STRENGTHENING PUBLIC HEALTH
National public health capabilities are an integral part of an effective health system and the first line of defense against infectious-disease outbreaks. Yet in many countries they suffer from underinvestment. Even in wealthy countries, public health is often given relatively low priority. In poor countries, there are frequently substantial gaps in skills, systems, and infrastructure. Previous efforts to galvanize increased investment in public health capabilities and infrastructure — after SARS and again after H1N1 — have had limited effects. For example, according to their own assessments, more than two thirds of countries are less than fully compliant with the requirements of the International Health Regulations (IHR). Rigorous external assessments would undoubtedly have even more sobering results.
The Commission’s report argues that reinforcing public health capabilities should be a top priority. It sets out 10 interrelated recommendations to make this happen. Six aspects of our approach are worth highlighting.
First, national public health capabilities should be assessed rigorously, objectively, and transparently, against clearly defined benchmarks. Self-assessment of adherence to insufficiently precise IHR requirements is inadequate. To identify and prioritize gaps and hold governments accountable, we need a mechanism more akin to the World Bank’s “Doing Business” report or the Financial Action Task Force’s “Mutual Evaluations.” The pilot peer assessments conducted under the Global Health Security Agenda initiative provide a useful model.