Sustainable Health Development Becoming Agenda for Public Health Academia

Abstract

Background:

Sustainable Development Goals (SDGs) aim to transform our world, and each goal has specific targets to be achieved by 2030. For the goals to be achieved, everyone needs to do their part: governments, academia, the private sector and all people. This paper summarizes the main evidence-based recommendations made by excellent academics and scholars who discussed their experiences and views during the conference to respond to the challenges of sustainable health development.

Methods:

To contribute to exploring to the academia’s role in reaching SDGs, the 1^st International Conference on Sustainable Health Development was held at Tehran University of Medical Sciences, on 24–25 April 2016, in Tehran, Iran.

Results:

In line with Goal 3 of SDGs: “ensure healthy lives and promote well-being for all at all ages”, the conference discussed various aspects of Universal Health Coverage (UHC), as well as Global Action Plans for prevention and control of Non-Communicable Diseases (NCDs), and explained the special role of academic public health institutes in education, research and service provision in the two above-mentioned areas.

Conclusion:

To fulfill the requirements of SDGs, modern approaches to funding, education, teaching, research priority setting and advocacy, which in turn need novel strategies in collaboration and constructive partnerships among academic public health institutes from low, middle and high-income countries, are essential.

Introduction

On 25^th September 2015, the United Nations approved a set of 17 goals and 169 targets to end poverty, protect the planet, and ensure prosperity for all as part of a new sustainable development agenda. These so-called Sustainable Development Goals (SDGs) aim to transform our world, and each goal has specific targets to be achieved by 2030¹. The Goals and targets are setting out a supremely ambitious and transformational vision to stimulate action over the next 15 years in areas of critical importance for humanity and the planet: people, planet, prosperity, peace and partnership². SDGs are the result of first consensus among world leaders reached across such a broad and universal policy agenda.

SDGs build upon the achievements of Millennium Development Goals (MDGs), approved at the beginning of 3^rd millennium to foster universal development. However, the progress towards MDGs has been uneven, particularly in less developed countries, where some MDGs remain off track, in particular, those related to maternal, newborn and child health and to reproductive health³. Seeking to complete what MDGs did not achieve, particularly in reaching the most vulnerable, SDGs envisage a world free of poverty, hunger, disease, fear and violence, and desire a universal literacy, equitable and universal access to quality education at all levels, to health care and social protection among all global citizens.

The new Goals and targets came into effect on 1 January 2016. It presents a good opportunity to bring all countries and citizens of the planet together to take the bold and transformative steps to shift the world on to a sustainable and resilient path, aiming to improve the lives of human beings anywhere they live, in a way that no one will be left behind. For the goals to be achieved, everyone needs to do their part: governments, academia, the private sector, civil society and all people.

Methods

We conducted document analysis to identify the main literature around UHC and NCDs in the format of SDGs and created a full report of the two days conference on sustainable health development. The final resolution was approved by scholars who attended the conference.

Results

Sustainable Health Development as the main agenda of academic public health institutes

To contribute to exploring to the academia’s role in reaching SDGs, the 1^st International Conference on Sustainable Health Development, was held simultaneously with Commemoration of the 50^th Anniversary of the Establishment of School of Public Health (SPH), Tehran University of Medical Sciences, on 24–25 April 2016, in Tehran, I.R. Iran⁴. In line with Goal 3 of SDGs: “ensure healthy lives and promote well-being for all at all ages”, appreciating the great need for more efforts to fully eradicate a wide range of diseases and address many different persistent and emerging health issues, and on the basis of the priorities of the health system of the Islamic Republic of Iran, the conference provided an opportunity to study and discuss various aspects of Universal Health Coverage (UHC), as well as Global Action Plans for prevention and control of Non-Communicable Diseases (NCDs), both of which are among the targets of SDG 3, and explain the role of research and higher education institutions in this regard. Attracting over 700 participants, the 2 days event accommodated six specific panels with 39 speakers from policy makers, managers, academics, and researchers at the global, international and national levels, who discussed in the presence of above 700 participants, the special role of academic public health institutes in education, research and service provision in the two above-mentioned areas.

