Why policymakers should pay more attention to public health 

In democratic societies, policymakers and technocrats are entrusted with promoting the well-being of the public they serve. Despite the consensus that public health is an essential component of social well-being, investments in this area are often seen sidelined in favor of other sectors reflecting a fragmented approach to policymaking. 

An integrated approach to public policies offers numerous benefits across sectors. For instance, the European Observatory of Health Systems and Policies Policy Brief 50 highlights the concept of “Health for All Policies”, emphasizing the interconnectedness between health and various other societal domains. The Policy Brief indicates that a healthier population is more educated and more productive, adding that the health sector is important from an economic point of view, being a large employer and buyer, which influences development in general (1). 

This understanding of health is based on two fundamental historical landmarks. First, ‘health’ was defined by the World Health Organization Constitution (2) as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity", that serves as a vital resource for personal, economic, and social development. Health is not just the absence of disease but a fundamental aspect of overall well-being and development. However, this definition does not consider the functional capacity of people in their context nor the existence of different degrees of health. The second landmark is the Ottawa Charter (1986), a founding document of the Health Promotion movement that stands as a significant milestone in advocating for holistic well-being. While it maintains the original WHO definition of health, it goes further, emphasizing the importance of individuals identifying aspirations, fulfilling needs, and fostering environmental harmony to attain complete well-being. This perspective reframes health not as an end in itself, but as a vital asset for personal, economic, and social development. 

Empirical studies have revealed the intricate interplay of biological, psychological, and social factors in influencing human health outcomes. Yet understanding how these factors interact to shape the quality of life, lifespan, and level of limitations faced by individuals remains a challenge. The World Commission on Social Determinants of Health (WCSDH), supported by an exhaustive bibliographical review, proposes a theoretical model (3), further emphasizing the impact of social factors on health outcomes. Structural mechanisms that influence power and wealth distribution play a significant role in shaping health disparities among different social groups. This makes addressing social determinants crucial for achieving health equity and fostering social cohesion.  The complex relationship between health and socioeconomic status underscores the importance of addressing social determinants in public health policy. 

Structural mechanisms, such as the distribution of power and wealth, shape socioeconomic positions and consequently influence health outcomes.  These positions affect various intermediate determinants of health, including living conditions, psychosocial factors, and access to healthcare. Access to health services is an intermediary factor that affects both individuals’ exposure to health risks and their vulnerability to diseases, consequently influencing the outcome of illnesses in people's lives. Ultimately, the synergy between structural and intermediary determinants of health equity and social well-being forms the cornerstone for social reproduction and cohesion. 

The interconnectedness between health status and social progress underscores the importance of addressing them as comprehensive concerns for both governmental and societal stakeholders. Yet, the prevailing measure of development, primarily based on Gross Domestic Product (GDP), confines development to mere economic expansion. An increase in GDP and personal income, or advancements in technology and industry, may enrich a population economically to a certain extent. However, authentic development requires an improvement in the overall living standards for all individuals, ensuring that societal well-being is advanced alongside economic growth. 

Thus, a wealth generation process solely focused on commercial activities, while overlooking the depletion of natural resources, is not just inadequate, but can also be detrimental to overall development. Sustainable development, therefore, requires ensuring that resources are conserved and replenished for future generations to have opportunities equivalent to or better than those of the present generation. 

Development encompasses various dimensions of well-being, including material living conditions, health, education, personal activities, political engagement, environmental sustainability, and economic security (4). It should be noted that these facets are not only indicators of development but also prerequisites for its realization. Health, in particular, holds a central position in this holistic framework.  

In this sense, economic growth is closely intertwined with health outcomes. The inverse relationship – health as a cause of economic growth – is not difficult to understand either. A World Bank report dedicated specifically to the topic of health lists five contributions of the population's good health status to the country's economic growth: (a) enhanced in labor productivity; (b) optimal utilization of natural resources; (c) improved educational attainment for future generations; (d) reduced healthcare costs; and (e) alleviation of poverty.  The report concludes that improved health conditions should lead to improved economic performance at the national level (5). When considering the relationship with economic growth, it’s important to acknowledge that health is not simply a sector of the economy. What truly matters is how the production and distribution of goods and services contribute to healthcare initiatives and the delivery of health services, ultimately contributing to economic prosperity. According to data from the World Health Organization (6), the resources allocated to the health sector represent a significant portion of global GDP, estimated at 9.7%, or roughly US$5.3 trillion in 2007. Therefore, irrespective of its impact on improving public health, both industry and healthcare services are vital components of the economy. 

