Public Health as Never Before: 'Health in All'

The scope of public health goes far beyond what actors in the health sector must do. To quote the Alma-Ata Declaration again: ‘It includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child healthcare, including family planning; immunisation against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs. It also involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors’ (WHO 1978, Declaration VII). The latter is now referred as the ‘Health in All’ policies.

Cross-sector health impact assessment of all policies is increasingly being recognized as essential—even indispensable. For example, the rise in food prices, or the enforcement of laws against air pollution, or introduction of road safety measures or increasing duties on tobacco products and alcohol, could each have an immediate influence on health outcomes. As every sector gets to grips with using digital platforms, the possibilities of studying and correlating trends in morbidity with policy changes and changes in the determinants of disease become immense. Finland is an acknowledged leader in this area. But such work has barely begun in most LMICs.

Knowledge of the relationship between the social and environmental determinants of health and morbidity trends can catalyse policy change, as well as influence individual lifestyles and health-related practices. Knowledge on the link between cancer and tobacco use, or rise of admissions for acute respiratory illness during peaks of urban air pollution have been critical for driving control measures that address these determinants. Many disease- environment links require a much higher quality of health records. For example, the incidence of mesothelioma, a fatal form of lung cancer that occurs almost always due to exposure to asbestosis, is seriously underestimated in most LMICs, simply because there are no cancer registries or that the existing registries capture only a fraction of the desired health events and with insufficient quality.

It is also essential to recognize that access to such information should not be limited to policy makers, but must be available on the public domain. It is the weight of public opinion that, more often than not, drives pro-health policy changes. The forces that shape policy are many. In most contexts, the interests of industry and politically powerful elite would predominate, unless confronted with evidence which points to the impact on health and argues it from an equity perspective. And this not only needs information, but a transparency on how this information is collected, aggregated, and interpreted.

One principle of ‘health for all’, stated with great brevity and precision in the Alma-Ata Declaration is: ‘The people have the right and duty to participate individually and collectively in the planning and implementation of their healthcare’ (WHO 1978, Declaration IV). There are many reasons for providing communities a greater role, including strengthening democratic participation and accountability of public health systems. Communities can and do play a valuable role in priority setting and in choice of strategies, especially as regards access to services. Accessible, relevant health information can empower communities to participate much more effectively at the local level.

Health informatics has too often seen itself as only the tool of the provider and the individual patient. But public health informatics needs to re-discover the meaning of the word public, not only as an object of study but also as one of its primary subjects, that is, as one of main users of health information.