Strong public health base central to building health capacity
Wednesday, 27 June 2007
A strong public health base is crucial to building the capacity of health systems, David Harper of the Department of Health told delegates at the parallel session on Building global public health capacity, and the Faculty has an enormous amount to offer through its training, development of the evidence base, knowledge management and setting of standards.
‘Globalisation has not delivered on its promise to deliver skills, knowledge and techniques. There is nothing natural about this.'
Sir Michael Marmot
‘Is our engagement with global public health sufficient,' he asked delegates, acknowledging that the Department of Health had been criticised for concentrating on domestic health problems. But the domestic health agenda was very much influenced by what happens worldwide, he said, so the question was how best to make use of the resources and evidence base that exists.
There had been significant increases in both funding and partnerships, said Director of Partnerships and UN Reform at the World Health Organization, Alex Ross, however there was a great deal of fragmentation and unsustained financing. ‘The UK has an enormous talent pool,' he said, ‘and the question is how that can be co-ordinated to tackle health problems worldwide.'
People in the health sector needed to broaden their perspective and realise that what is happening in other sectors is essential, said Michael Marmot, who has been leading the Commission on the Social Determinants of Health. ‘I am so steeped in the social determinants of health that I delude myself that everyone is,' he said. ‘And that is a delusion.' Whether or not anything would happen as a result of the commission would depend on ‘all of us', he stressed.
The commission focussed on the ‘causes of the causes,' he said.
There was no biological reason for the 50 year gap in life expectancy between the worst-off women in Africa and the best-off women in Japan. ‘We are all the reason for this.' The social determinants of health and primary health care go hand in hand, he emphasised, and it was essential that people in other sectors who influence the health of the population were made to think about health.
One of the explanations often heard was that gross inequalities in health and life expectancy were somehow ‘the natural order'. ‘Globalisation has not delivered on its promise to deliver skills, knowledge and techniques' he said. ‘There is nothing natural about this.'
What was needed was a common framework for understanding why the worst off people in rich countries had shorter life expectancies than people in some of the poorest countries, he said, and the answer lay in empowerment – whether material, psychosocial or political. It was essential to create the social conditions for empowerment. ‘It's about integrating knowledge for action,' he said. ‘Not just studying the problem, but doing something about it.'