Código: SP 589

This book stresses the need to rediscover public health and give it its due as one of the most significant legacies in the history of mankind. Backed up with the works produced by the countries of the Region of the Americas on the Essential Public Health Functions (EPHF), and especially with the publication of these works, an attempt has been made to make health, and public health in particular, one of most important assets and spheres of citizen action in the new millennium. This book also summarizes the principal conceptual, methodological, and empirical developments stemming from the institutional efforts of PAHO and WHO, which have entailed the broad, committed participation of the member countries. Finally, it provides an overview of the status of the EPHF in 41 countries and territories of the Region, based on performance measurement exercises.

At the heart of this work, its leitmotif, is a three-pronged approach. The first prong is think-piece that allows us to take a fresh look, from the conceptual and analytical standpoint, at state and non-state public responsibilities—at current public health practice in the Americas- employing an effective problem-solving approach (Parts I and II). The second is the possibility of translating that conceptual framework into operational definitions, with great pragmatism that comes from the explicit definition and operationalization of the EPHF; this has made EPHF performance measurement by the health authorities of each Latin American and Caribbean country an exercise in self-evaluation (Part III). The third is the formulation and discussion of processes and instruments that will make it possible to move from measurement to action, identifying the strengths and weaknesses of each country, each subregion, and the Region of the Americas as a whole. This will lead to improvements in public health practice, leading the way to the promotion of institutional development and the strengthening of the public health infrastructure, considering methodological instruments for determining cost, budgeting, and financing (Part IV).

Part I, therefore, provides two gateways or points of entry that are especially important for the orientation of the work. These gateways consist of two chapters, one on the Public Health in the Americas Initiative and the other on strengthening the sectoral steering role of the health authority. Each offers complementary dimensions that intersect.

Part II deals with the conceptual renewal of public health, devoting its chapters to the diverse and complex environment from which this sphere of activity springs, is nourished, and develops. This section is fundamental for comprehending the historical path of public health, giving people from other fields and disciplines--and, of course, public health specialists and other health professionals--a better grasp of the importance of conceptual renewal in this field, the link between social practices and public health, and the origin and relevance of the concept and categories of the EPHF. For this reason, each chapter of Part II gives great importance to the concept of public health in an effort to move from theory to practice, constantly searching for linkages.

Finally, Part IV suggests some of the roads that will have to be taken, based on the knowledge obtained from this instrument. It leaves the door open to the possibility of developing new processes and tools to face the challenges emerging from this performance measurement exercise: the need to pay greater attention to the institutional development of the health authority, to the strengthening of the public health services infrastructure, and to the importance of improving knowledge about the financing, expenditure, costing, and budgeting of the EPHF. From here it arrives at the imperative and strategic value of resolutely promoting the development of the public health workforce with no stepping back and the possibilities offered by international cooperation in all these areas.

The book concludes with a discussion of strategic areas and lines of action for strengthening the public health services infrastructure in the countries of the Region, adding some thoughts in the hope of providing useful input to lay the foundation for a regional program to improve public health practice in the Americas.