Alexandru I. Petrisor, MSPH, PhD Aspirant
Norman J. Arnold School of Public Health
"The Student Diplomat", Newsletter of the Professional Society of International Studies, Vol. 6, Spring 2001
The way in which various communities throughout the world perceived and involved in public health depended, depends and most likely will depend on a large number of factors, some of which are subjective.
Public awareness to various public health issues is certainly an important factor. A brief search on the Internet, an analysis of a newspaper or a TV or radio program will certainly indicate at some level how much are public health issues important to the communities. The rating can be assessed in a multitude of ways. For instance, considering a journal, let's ask: How many times do public health issues cover the front page? How many columns are dedicated to these issues, and how are the topics presented and discussed? There are far away more questions to ask, but they will indicate something - are people aware of the importance of public health issues?
If the media coverage of what means public health, in the context of presenting information in a professional way, is not acceptable, then it is easy to draw the conclusion that people do not involve in public health planning and practice because they are not aware of it. Their participation may be therefore increased simply by increasing the coverage of these issues. At this moment people may become conscious that public health problems are real and important problems and may come together to resolve them.
Since the true significance of “public health” as a concept was misunderstood, and this resulted into a problem, this may be solved by education. At all its levels - formal and informal - public health education should present public health in a different perspective, underlying its importance and role to the advancement of the society. First, formal education should include programs that will increase public awareness to public health problems, especially in less developed countries, where public health issues are critical. Educated people could generate a pro-public health trend, and public health will be perceived at its true importance. Secondly, informal education should also promote public health.
It is somehow easier to implement non-formal education programs than it is to develop formal education programs. Furthermore, through non-formal education, addressed especially to educated people, can be constituted “nuclei” through which public health can spread out and increase its importance as a field of study and as a main component of society. I may use as an example the program I was participating in Romania. The idea was to attract students with a particular interest in Ecology and offer them special training, aiming a better environmental education. These students constituted non-governmental associations who attracted other students (colleagues and friends) and found their way to improve their knowledge in this field. Adults were also involved, contributing to a better knowledge of the environmental problems at the local level, and ending with concrete actions.
Even if, at regional scales, the contribution appeared to be invisible, something happened at the local level. Through a better coordination of similar organizations and programs, and by interconnecting in a web all those working in a field, significant changes could be expected at different scales.
Another issue relates to the fact that public health is perceived as “granted by the community”, forgetting an essential aspect, i.e. the benefits of a community upon public health progress. Obviously, this relates also to economical, social, or ethical issues, and to cultural differences, so it is hard to propose a panacea type of solution. However, by changing the view of public health as a “Cinderella” through activities like the ones previously presented this goal can be achieved - each society may identify its problems and find its own solutions.
Globally speaking, addressing public health issues involves international cooperation and also assumes that the developed countries will support less developed countries. The nature of this support is mainly economical, and it leads to some political aspects that delay the whole process. However, steps were made toward the achievement of this goal, and there are chances for the progress to be seen. It is important that humanity, as a whole, to perceive the importance of this solution to more global problems.
Another aspect is represented by the fact that public health policy remains a policy, and due to this aspect is influenced by the political changes that take place in any society. It is impossible to separate public health policy from environmental policy, from economical policy, from social policy, and, generally speaking, from all the other policies. It is impossible for public health policy to work separately from other policies at it is for an organ to work outside of an organism. What has to be done is to define the place of public health in the system and completely understand its importance and role in the advancement of the society.
Furthermore, we do not have to forget that public health involves the science. This leads to basic philosophical questions, i.e. what is the purpose of science? And, if the role of science can be defined, what would be the connection between science and policy? Obviously, there are tight connections between the two elements, but we have to distinguish between what is a myth and what is reality. There are a lot of specialists who argue that science is the base of the political decisions, but is it the truth? In most of the cases, it seems that reality indicates the contrary. And a brief example would illustrate this statement - consider environmental decision-making process. In this case, there are lots of authors who strongly believe that science is omitted and political decisions dictate.
The development of public health services is, also, complex. Once more, it relates to various social, economical and political aspects. A proof is that it varies across the world, as the social, economical and political aspects vary. We cannot talk about a certain structure of the services without touching sensitive political areas that also dictate the economical and social aspects. It is obvious that there is a need for strong public health services especially in areas where there are lot of public health problems, and this relate to poverty, and to economical development. It is also connected to the existence and development of a public health policy, and all compose a public health system. Moreover, the development of a public health system depends on people with at least some education, and, hopefully, some experience in the field, and to the development of public health education. Attention should be focused toward these regions, as usually they are associated with serious and widespread public health problems.
Networking is also an important issue. Obviously, the ability to network people who are components of the public health system depends in each country on various factors, such as the development of technology, which is influenced by the economical development. There should be a better understanding of the whole system, a better knowledge of its components, and then productive links can be created among them. First of all essential components have to be identified. There is no universal solution, and a certain country cannot just copy the model from another country that proved to be successful, but adapt it and implement it comprehensively. Various aspects, such as public policy, social end economical aspects, or education should be taken into account and the model must adapt to them. Secondly, links should be created productively and in the order of priorities that better fits the situation existing at a certain moment in a certain place.
Last by not least, cultural aspects play an essential role in the way that public health issues are perceived. Certain religious or purely cultural aspects influence the perception of critical public health issues, such as birth control. These aspects may decisively influence the opening of different communities to participating in public health, and this may occur in various regions of the world, and affect a large part of the population. Usually, it may result at least in different attitudes towards public health issues and different reactions, sometimes stronger than they are expected to be.
A key element of the success of programs based on public participation is the interaction. This is about people interacting one with the other, specialists interacting with people, managers and administrators interacting with people. Such complex interactions ought to be based on mutual understanding and communication, and mutual respect as well. Dialogue shall be the first objective, disregard of being a top specialist, a state official or a regular person.
I would conclude that the complexity of this problem does not allow a single solution. As there are various aspects of the problem, there should be multifarious solutions relating to each of these aspects. But I would like to express my confidence in the chances of this generation to discover them, at least as a serious commitment for this millennium.