Vol. 16, No. 2	July 1995

WHO Interregional Meeting on New Public Health
Geneva, 27-30 November 1995

Background

Public health policy in the decade of the 1990s has been influenced not only by the health-for-all movement, with its emphasis on equity, but also by political and economic changes in the world at large. At the same time it is recognized that providing more equal access to health care, a traditional goal of public health authorities, will not necessarily reduce gaps in health status, insofar as disease is determined by individual behavior and by the working and living environment. Any genuine improvement in health will thus call for integrated, intersectoral action in addressing all the determinants of ill health. The training of health professionals will have to be reoriented accordingly.

The WHO Ninth General programmes of Work takes an integrated and multisectorial approach in addressing health problems. It stresses equity, health promotion and protection, and disease prevention. Cost and ethical aspects will plan an important role in decision making.

During the period covered by such a program (1996-2001) both the technical cooperation with countries and the directing and coordinating functions will be focused on enhancing the capacity of countries to define and implement their own priorities for health promotion, and to establish sustainable health infrastructure.

One of the major results of world action during the Ninth General Programme of Work must be: "strengthened capacity of governments and policy makers to undertake health-sector reform and establish national and local strategies to tackle such major public health tasks as removing inequities in health status; meeting the special needs of women; strengthening the role of the family; improving living conditions; ensuring equitable access to health care for all; protecting people against violence and health hazards; integrating vulnerable groups into the mainstream of social and economic life".

One of the priorities for WHO's work will be determining "emerging public health risks and access to health services".

The eight essential elements of primary health care served well as a guide during the last 20 years. Experience shows, however, that while new emphases have emerged, some elements are lagging behind, causing an imbalance in primary health care implementation. Health policies must be extended beyond the health sector, while continuing to be based on primary health care. The new policy needs to be strengthened through four main thrusts: political action for health; health protection and promotion; health system development, reform and management; combating ill health.

The Development Team on WHO's Policy and Mission, which met in August 1994, proposed the elaboration of a new global health policy evolving from health for all, with a 25-year horizon. The purpose of this policy would be to further the goals of the health-for-all strategy and to revise and update those elements made obsolete by the evaluation of the world situation.

In January 1995 the WHO Executive Board recommended a resolution to the World Health Assembly requesting the Director-General, inter alia, to:

• take the necessary steps for renewing the health-for-all strategy together with its indicators, by developing a new global health policy based on the concepts of equity and solidarity, emphasizing the individual's, the family's and the collective responsibility for health and placing health within the overall development framework;

• elaborate the new health policy to serve as objective and guidance for the updating of global, regional and national health-for-all strategies and for the development of mechanisms to enable all concerned to fulfill their role;

• redefine WHO's mission and the meaning of technical cooperation for WHO in pursuance of that policy;

• take the necessary measures for WHO to organize a high-level world conference, by the end of 1997, to adopt a health charter based on the new health policy, in order to obtain political ownership of the policy and commitment to its implementation.

Planning, management, monitoring and evaluation will need to be enhanced to ensure optimal efficiency and effectiveness of the health sector. This also implies an improved information database to support such measures, complemented by enhanced skills of analysis and interpretation.

Today and tomorrow's public health professionals need to be aware of multisectorial issues and be knowledgeable in the areas of policy development, political sciences, communication and negotiation. Since resources are not increasing, new skills and competencies, especially regarding cost, value, policy, planning, and management, need to be developed.

It is clear that many schools of public health are providing sound training in a number of disciplines under the umbrella of public health, but emphasis on epidemiology alone is no longer sufficient. There are some gaps in the existing curricula, and many essential public health skills are not properly taught. Important issues such as resource allocations and priorities, which demand sound ethical principles, need to be considered.

But not everyone working in public health needs all these skills to the same extent. Therefore, in addition to a redefinition of what constitutes the new public health and the essential competencies required, it will be useful to develop a taxonomy of public health workers so that their training can be made as relevant as possible.

Achieving a Consensus

In 1994 the WHO Global Policy Council decided that to "reach the goals set out in the (WHO) Ninth General Programme of Work, a new public health concept is needed and a global consensus should be reached on training in public health". It was however stressed that any new public health concept would have to emanate from an adaptation of the existing Health for All Policy.

To this end, WHO is preparing to hold an Interregional Meeting on New Public Health in Geneva from 17 to 30 November 1995. The objectives of the meeting will be:

1. To arrive at an optimal definition of the content and structure of the new public health practice for the implementation of the Ninth General Programme of Work and the renewed strategy for health for all.
2. To recommend how training and development of public health workers could be adapted to ensure an efficient delivery of new public health services.
3. To produce a monograph on the meeting.

In order to enrich the discussions and get as wide a perspective as possible on new public health issues, the WHO Director-General has decided to combine the annual Consultation with Leading Medical Practitioners (representatives of national medical associations for all the regions) with this interregional meeting. The main background position paper will, inter alia, synthesize the regional positions on public health. In addition, papers representing the views of medical and public health associations are expected.

The challenge of defining a new and clear view of public health has been taken up by all regions of WHO. As examples, a series of initiatives in the Americas has resulted in two recent reports, which stress the need for the development of more comprehensive explanatory frameworks for public health¹. These reports identify and debate many critical issues, among them the need for public health practitioners to develop the skills to manage the political processes that affect health. The WHO Regional Office for Europe, working with its collaborating centers and other partners, has begun to re-examine the public health training and research requirements in order to allow a process of reform and strengthening of health systems, and improvement in public health^2,3.

Such requirements strongly reinforce the need for an intersectoral approach to health policy development, which would require that public health, be capable of engaging in a dialogue with the actors in the other sectors. Mechanisms for such a dialogue must be developed. Policy directions and frameworks that have and will emerge from global initiatives such as the Fourth World Conference on Women to be held in Beijing and the World Summit for Social Development recently held in Copenhagen must be carefully evaluated and considered in the new public health. Similarly the work of the WHO Commission of Health and Environment will⁴. WHO/EURO argues that public health, to regain its position of influence, needs a consensus among policy makers, the scientific community, health care providers and consumers as to its scope and purpose. This interregional meeting will begin to forge such a consensus.

1. Pan American Health Organization, On the theory and practice of Public Health: One Debate, Several Perspectives. PAHO, 1993.
2. Pan American Health Organization, The Crisis of Public Health: Reflections for the Debate. PAHO, 1992.
3. World Health Organization , Regional Office for Europe and Centre for Public Health Research, WHO Collaborating Centre, Karlstael, Sweden, Training and Research in Public Health, 1994.
4. World Health Organization, Our Planet, Our Health. Report of the WHO Commission on Health and Environment.  WHO, Geneva, 1992.