What is the primary goal of territorial community in the field of health care? The most obvious answer seems to include providing community residents with affordable and quality health care services. And it is logical that health care facilities should deal with this first of all. However, this article is about the somewhat different, yet, equally important, and often unconscious, need of each of us – maintaining one's own health. It is the very need that such a separate section of medical science as Public Health deals with.
"If the doctor saved a person's life, they start talking about him or her. If the doctor cured 10-15 people, he or she is glorified. But if the doctor helps eliminate the particular disease that has sickened thousands and thousands of people, no one will appreciate it. "After all, how can you assess what did not happen?" Lev V. Hromashevskyi, a prominent Ukrainian epidemiologist, wrote. It is public health that is about what did not happen and which one can and should be warned about. It is very difficult to arouse awareness and motivation in a person to work on the prevention of an ephemeral disease when it does not even exist in humans.
As the basis of preventive medicine, public health includes the following areas:
- Health protection
- Disease prevention
- Health promotion (maintaining)
By definition, it is the prevention of diseases, injury, disability and increasing life expectancy on condition of living a healthy lifestyle in a healthy environment and conditions of vital activity of present and future generations.
In present-day Ukraine, there are five key areas of public health development: (https://www.kmu.gov.ua/npas/249618799)
- Promoting the health policy formulation
- Developing personal skills of living a healthy life
- Creating a favourable natural and social environment
- Strengthening the activity of the communities and organizations
- Refocusing the health care system priorities
Unfortunately, there are not many practical examples when Ukrainian local governments invest in retaining human capital. After all, usually, investments are considered unpopular if they do not give a quick return, and in most cases the waiting time for the effect can be measured in years or even decades. This often occurs, among other things, due to a lack of proper understanding of the necessary measures to be undertaken.
We invite readers to consider specific examples in each of the five areas.
- The health policy formulation process includes both national and local policies. The Public Health Care System Development Framework was approved in Ukraine at the national level (30 November 2016) (https://www.kmu.gov.ua/npas/249618799), and its implementation has already started. Examples include legal regulations on the quality of plastic containers used for hot meals and beverages, which prevents the development of cancer if the required standards of use are observed, the fight against smoking in public places, and the prohibition of crossing a street beyond the marked pedestrian crosswalks. The government's Affordable Medicines Programme may serve as a similar example, which aims to provide secondary prevention of complications of diabetes and hypertension and make it available to the public. An example of local policy can be the experience of local programmes developed in the Mukachevo City Territorial Community. There, in 2016, the mayor refused to invest in patching budget holes in the hospital, which repeatedly emerged due to poor management. Instead, such funds in the amount of over UAH45 million per year were used to meet such needs of the community as procurement of medicines at the concessional rate and covering the cost of expensive treatment for the community residents.
- Motivating the community residents to take care of their health and adhere to the recommendations of specialists in the field of a healthy lifestyle is still a difficult task. One of the successful examples includes doing morning gymnastics with well-known people, opening of sports grounds in communities, support and motivation for physical culture and going in for sports. Interesting examples include the experience of creating and implementing local programmes in the Koropets Community (Chernihiv Oblast, Novgorod-Siverskyi Raion) – https://cutt.ly/0E1mu3R and the Brovary City Council, Kyiv Oblast – http://surl.li/ajgkq.
- Ecology and caring for the environment are closely linked to public health. A healthy community largely depends on this. Good examples of national measures in this field are regulation of emissions of harmful substances into the atmosphere, soil or water from industrial enterprises. In one Polish city, health experts found that the municipality's lung cancer rate was twice the national average. They started to analyze the situation and found out exactly what the cause was. As it turned out, 90 per cent of households in the municipality heated their homes with furnaces and it was the detrimental effect of carbon dioxide that caused such a significant increase in cancer rate. Based on these data, the municipality invested additional funds in the gasification of apartments. During the period of ten years, it was noted that the rate of lung cancer dropped sharply and started to correspond to the national average.
- The civil society sector plays an important role in the development of public health. Citizens' self-organization is often a counterbalance to any potentially detrimental effects on the environment or community residents' health. One of the examples is a study conducted by non-governmental organizations on the increased risk of objects and fittings that protrude from the vehicle exterior for pedestrians in the event of a collision between the vehicle and the pedestrian (Reference:). This, in turn, led to standardization efforts in the automotive industry. Therefore, such elements as sliding headlights, brand marks on the hood have become a rare phenomenon. Many countries (unfortunately, except Ukraine), for example, have directly prohibited equipping vehicles with rigid additional fittings on the front of a motor vehicle, the so-called "kangaroos."
- In the last four-to-five years, the reorientation of priorities in the health care system has been extremely observed. The system that was previously focused mainly on treatment is starting to place significant emphasis on cancer prevention, vaccination, the development of the public health sector, prevention of non-infectious diseases, and the promotion of a healthy lifestyle. One of the truly historic steps was the establishment of the Public Health Center and its development as an institution. This is a really important decision, which gave rise to the official recognition of the significance of issues and measures related to health protection in contrast to the old system when all resources in the health care system were directed at the provision of treatment services for clients. This event contributed to the formation of a broad regional system of public health facilities.
Evidence-based screening programmes have emerged at the level of primary health care for early detection of various diseases (for instance, colorectal cancer, prostate cancer, cervical cancer, diabetes, coronary heart disease) and at the level of tertiary health care in the form of priority service packages (mammography for the diagnosis of breast cancer, endoscopy for the diagnosis of cancer of the mucous membrane of the gastrointestinal tract and respiratory tract).
Local governments play an extremely important role in maintaining the health of community residents. After all, it is they who have information that in the center of the village there is a crossroad area where pedestrians are constantly hit by a vehicle (lack of controlled crosswalks), or there are Heracleum plants growing near the park and people with chemical burns caused by this plant are constantly hospitalized, etc. Another example can also be a local additional medicines supply programme, better access to examinations for the early detection of diseases, raising the level of nutrition and living conditions in educational institutions, organizing a system of healthy lifestyle education for the population, etc. For convenience, we include a link to the handbook containing expert knowledge about the development of regional and local public health programmes (http://surl.li/ajgkv).
And most importantly, remember that any disease is better prevented than treated and healthy people are the highest value for every community.