International Development of Public Health

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INTERNATIONAL DEVELOPMENT OF PUBLIC HEALTH

While most public health associations were organized during the closing decades of the twentieth century, some were formed over a century earlier. The older ones were established in Europe— Germany and the United Kingdom have a longstanding tradition of public health practice rooted in public health education and training—and in the United States. The American Public Health Association, the oldest and largest association in the world, was founded in 1872.

Public health associations generally differ from other professional health or medical-related associations in one aspect: They are multidisciplinary in membership. Therefore, they include in their ranks professionals from across the full spectrum of public health practice—sanitarians, health educators, nurses, physicians, health administrators, and so on—not just doctors, nurses, or dentists, who usually have their own separate professional societies in a given country.

Public health associations vary greatly in their degree of development. As such they can be located along a continuum that ranges from relatively small and undeveloped associations at one end to highly developed, sophisticated, multifunctional, organizations at the other. The smaller associations are often grouped around a few professionals, such as a social network of family or friends, and they undertake relatively few functions, such as hosting periodic meetings or issuing a newsletter. In contrast, the most developed associations are active in a variety of areas, including policy development, which may include advocacy and legislative support; communications, including media and publications; and programs in scientific and professional affairs.

A wide range of activities currently characterize public health associations in the United Kingdom (U.K.), Canada, and the United States. In the United Kingdom, for instance, the Royal Society for the Promotion of Health is an accreditation body for two accreditation schemes and an awarding body for a number of qualifications. The accreditation schemes are designed to ensure safe practices in health and hygiene in the packaging of food products such as sugar and beverages. The Society has also been active in providing its expertise to plans to establish a food standards agency in the United Kingdom. While it has agreed in principle to the agency's establishment, it has expressed reservations about its proposed financing, structure, and role. The United Kingdom Public Health Association is active in injury prevention and control, an issue of increasing importance, and in developing health information and monitoring systems in Europe. It participates in European task forces on cause-of-death statistics, statistics on health care, and health and health-related survey data.

In Canada, the Canadian Public Health Association has six strategic program areas: administration of health services, disease surveillance and control, equity and social justice, health promotion, human and ecosystem health, and international health. The association's principal roles are in policy advocacy and liaison; national programs, including a national AIDS (acquired immunodeficiency syndrome) clearinghouse and national literacy and health programs; international programs, including ones involved in strengthening public health associations and international immunizations; national health resources; and conferences and workshops.

In the United States, public health associations such as the American Public Health Association (APHA) place a high priority on policy development. The APHA has recently seen the need to broaden its public advocacy efforts, developing relationships with partners in the political arena as well as with a number of government agencies at the federal, state, and local levels. By using current technologies such as e-mail messaging, e-mail list-serves and broadcast faxes, APHA is able to rapidly inform members about pending policy measures, including legislation and regulations, and to marshal support for its positions.

A second important function involves continuing education. The APHA presently provides affordable, fully accredited continuing education in eight disciplines, and it plans to further improve the training of public health professionals by expanding the number of accredited programs offered and by broadening collaboration with training partners. The APHA also promotes the public education role of public health associations. These groups can provide an evaluation of health standards for the public and help document where service is poor or falls short of adequate standards. They can also evaluate private-sector programs from a perspective other than the government's.

Since 1967, public health associations from around the world have been grouped together or "federated" through the World Federation of Public Health Associations (WFPHA). The founder member associations were from India, Japan, New Zealand, Pakistan, the United Kingdom, the United States, and Venezuela. The federation's goals are:(1) to facilitate collaborative efforts for improving health and health services, (2) to provide a mechanism through which nongovernmental health organizations can work with national and international health agencies to improve community health, (3) to encourage the formation of national public health associations, (4) to strengthen existing associations in their work of supporting the public health professions, and (5) to exchange information among member associations.

In 1970 the World Health Organization (WHO) recognized the WFPHA and granted it official relations status. Subsequently, the federation established official relations with the United Nations Children's Fund (UNICEF) and other international organizations. In 1999 the federation comprised sixty-one member associations, with representation from each of the major regions of the world.

The largest and most developed public health associations are generally in the world's more developed, industrialized nations. These associations provide a model for associations in the less developed countries of the world. In Africa, where public health associations are relatively new, a number have developed through donor assistance from western countries. For instance, the Canadian Public Health Association has supported, with government funds, the establishment and development of public health associations in various African countries. A number of such associations are now doing well on their own and are less dependent, if at all, on outside support. An example is the Tanzanian Public Health Association, which now independently organizes branch associations, holds meetings, and publishes proceedings. This association also took on a significant added burden by hosting the WFPHA Eighth International Congress in October 1997.

Like the WHO, the UN agency with which it has its closest ties, the WFPHA has organized itself along regional lines. Member associations are grouped regionally and have a regional liaison officer appointed by the federation.

The European region is the largest with 23 members. Next is Latin America (13 members), followed by Africa (9), Southeast Asia (6), the Western Pacific (5) and the Middle East (4). A look at a few of the member associations and their activities during 1998–1999 furnishes a sampling of the public health concerns faced by these associations, and as such provides some global measure of the status of public health.

The Costa Rican Public Health Association, for instance, has focused on global tobacco issues and has translated and disseminated a federation position paper on global tobacco control. The Ethiopian Public Health Association carried out workshops on "Networking Public Health Schools," and "HIV/AIDS and Development in Ethiopia." It has also published the abstracts from its annual scientific conference and begun publication of the Ethiopian Journal of Health Development and a newsletter, Felege Tena.

The Indian Public Health Association held its forty-third annual conference in March 1999, with the theme "Environment and Health: Challenges for the Twenty-first Century." The Japanese association continued its activities promoting public health, focusing recently on community health. The association plans, implements, and evaluates comprehensive programs in community health, medical services, and welfare services. It also offers training programs for community health staff, including physicians and planners.

Public health associations around the world are working to improve the health status of their populations. They may differ in stages of development, and some are more active and have greater resources than others. Yet they all share the same goal of promoting better health through policy advocacy, information sharing, and a variety of program activities.

Allen K. Jones

(see also: American Public Health Association; International Health; UNICEF; World Health Organization )