6. Public Health Infrastructure and Knowledge
John Powles, Flavio Comim
1. Institutional capacities
Public health activities require:
- Appropriate legal and regulatory frameworks to enforce public health measures
- Capacity to monitor and respond to changing patterns and determinants of disease
Public health activities have two prerequisites:
1. An appropriate legal and regulatory framework to enforce public health measures, in concert with the wider contribution of health-related civic organisations. Such institutional capacities - encompassing state and non-state actors - require political and social institutions to accord priority to collective measures to control disease. The political recognition of this priority will typically be supported by the perceived social and political legitimacy of public health endeavours. This legitimacy derives from the intrinsic importance of health to wellbeing, and from the importance of health to economic and social development.
2. The capacity to monitor and respond to changing patterns and determinants of disease. Just as national public health agencies are oriented in their tasks by systematic surveillance of trends, so too can they benefit from an appreciation of where their own country's health experience fits in relation to the experiences of countries in broadly similar circumstances. International public health surveillance performs this role but remains highly dependent on national surveillance capacities that have, in turn, their own institutional requirements. In middle- and high-income countries surveillance systems can be built on the foundations provided by comprehensive systems for the registration of vital events and of notifiable diseases. In low-income countries surveillance systems will be less comprehensive, but some effective system remains essential.