. We can work for a world where people have equitable access to health care, and where they are protected from the leading drivers of death and disease no matter their race, gender, or sex or where they live. Here are five critical priorities: Invest in Epidemic Preparedness We know that the next pandemic is only a plane flight away. Every level of government must do better to be prepared. We must seize and build on the public interest and political will that has been created by the experience of living through and witnessing the impact of COVID-19 This means investing in global surveillance systems like the WHO’s Joint External Evaluation (JEE) tool so that new outbreaks can be identified and contained. Spurred by the 2014 Ebola crisis, the JEE provides a way for countries to assess their ability to find, stop and prevent epidemics, and target improvements. We need to accelerate this process so that every country completes a JEE. We need to provide funding for improvements—an estimated investment of just US $1 per person per year could significantly blunt the health and economic costs of future epidemics. Consider the alternative—The International Monetary Fund estimates the impact of COVID-19 is at least US $28 trillion in lost output. And then, technical assessments and competency are not enough—the countries that did the best to address COVID-19 also had strong and coordinated leadership across agencies and levels of government, depended on science to guide their actions rather than political considerations, and carried out effective public communication. Invest in Prevention of Noncommunicable Diseases Governments need to prioritize prevention to slow the staggering increase in conditions like cancer, diabetes and high blood pressure—noncommunicable diseases that cause up to 80% of premature deaths throughout the world. Investing in prevention will save trillions in treatment. This means properly resourcing national and state ministries of health and urban health departments that are too often poorly funded. In the United States, a paltry 3% of all health spending goes to public health. Public health protections may seem invisible—a tax on sugary drinks to discourage consumption, strong surveillance data that improves resource allocation, the absence of tobacco advertising—but COVID-19 has brought new visibility and public and political support for greater investment in health. Public health entities are essential and must be properly funded. We have a rare opportunity to implement a comprehensive approach to health. Let’s not lose the moment. Build Economies Around Health There’s growing momentum behind the idea that successful economies prioritize investments in the wellness of people. We can better harness the power of economic policy and partnerships. Even before COVID-19, more than 100 CEOS of leading Fortune 500 companies came together to declare that company performance must be measured in more than shareholder returns. Among its ideals: investing in their employees and protecting the environment. Let’s empower large employers to invest in the health of employees—including mental health—and promote business practices that promote healthier environments including fewer health-harming emissions. Governments can tilt economies away from ill health by ending subsidies for products with negative impacts on health—tobacco, alcohol and fossil fuels—and taxing unhealthy commodities. This will reduce health care costs and generate revenue for social good. Policies can make healthy choices the easy choice for people, by making fruits and vegetables more affordable, junk food less accessible, informing consumers with clear warning labels on packaged food, and promoting smart city designs that create safer spaces for walking, biking and playing. Put Equity at the Center COVID-19 has laid bare the tragic scope of health inequities across many dimensions. In the United States, Black, Indigenous, and Latinx Americans are dying from COVID-19 at triple the rate of white Americans. As the vaccine rollout continues, it is critical that the shots are distributed to the Black, Indigenous, and Latinx Americans communities to avoid exacerbating existing health disparities. Globally, a Duke University study warns that billions of people in low- and middle-income countries will not have access to the COVID-19 vaccine until 2023, and in some cases, 2024. Until all people are protected equally, we must concentrate investments—not only for COVID-19 but also on the myriad health problems exacerbated by inequity—in communities that are disproportionately affected and work to address root causes. This means speaking out, partnering with all levels of government and other sectors such as education and housing where good health is rooted, and empowering the most-affected groups to shape the health and social policies that have placed disproportionate health burdens on them. Increase Global Cooperation The weakness of our global health coordination systems was one reason a preventable epidemic mushroomed into a global pandemic. Formal mechanisms of global cooperation from the Paris Climate Change Treaty to the Framework Convention on Tobacco Control, bring country accountability. Alternatively, we can strengthen health-related components of existing frameworks, such as demonstrating that the Conventions on the Rights of the Child includes committing to access to healthy nutrition and protecting children from the unhealthiest commodities. We must also bolster our coordination bodies and mechanisms across multilateral organizations and governments, focusing first on the World Health Organization. In revealing systemic weaknesses, COVID-19 also has painted a way forward for greater progress. Together, we can reimagine a world where everyone is protected by a strong public health system so they can lead longer, healthier lives, where science is the core of public health decisions and measures, and where we can effectively prepare for and even prevent future pandemics. This will not be our last. José Luis Castro, president and CEO of global health organization Vital Strategies Image Credits: Vital Strategies, Tewodros Emiru, Vital Strategies. 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