A- The role of academic public health institutes in UHC

UHC and health services

Traditionally, many developing countries, and also a number of currently-developed countries, did not have a strong health system in place for provision of health services. Therefore, health-related academic institutes, i.e. SPHs were in charge of providing some health services to the public⁵. For instance, SPH at Tehran University of Medical Sciences has been in charge of conducting some specific viral and parasitology lab tests for the public. The gradual strengthening of health systems in many countries, has resulted a less prominent role for academia in service delivery, but a more pronounced focus on advocacy, community sensitization, i.e. community-based initiatives (CBIs) and promoting health in the societies. Because of ever-improving health technologies and the significant attention to financial risk protection and UHC, a number of countries have implemented a high cost approach to provide specialized treatment services. The conference covered three areas: A) UHC and Social Determinants of Health, B) Primary Health Care and UHC, and C) Essential Health Functions and UHC. The key question was whether these three issues have been properly addressed in the implementation activities of the world health systems in the area of UHC and possible ways that public health academia could address these.

The special role of academic public health institutes in capacity building of human resources and education

By definition, public health involves all aspects of prevention as well as all fundamental services, which have demographical dimensions. Conventionally, academic public health institutes have focused on the issues of promotion, primary prevention and primary health care, hence, leading UHC to deal mostly with primary prevention rather than palliation services. The panel addressed the role of academic public health institutes in providing health care, rehabilitation and palliative services, as well as the distinction between schools of public health and other higher education institutes in the fields of medicine, rehabilitation, and other disciplines. In addition, the appropriate structural model of academic public health institutes in addressing managerial and leadership aspects of SDGs was discussed, with special focus on the workforce needed for UHC.

UHC and research

Two topics of A) filling the gap between research and higher education institutions and the decision making environment and B) networking and areas of cooperation between academic public health institutes were the main topics of this panel. In fact, the differences between the decision-making environment and the academic environment are a well-known phenomenon, which has drawn global attention⁶. The discussion introduced successful models and shared experiences in this area, from the Eastern Mediterranean region, as well as other parts of the world. Finding mutual areas of interest for collaboration among academic public health institutes and agreeing upon practical ways to move this initiative forward, which was discussed in more details during the specific meeting of academic public health institutes of Eastern Mediterranean region as the side event on 3^rd day of the conference, was the main aim of this panel.

B- The role of academic public health institutes in prevention and control of NCDs

Role of academia in prevention and control of NCDs: identification, involvement and institutionalization

The academic public health institutes have an important role to play in prevention and control of NCDs⁷. However, the academic community has been sporadic and heterogeneous in terms of its interest and exposure to NCDs-related programs. It seems that it is more the individuals within the institutions, rather than the institutions themselves, who have been involved in NCDs-related research or policy drafting. This panel discussed the mechanisms for institutionalizing the ways that the individual NCDs’ focal points can work jointly together, so that the ‘NCDs academia’ becomes more recognizable and perceptible. Preparing the academic public health institutes to undertake greater responsibility in NCD-related works, especially when there is inevitable increase in attention and funding from the global, regional and the national agencies, was also discussed. In particular, the panel recommended the formation of a number of specialized research centers on NCDs, e.g. mental health, which could be affiliated with SPHs, to work on focused research and education on NCDs on below areas:

• Research, policy analysis and policy making

• Advocacy, partnership and leadership e.g. partnering with other stakeholders

• Support healthy lifestyle and reduction of major NCDs risk factors by incorporating health promotional activities in academic public health institutes’ endeavors, including community-based initiatives.

• Health system strengthening for early detection and management of NCDs.

NCDs and other sectors

NCDs are multi-factorial and their prevention and control needs strong multi-sectoral collaborations. This panel discussed the role of a wide range of stakeholders, i.e. ministry of health and other State ministries; academia; non-governmental and civil society organizations; private sectors; as well as external and international agencies, in prevention and control of NCDs and ways to strengthen their involvement in this regard.

