The Architecture of Public Health: International Experience and National Priorities
KEY CONCLUSIONS
A focus on public health is key to improving quality of life and life expectancy
“Forty-one per cent of deaths in Russia are potentially avertable. Of this figure, just under half are avertible through a comprehensive set of reasons stemming from economic, social, and other factors. We call this public health. This is about promoting health in general and encouraging people to lead healthy lifestyles,” Veronika Skvortsova, Minister of Health of the Russian Federation.
Investment in healthcare boosts economic growth overall
“Spending on health cannot be seen any more as just plain expenditure. It is a major investment in human capital,” Patricio Marquez, Lead Health Specialist, Health, Nutrition and Population Global Practice, World Bank Group.
“Public health, and health in general, is a key aspect of economic growth,” Nick Guldemond, Associate Professor, Erasmus University Rotterdam.
Investing in child healthcare brings substantial rewards
“Public and private investment in healthcare must begin with child healthcare. <...> We have declared the coming decade to be the decade of childhood,” Irina Yarovaya, Deputy Chairman of the State Duma of the Federal Assembly of the Russian Federation.
“UNICEF is calling for far greater investment in children’s health. We see it not only as a moral imperative, but an economic one as well. The highest economic returns come from investments in a child’s earliest moments,” Afshan Khan, Regional Director for Europe and Central Asia, United Nations Children's Fund (UNICEF).
Primary care is the cornerstone of healthcare
“The idea [of universal healthcare] first emerged in Russia in the 1930s with the Semashko system,” Veronika Skvortsova, Minister of Health of the Russian Federation.
“We recognize the importance of primary healthcare as a first step, but we also recognize that universal health coverage cannot be achieved without a consortium of stakeholders, and a better-informed public, for which the media is key,” Afshan Khan, Regional Director for Europe and Central Asia, United Nations Children's Fund (UNICEF).
“Universal health coverage has to be an integral part of the sustainable economic growth agenda of countries and international organizations,” Patricio Marquez, Lead Health Specialist, Health, Nutrition and Population Global Practice, World Bank Group.
PROBLEMS
Insufficient funding
“We are interested in increasing funding for the system. We are currently working at the point of maximum efficiency. <...> We have squeezed everything we can from our rates. <...> If another resource appears, we will be able to take the next step,” Veronika Skvortsova, Minister of Health of the Russian Federation.
“More resources are needed, but then again, we have to be mindful that there is a lot of inefficiency and waste in health systems right now,” Patricio Marquez, Lead Health Specialist, Health, Nutrition and Population Global Practice, World Bank Group.
Poor food quality
“According to WHO data, 600 million people across the world fall ill from consuming contaminated products. This is a problem that mainly affects children,” Irina Yarovaya, Deputy Chairman of the State Duma of the Federal Assembly of the Russian Federation.
Decreasing number of years of healthy life as life expectancy increases
“The number of years of healthy life is decreasing, rather than increasing with age. So, although we have been quite successful at increasing life expectancy, healthy life years are under threat – they are decreasing, with an impact on productivity and economic growth,” Nick Guldemond, Associate Professor, Erasmus University Rotterdam.
SOLUTIONS
Projects aiming to improve public healthcare must encompass the entire population
“The situation in Russia today is unique in that the political will is clearly there. Resources are being allocated, and there is a willingness to implement these projects among society, public institutions, municipal governments, and the regions [to improve public health – ed.],” Igor Kagramanyan, First Deputy Chair, Committee on Social Policy, Federation Council of the Federal Assembly of the Russian Federation.
“I head a major national network called Healthy Cities of Russia <...> This Russian network is a pilot platform to implement major public health projects and create a public health space. We encompass 92 municipalities uniting 16 million people. <...> We are also launching projects in cities aimed at promoting a healthy long life,” Oleg Kuvshinnikov, Governor of the Vologda Region; Chairman, Healthy Cities, Districts and Villages Association.
Involving the business sector in improving people’s health and quality of life
“When we speak about social responsibility in the business sector, it is not only about a desire for funds. <...> It is much more important that businesses act in a fair way, an offer goods and services which will have a positive effect on people’s health and quality of life,” Irina Yarovaya, Deputy Chairman of the State Duma of the Federal Assembly of the Russian Federation.
“The working population of Russia stands at over 70 million. <...> If we can organize care with the assistance of employers, we will achieve a great deal,” Elena Zhidkova, Head, Central Healthcare Directorate, Russian Railways.
“Good public health is good for business, and good business is good for public health. We have in the private sector both an opportunity and a responsibility to contribute to the health of our employees,” Julie Gerberding, Executive Vice President, Strategic Communications, Global Public Policy and Population Health, Chief Patient Officer, MSD.
“It is the business sector that offers solutions that make a project feasible. <...> Business does two crucial things: it increases the amount of resources available in the sector overall, and creates a specific set-up,” Mikhail Yugay, General Director, International Medical Cluster Foundation.
“In Egypt, with the support of the government, in only seven months we will conduct a massive campaign to test 61 million people. <...> I know that the minister is launching a massive screening test next year. This is the kind of partnership between the public and private sector,” Raul Alberto Gatica, Division Vice President for Government Affairs and Policy for Latin America, Europe, Russia and Turkey, Abbott.
Implementing new technologies in healthcare
“UNICEF is committed to a lifecycle approach that looks at the continuum of care that is needed. We recognize that some of the innovations that are being made, particularly around digital health and new technologies, can be game-changers – not just for children, but for young people as well,” Afshan Khan, Regional Director for Europe and Central Asia, United Nations Children's Fund (UNICEF).
“You need to avoid the graveyard of equipment, whereby equipment is bought but not maintained. I am very much in favour of technology as a service, as a way forward,” Frans van Houten, Chief Executive Officer, Chairman of the Board of Management and the Executive Committee, Royal Philips.
Increasing taxation on harmful products
“We are advocating taxation of tobacco, alcohol, and sugary drinks. We have estimated that an increase of 15% in the current rates of taxation by 2050 will generate USD 20 trillion worldwide,” Patricio Marquez, Lead Health Specialist, Health, Nutrition and Population Global Practice, World Bank Group.
Introducing diet standards for children
“We have drafted a law which aims to outline a good diet for a child – one which specialists claim will offer sufficient nutrition, and will support their health and all-round development. <...> We are working with the government to ensure that all children in primary school are provided with free hot meals. These are investments in health. <...> It may also be beneficial to draw up a declaration at the World Health Organization covering the requirements and quality and safety standards for school meals across the world. <...> We would suggest that consideration is given to offering a single set of technical regulations, using the example of Russia and the EAEU. This could serve as a quality standard for every producer, and create an understanding that there is a shared responsibility for people’s health, life expectancy, and quality of life,” Irina Yarovaya, Deputy Chairman of the State Duma of the Federal Assembly of the Russian Federation.
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