THE NEW FACE OF PUBLIC HEALTH AND THE TASK BEFORE DEVELOPING NATIONS.
Anyanwagu Uchenna Chidi
Acheson’s definition of public health as “The science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society” 1 clearly brings to the fore two important aspects- Health and its promotion. Public health is a social and political concept aimed at the improving health, prolonging life and improving the quality of life among whole populations through health promotion, disease prevention and other forms of health intervention2. Public Health encompasses all factors that can improve the health of the community 3. It is both an art and a science. Beaglehole and Bonita4 identified the essential elements of public health to include: collective responsibility, partnership with the people served; emphasis on prevention; prime role of the state in protecting and promoting the public’s health; and recognition of the underlying socio-economic determinants of health and diseases 5-7.
Diseases are at the centre of all health targets, and this has prompted the shift and several distinctions in health promotion literature2, 8-12 between public health and a new public health. The new public health has, at its heart, the need to emphasize the significant different approaches to the description and analysis of the determinants of health, and the methods of solving public health problems. The WHO definition of health as “a state of complete physical, social and mental well being…” 2, 13 was therefore seen as the first conscious attempt to emphasize health in its holistic nature. Holistic, in that it takes into account the separate influences and interaction of these dimensions of health.
Health, nay, this new public health 10 is further distinguished by its basis in a comprehensive understanding of the ways in which lifestyles and living conditions determine health status, and recognition of the need to mobilize resources and make sound investments in policies, programmes and services which create, maintain and protect health by supporting healthy lifestyles and creating supportive environments for health. This new face is Health-Promotion 2, 10, 11.
Health-Promotion is “the process of enabling people to increase control over, and to improve, their health” 10. Within the context of health promotion, health has been considered less as an abstract state and more as a means to an end which can be expressed in functional terms, as a resource which permits people to lead an individually, socially and economically productive life. Health is a resource for everyday life, not the object of living 10, 14, 15. It is a positive concept emphasizing social and personal resources as well as physical capabilities. The Ottawa charter 10 and subsequent declarations 14, 15 on health promotion embodies the basic principles of achieving health for all by 2000 and beyond, outlined peace; shelter; education; food; income; a stable eco-system; sustainable resources; social justice and equity as the basic prerequisites for health. It listed that a viable Health Promotion action must include: Building a healthy public policy; Creating supportive environments; Strengthening community actions; Developing personal skills and Reorienting health services2,10
Services required from our legislators and policy-makers at all the tiers of government include promulgation of enabling laws that will engender a healthy public policy and reduce the inequities in health among individuals, villages, communities and cities. It must be seen to level up this divide. Health Promotion goes beyond health care. The Nigerian healthy policy16 must measure up to the Swedish17, which has been adjudged the best, because it has at its heart, a combination of diverse but complimentary approaches 18. The government and non-governmental agencies must see the impact of the changing patterns of life, work and leisure on health. The Niger-delta issue, the marginalization of the eastern part of the nation and the extinction of the socioeconomic middle class impede the attainment of a healthy society. The strength of the abounding Community-Based Organizations (CBOs) must be tapped fully if we are bound to make headway. Government must draw from the existing human and material resources in the communities in setting priorities19, decision making, planning and implementation of strategies to achieve better health. The gains achieved by the CBOs must be consolidated for effective and concrete actions. Personal skills and social development can best be developed through education, empowerment20 and enhancement of life skills. This must be done with the mind of increasing the options available to the people so as to make the healthier choice the easier choice10. Health services should be extended beyond the scope of clinical and curative services and should embrace an intersectorally expanded mandate that is sensitive.
Sensitive, as well as Herculean, are these tasks before Nigeria and other developing nations. These tasks are, however, attainable, but require an intersectoral, multidisciplinary approach by all the stake holders. Government must show greater political will and commitment, backed up by enabling laws in order to confront these challenges. Corruption at all levels of governance must be shown the back-door if any headway is bound to be made. The health sector must play a leading role in the integration of all other sectors through mediation, enablement, and advocacy if much is desired to be achieved. At the global level, the WHO and other international agencies must play advisory roles as well as provide the needed funds, leadership, and necessary tools to level up the inequities in health between the developed, developing and under-developed worlds21, 22.
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