As Sen (7) articulated, the relationship with health becomes more intricate and merits careful exploration when considering development as a comprehensive condition of freedom. Firstly, health and freedom share a common expression: the autonomy and capacity of individuals to determine their own life paths. Secondly, by enhancing people’s capabilities to pursue lives aligned with their values, development inherently fosters both freedom and health for all parts of a population. Achieving this type of development goes beyond mere macroeconomic strategies focused on economic growth through technological advancement. It requires well-crafted public policies that address the entire spectrum of social determinants of health and strengthen both instrumental and substantive freedoms. 

The intermediate determinants of health represent instrumental freedoms that can be effectively addressed through targeted policies: (a) enhancing access to healthcare services tailored to individual’s health requirements; (b) promoting healthy lifestyles – including regular physical activity, balanced nutrition, and efforts to reduce smoking and substance abuse (c) strengthening social support systems and ensuring public and international security; (d) improving living conditions encompassing housing, transportation, sanitation, and other material factors crucial for health and well-being.  

The structural determinants of health, representing substantive freedoms, require comprehensive economic, social and cultural policies to address them. These policies should aim to: 

1. Improve education, occupation, and income opportunities for all individuals 

2. Combat prejudice and various forms of discrimination 

3. Adopt a sustainable perspective as a core value 

4. Facilitate an equitable distribution of power and wealth, both within and between generations 

5. Intensify mechanisms of social participation and democracy to enhance autonomy and empower individuals to pursue the lives they value 

Ultimately, the connections between development and health are multifaceted and reciprocal. To effectively promote well-being, policymakers must expand their focus beyond mere economic growth. They must recognize the intricate interplay between public health and various sectors. This broader perspective underscores the importance of addressing health in its intersectoral dynamics, ensuring that policies and initiatives consider the diverse factors influencing both development and health outcomes. 

The Covid-19 pandemic illustrates the need for intersectoral policies. Actually, the global failure to face it is an example of the effects of the lack of coordination between different policies. Indeed, as we point out in another text (8), the deficiency in global preparedness and response to the pandemic was associated with problems of governance at several UN bodies (WHO, World Trade Organization, the Economic and Social Council and even the UN General Assembly). Moreover, many countries had difficulties implementing social protection measures that were strongly needed to allow social distancing and fulfil stay-at-home orders. Finally, how the world fought Covid-19 contributed to setbacks in achieving Sustainable Development Goals. Over four years of progress against poverty has been erased by Covid-19, which has hampered global economic recovery and caused the first rise in between-country income inequality in a generation (9). 

The World Federation of Public Health Associations (WFPHA) has the mission of protecting people and the planet, preventing diseases and promoting peace, health and well-being. To accomplish this, WFPHA advocates for an integrated approach to public policies. As part of its advocacy activities, WFPHA organizes the annual Global Public Health Week. The third Global Public Health Week (GPHW2024) will begin on April 8, 2024. This hybrid event, themed "Fostering Peace as a Prerequisite for Equitable Health," will bring together institutions, communities, and public health professionals worldwide through both in-person and digital platforms, to foster discussion on the best practices and missing gaps fundamental to promoting health and wellbeing through intersectoral policies. 

For more information on GPHW 2024: www.wfpha.org 

References 

(1) EUROPEAN OBSERVATORY OF HEALTH SYSTEMS AND POLICIES. Making Health for All Policies: Harnessing the co-benefits of health. Policy Brief 50. Access: 19 Feb 2024. 

(2) WHO-World Health Organization. Constitution of the World Health Organization (1946). In: Basic documents: 49th edition. ISBN 978-92-4-000051-3 (electronic version), 2020.

(3) SOLAR, O.; IRWIN, A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva: World Health Organization, 2010. Available in: https://www.who.int/publications/i/item/9789241500852. Access: 19 Feb 2024. 

(4) STIGLITZ, J.; SEN, A.; FITOUSSI, J. P. Report by the Commission on the Measurement of Economic Performance and Social Progress. Paris: 2009. Available in: https://ec.europa.eu/eurostat/documents/8131721/8131772/Stiglitz-Sen-Fitoussi-Commission-report.pdf. Access: 19 Feb 2024. 

(5) WORLD BANK. 1993. World Development Report 1993: Investing in Health. © New York: Oxford University Press. http://hdl.handle.net/10986/5976 License: CC BY 3.0 IGO. Access: 19 Feb 2024. 

(6) WHO-World Health Organization. World Health Statistics 2012. Available in: http://www.who.int/gho/publications/world_health_statistics/2012/en/ Access: 19 Feb 2024.  

(7) SEN, A. Development as Freedom. New York: Alfred Knopf; 1999.  

(8) SOUZA, L. ET AL. (2022) The global failure of facing the pandemic, Global Health Action, 15:1, 2124645, DOI: 10.1080/16549716.2022.2124645 

(9) UN-UNITED NATIONS. The Sustainable Development Goals Report 2022. Available from: https://unstats.un.org/sdgs/report/2022/