Essential public health functions: the key to resilient health systems

• Authors: Neil Squires, UK Health Security Agency, London; Richard Garfield, US Centers for Disease Control and Prevention, Atlanta; Olaa Mohamed-Ahmed, University of Oxford; Bjorn Gunnar Iversen, Institute of Public Health, Oslo; Anders Tegnell, Folkhalsomyndigheten, Solna; Angela Fehr, Robert Koch Institut, Berlin; Jeffrey P Koplan, Emory University; Jean Claude Desenclos, Sante Publique France, Saint-Maurice; Anne-Catherine Viso, Sante Publique France, Saint-Maurice
• Journal Title: BMJ GLOBAL HEALTH
• Volume: Volume 8, Number 7
• Publisher: BMJ PUBLISHING GROUP | 2023-07-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/bmjgh-2023-013136
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; COVID-19; Public Health; Health systems

Abstract

On 5 May 2023, the WHO declared an end to the designation of COVID-19 as a public health emergency of international concern.1 While COVID-19 remains a threat to health, the world is ready to move forward from a disease that has dominated life for the past three years. Now is the time to assess whether the commitments made to ‘build back better’2 will incorporate learning from diverse country experiences of responding to COVID-19 and its wider system consequences, and increase the resilience of all countries to future public health challenges. Health expenditures and life expectancy in most of the world rose between 2000 and 2019; however, the onset of the pandemic resulted in significant and prolonged disruption to essential health services, delaying progress and even reversing gains in life expectancy. This lack of resilience stems from chronic underfunding of public health capacities, even in relatively advanced economies.3 It is these preventive and promotive public health capacities both within and beyond the health system that are essential if we wish to reduce health risks and the impact of shock events like COVID-19, and thus reduce the burden on secondary and tertiary care that occurs when public health systems fail. Increased mortality and morbidity from non-COVID-related causes were seen in many countries,4 with an estimated 15 million excess deaths associated with the COVID-19 pandemic in 2020 and 2021 alone.5 6 The impact on livelihoods and society has also exacerbated social inequities and negatively impacted on mental health,7 while misinformation has undermined trust in health services.8