NCDs and Environmental Health

Unsustainable environmental systems have a great impact on NCDs. SDG 3 has endorsed environmental health challenges as one important component of sustainable development. This panel provided an overview of environmental challenges, i.e. water scarcity, poor air quality, global warming, waste management, climate change, the link between environmental health issues and UHC, and the need for academic public health institutes to address such challenges to reach sustainable development.

Discussion

The resolution of conference: Together, geared up towards sustainable health development

In line with Sustainable Development Goal 3, the 2012 UN General Assembly Resolution on Universal Health Coverage (UHC) A/67/L.36, World Health Assembly Resolution WHA67.23 and WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020 (resolution WHA66.10), the 1^st International Conference on Sustainable Health Development approved a resolution in its final session.

The resolution⁴, which is meant to be a manifest for participating academic public health institutes in the conference, recognized:

1. UHC to deliver equitable opportunities for the highest attainable standards of physical, social and mental health;

2. The importance of non-communicable diseases (NCDs) in disabling and killing people, their considerable burden to peoples’ health, and the importance of having national, robust and evidence-based plans and policies for prevention and control of NCDs;

3. The specific and central role of academic public health institutes in provision of useful and need-based education, research and service to address the challenges of public health, as well as reach sustainable development;

4. The great need of reconsidering the role of academic public health institutes in the context of low-middle income countries to respond to the emerging challenges of public health;

5. That public health policies are only meaningful when they are translated into action by regulation, budget allocations, purchasing and procurement, monitoring, evaluation and supervision;

6. That global and national action is required to find a right solution to support priority settings for health that ensure alignment, participation, transparency, empowerment, nondiscrimination and accountability resulted by a synergistic collaboration of stakeholders.

The resolution called on all academic public health institutes across the world, and the global public health arena to:

1. Take progressive action to achieve the health related SDGs and their indicators by nationalizing the goals within their countries.

2. Facilitate exchange of faculty members, scholars and other researchers among different academic public health institutes in order to share and learn various experiences, as well as franchising a spectrum of projects and activities.

3. Develop, strengthen and sustain collaborative research on similar problems in different countries within a region and beyond it.

4. Deploy joint implementation of public health practices and interventions to enable governments to achieve UHC and program and implement national plans for prevention and control of NCDs.

5. Share best practices of each academic public health institute and contextualize them for integration into the health system.

6. Increase communication and exchanges regarding the SDGs to achieve a unified vision about the goals and indicators.

7. Assist and play a fundamental role in the interpretation of SDGs, i.e. UHC and NCDs in the context of their own countries.

8. Establish objective-driven networks to fulfill the above-mentioned vision.

Conclusion

Academic public health institutes must invest in transforming their conventional approach in research, education, advocacy and service provision, should they decide to play a meaningful role in reaching sustainable health development⁸. Multidisciplinary partnerships with communities, institutions, and policy-makers, is an essential step that academic public health institutes need to take for establishment of a sound basis for effective and sustainable solutions to priority population health challenges and related health system problems. As the global agenda for health by 2030, SDGs have created an evidence-based, universal and comprehensive platform for more meaningful multi-sectoral collaboration in this regard. Academic public health institutes should seize the opportunity to establish their role in backing sustainable health development within their home countries. This requires fundamental changes in the infrastructure, administrative skills, and leadership capacities necessary to empower faculty and staff, which may be fundamentally different from traditional approaches to address public health challenges.

Academic public health institutes must pioneer in finding innovative approaches to respond to the challenges of sustainable health development. This requires modern approaches to funding, education, teaching, research priority setting and advocacy, which in turn need novel strategies in collaboration and constructive partnerships among academic public health institutes from low, middle and high-income countries. The opportunity of SDGs has created a common forum to fulfill such a mission by the academic public health institutes from across the globe. With a motto of leaving nobody behind, and considering partnership as their core, SDGs should be effectively and cooperatively utilized by the academic public health institutes from all settings for improving the health and wellbeing of citizens of the planet through sustainable health development.