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A world without Public Health?

By Randa Osman

The world we live in may be very large, and what happens in one part may seem so distant that no attention is given to it at all. However, the COVID- 19 pandemic we are currently facing has proven otherwise and shown the extent of our world’s interconnectedness and interdependence. It has proven that at the end of the day we’re all on the same boat and that each and every member on board is responsible for its wreck and for its recovery.

Upon reading the first paragraph it is natural to ask: How come then scientists were in oblivion of this obvious fact until COVID-19 hit? How come they didn’t warn us before hand?

Scientists and Public Health professionals have, in fact, been warning authorities for years. The notion that countless viruses are continuously mutating and may at any moment cross the human-animal barrier and crack the human code is not new. History proves that impending emergent infectious diseases have always been a threat to the public’s health since time immemorial. For instance, the world suffered from an Influenza pandemic in 1918 with nearly 50 million people killed and was hit again by a mutated strain (2009 H1N1) of the influenza virus nearly 90 years later in 2009. Coronavirus pandemics similar to COVID-19 have also been experienced with the emergent viruses of SARS and MERS.

So, what made COVID-19 hard to forecast?

The blind focus of governments and international entities on economic gain and political power played a big part in leading the world to neglect Public Health and act as if such science is not important. People would applaud a politician announcing the opening of hospital buildings at considerable cost but wouldn’t understand the purpose of awareness building meetings with communities. Little do those people know that the knowledge gained at those meetings would save them tons of money that would otherwise be spent on those very hospitals whose opening they so warmly celebrate.

Public Health is defined as the science and art of preventing disease and promoting health. It protects populations from risks and dangers to health by addressing modifiable determinants of health such as safety of food, water as well as the physical and social environment of people. It also addresses equity ensuring that no one is denied access to life-saving health interventions or quality health services on the basis of gender, race, ethnicity, geographic locations or social and economic status. Thus, Public Health is the invisible science that works behind the curtains to provide cost-effective Universal Health Coverage creating healthy communities capable of growing the economy and saving costs for governments and families.

A unique feature of Public Health is its broad multi-sectoral engagement given that ill health is driven by social, economic, behavioural and environmental factors. The science of Public Health can be described as a leverage point which, if invested, will give very high returns. In fact, if the world cared so much as to change the reality of underfunded Public Health systems sooner, today we would have had robust surveillance and response systems and the current pandemic would have been avoided or would have passed with significantly less repercussions. Not giving this invisible science its due importance has cost the world incredible amounts of money, not to mention the many lives lost to this pandemic.

Therefore, it wouldn’t be an exaggeration to say that Public Health is the backbone of human development.

Eritrea has been one of the few countries in the world to effectively control COVID-19 pandemic. It has succeeded in what high-income countries failed by following a robust preventive strategy. Eritrea’s success is owed to a trust in Public Health measures and timely responsiveness, encompassing the adoption of voluntary foreign travel ban to and from the country, a comprehensive and mandatory quarantine of all travellers to the country, testing of quarantined individuals as well as random testing, aggressive media campaign, a strict nation-wide lockdown and systematic lifting of restrictions.

The roots of Eritrea’s trust in Public Health can be traced to the years of the armed struggle when the EPLF established a system that focused on comprehensive primary health care to protect its people from disease and promote their health. Eritrea also reaped benefits of this trust after its independence when it made considerable progress in many areas and was one of the few countries to achieve the Millennium Development Goal 4 by reducing under-five mortality rate by two-thirds between 1990 and 2013 (2 years earlier than the due date), that is from 150 to 50 deaths per 1000 live births (MoH, 2014).

Thus, Eritrea is the perfect example of how small investments in public health can lead to great outcomes.

There is no question that the creation of tertiary hospitals or expenditure on sophisticated medical devices has a great role in health care, especially in diagnostic and treatment facilities. However, it should not compromise the investment on public health infrastructure or the efforts addressing modifiable determinants of health.

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