A new public health agenda for Europe: health under a sustainable development framework

Background As a science and normative framework, sustainable development attempts to comprehend and regulate the interaction between the global economy, society, and environment. The connection between health and sustainable development is widely recognized by the Sustainable Development Goals (SDGs), challenging the way we understand and do public health. In the absence of operationalizing tools, the SDGs would have limited value. Using policy documents (PDs), this study aims to diagram a new public health agenda for sustainable development in the WHO European Region. Methods 32 PDs ranging from 2010 to 2018 were identified and selected using the contents of the 2015-2018 Sessions of the Regional Committee for Europe. Based on the alignment of PDs and health-related SDG targets, a content analysis was used to characterize a new public health agenda. Results Preliminary results show several pathways of bidirectional contribution between heath, the environment, and economy. Closing the health inequity gap demands upstream measures to combat behavioral risk factors using a life-course and gender approach and a mix of cost-effective universal and target interventions. A transformative process of health and health delivery systems to provide people-centered, demand drive interventions are necessary. Addressing the determinants of health requires strong leadership in the health sector and partnerships for policy coherence. Preparedness to human and environmental induced emergencies requires tackling the root causes of climate change and violence and investing in systems and individual's resilience. Conclusions A public health agenda under the SDGs invites stakeholders to re-think policymaking, understanding health as a pattern of relations intertwined with the environment and economy. Moving beyond the treatment of diseases, this agenda calls for upstream interventions to tackle the determinants of health and improve health delivery systems to close the gap on health equity. Key messages The SDGs challenge the way we understand and do public health. A public health agenda for the SDGs conceives health as a shared responsibility across governance levels and policy sectors.

The Growing Divide in the Composition of Public Health Delivery Systems in US Rural and Urban Communities, 2014–2018

Objectives. To examine changes in the scope of activity and organizational composition of public health delivery systems serving rural and urban US communities between 2014 and 2018. Methods. We used data from the National Longitudinal Survey of Public Health Systems to measure the implementation of recommended public health activities and the network of organizations contributing to these activities in a nationally representative cohort of US communities. We used multivariable regression models to test for rural–urban differences between 2014 and 2018. Results. The scope of recommended activities implemented in rural areas declined by 3.4 percentage points between 2014 and 2018, whereas it increased by 1.4 percentage points in urban areas. The rural–urban disparity in scope of activities grew by a total of 4.8 percentage points (P < .05) over this time. The disparity in network density grew by 2.3 percentage points (P < .05). Conclusions. Urban public health systems have enhanced their scope of activities and organizational networks since 2014, whereas rural systems have lost capacity. These trends suggest that system improvement initiatives have had uneven success, and they may contribute to growing rural–urban disparities in population health status.

Building a Culture of Health

Commentary and published research on the value of healthcare has become more evident in recent times. There has been a noticeable shift from the focus on efficiency of health systems and practice to a greater focus on what effectively works, or more so, what doesn’t work. Health delivery systems struggle with increased demand on existing services and other health priorities remain underserviced. What do we need to do to better examine and understand what delivers value to people, communities, the health system and at the same time improves health outcomes? ........