By Marwaan Macan-Markar
BANGKOK, Aug 8 2005 (IPS)

Public health experts from the developing and developed world are calling on governments to pursue remedies for global health problems with a new vision rather than going by a ‘disease-based’ approach.

Fundamental to such a perspective is a greater stress on developing public health initiatives that involve many sectors, including local communities, they said in a concerted push to go beyond the conventional and narrow biomedical responses.

That message is expected to shape discussions underway here for the the Sixth Global Conference on Health Promotion, running Aug. 7-11.

A broader vision is pivotal to meeting new challenges that have emerged over the past two decades, like health inequalities, weak health systems and the ”rise of chronic diseases and the risk factors,” said Catherine Le Gales-Camus, assistant director general of the World Health Organisation (WHO).

”The fundamental premise of health promotion is that a wide spectrum of actors, representing all sectors of society, must engage in promoting health if the goal of ‘health for all’ is to be achieved,” she said Monday at a gathering of close to 700 health experts from over 100 countries.

”Tackling today’s systemic population issues requires working at community, national and international levels,” said a paper co-authored by Colin Butler of the Australian National University presented during a session on ‘Emerging Health Issues’.

”Linkages should be strengthened between the health sector and civil society, including those struggling to promote development, human rights, human security and environmental protection,” the paper said.

Not only must health-promotion transcend the health sector, but, increasingly, it must also ”engage beyond national boundaries,” Butler’s paper said.

Yet, this push to broaden the public health debate will not be easy going by some of the arguments that were made during the multiple sessions of this conference on Monday.

Indeed, delegates admitted that this has been the case even after the health promotion idea was embraced at the first international health promotion conference in Ottawa, Canada, in 1986.

Among the principle ideas that came out of that gathering was a shift towards a more preventive approach to health, with stress on initiatives that enhance healthy living.

The Ottawa Charter, which was endorsed at that meeting, also called for a public health approach that would enable people to ”increase control over and to improve their health”, a background note said.

”It also built on new types of health programmes in the developed world that moved beyond a focus on individual risk behaviour towards ‘making the healthy choice the easier choice’ through a wide range of environmental and social interventions”.

Impediments in the way of that ideal have included the continuing ”commercialisation and privatisation of global health,” said Ilona Kickbusch, an international health policy expert from Switzerland.

”(This has) introduced a biomedical and technological bias and often stands in the way of building sustainable health systems,” she said.

”The belief that the free market will deliver good for everybody will not work, particularly for health,” Butler, told IPS. ”It will only benefit a minority and for a short time”.

Health, he added, must be seen as a ”public good” and not a ”private good”. What is more, a shift towards the broader health promotion approach than the biomedical approach would be ”affordable and cheaper in the long run,” he added. ”You can never get it by emphasising health as a private good”.

Yet, even in a country like Thailand, seen in many quarters as having a progressive approach to public health, funds from the central government to the periphery for preventive programmes are still wanting.

”There still is a trend here towards acute care rather than health promotion. The limited budget from the central government towards health promotion reflects this,” Dr. Pisit Wechakama, director of a community hospital in Thailand’s north-eastern Ubon Ratchathani province, told the conference.

That, he added, was due to the bias among policy makers that ”health promotion funding must wait till all infectious diseases are overcome”.

It is a reality that leaves communities in the developing world vulnerable to health crisis that could have been prevented with the foresight of a health promotion approach, said an expert from the Americas.

”This is a weakness in the developing world, health systems lacking in readiness and not being able to draw on the strengths of an intersectoral approach,” Carissa Etienne, assistant director of the WHO’s office for the Americas, told IPS.

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