Perspectives in Public Health

Planning for health and creating healthy public policy has been one of the main priorities of the Healthy Cities Project since the early 1990s. The Healthy City Foundation of Pécs (Hungary) – as one of the founding cities of the Healthy Cities Project in Europe – has been involved in all phases of health profiling, health planning and health development planning throughout the years. The experiences of the Healthy Cities Project have strengthened the recognition that the decisions of elected local decision-making bodies are generally based on daily demands and not on long-term plans or concepts. The decision-making process has only one type of filtering system (operated by the city notary), which is for the preliminary legal control of the decisions to be made. Quality of life, health and equity are not considered in the system as a filtering issue. This article reports the experiences of the unique approach of health-orientated planning and decision making in the City of Pécs by using the method of health impact assessment (HIA) as a ‘health filter’. It describes the initiative, the success of training and the feasibility of creating a health filter to support the local decision-making process.

This study aimed to develop a practical toolkit to support non-government organizations (NGOs) in tackling health inequalities in the UK and to highlight the challenges and lessons learned. A mixed qualitative methodology within an action research framework was conducted. Semi-structured questionnaires, focus group interviews and discussions with an expert reference group aimed to identify the important themes and produce the toolkit content. A practical guide of information materials for NGOs working on addressing health inequalities was subsequently developed and successfully piloted. The experience of using participatory action research revealed a number of lessons and challenges. The key challenges were lack of training and experience in conducting action research, costs and insufficient resources, slow and time-consuming process, lack of commitment from marginalized groups, and differences in emphasis of goals and vision among participants. The main lessons learned were importance of effective leadership and project management skills, importance of integrating researchers and the researched as equal partners, creation and nurturing of trust, importance of evaluating and piloting processes, importance of engaging with marginalized groups, and use of evidence base in decision making. The lessons and challenges enumerating herein are of value to researchers aiming to implement participatory action research in developing checklists, tools, practical guidance and frameworks, and they offer important areas to consider before starting such projects. In addition, this offers an insight into how the dynamics of participatory action research methodology evolved in the development of the toolkit. Future research and initiatives in this area should focus on ways to improve the toolkit and make it more relevant to a wider community, and methods for evaluating the impact of the toolkit on practice.

In the centuries following the Enlightenment, scientific and technological developments gave ‘modern people’ an unprecedented ability to understand, predict and control the natural world. This has brought health and social benefits unimaginable to our ancestors and sets us apart from all previous generations. Yet there is a wide-ranging body of evidence that suggests that modernity is now in decline, largely because its methods and mindset are increasingly recognized as unsustainable. Problems are manifest in the emergence of new public health epidemics such as obesity and addictive behaviours, the loss of well-being and increase in anxiety and depression in affluent society, and the persistence of ever-widening health and social inequalities at national and global levels. Still larger problems now confront us, such as climate change, peak oil and the loss of biodiversity, all of which are linked to the ‘modern’ way of life. We are potentially faced with the collapse of certain aspects of modern society: we are certainly faced with the prospect of inevitable change. While the broad public health community has an important role to play in developing workable solutions to such daunting problems, we argue that some profound changes will be needed in order for us to cope successfully. No blueprints for dealing with change exist, which means that we will need to learn our way into the future. In this paper we take a perspective on the role and nature of the future practitioner in public health and health promotion. We argue that future practitioners will need to develop new ways of thinking, being and doing; new perspectives and new forms of understanding the world. We believe our discipline – and people generally – to be capable of such development, as insights from multiple sources tell us that human nature is malleable, not fixed. We use this analysis to trace, as examples, the imagined lives of five women living in different eras over the course of history in a Western society, and the emergence of different mindsets or worldviews, as the social, economic and cultural context changes. Post-modern analysts might insist that we have no basis for making value judgements between such different worldviews. In this paper, however, we argue that future practitioners should be empathetic to different views and willing to move beyond them, as necessary. We will need to learn and develop in ways that are compatible with our intrinsic needs as human beings and the needs of our ecosystem. We conclude by suggesting just some of the supportive processes of change needed in mapping out a more sustainable future for the public health community.

Shortages of water could become a major obstacle to public health and development. Currently, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) estimate that 1.1 billion people lack access to a water supply and 2.6 billion people lack adequate sanitation. The global health burden associated with these conditions is staggering, with an estimated 1.6 million deaths every year from diseases associated with lack of access to safe drinking water, inadequate sanitation and poor hygiene. In this paper we review the impact of water shortages on health and human development.

Health systems strengthening (HSS) is being increasingly recognized as a strategic cross-cutting issue in all World Health Organization (WHO) work. Health systems comprise six building blocks: service delivery; medical products, vaccines and technologies; health workforce; health systems financing; health information system; and leadership and governance. Public–private mix (PPM) approaches or partnerships consist of initiatives aimed at increasing collaboration and improving the relationships between public–public, public–private and private–private health providers. An important component of PPM is the clear distribution of tasks between the different providers involved in the provision of health care. In practice, most PPM initiatives are disease-specific and are often related to the health service delivery block mentioned above. Although there is widespread consensus that PPM initiatives are typically of an HSS nature, efforts to make explicit the links between PPM and health systems building blocks are rather uncommon. The present paper aims to identify – in order to facilitate operationalization – potential aspects linking PPM to health systems building blocks, using a few experiences from tuberculosis control and beyond. The paper targets policymakers, donors and health systems scientists and ends with a call for more aware and innovative leadership, for increased support of PPM initiatives covering various building blocks, and for more operational research.