Improving the World's Health through National Public Health Institutes
Koplan, Jeffrey P., Puska, Pekka, Jousilahti, Pekka, Cahill, Kathy, Huttunen, Jussi, Bulletin of the World Health Organization
Globalization is as applicable to health issues as to those of trade and economics (1). The increased frequency of travel, distribution of goods, migration, spread of communications and marketing of new lifestyles have promoted a set of risks and health challenges shared by all countries of the world, despite their varied resources, levels of development, demographics and other important considerations (2). The ability of any one country to solve these new challenges on its own is increasingly difficult and certainly inefficient.
In many countries, health authorities have established scientific entities that serve as national resources to prevent and control health problems through research, interventions or the development of policies. There is an increasing tendency to merge these entities and develop more comprehensive public health institutes to deal with the various issues from a public health perspective. We describe the current nature and status of such national public health institutes (NPHIs) and consider the elements that might make them increasingly effective in preventing disease and promoting health in an increasingly interdependent world.
An NPHI is an organizational unit of a national government health ministry (not of a state or province), which serves the whole country as a source of technical public health expertise and would be the unit called upon to respond to public health threats. The institutions listed in the co-authorship of this paper were selected by their ministries of health as meeting these criteria, although in some countries several organizations share roles and responsibilities for different health threats. The distinct, complementary entity of an NPHI is symbiotic with other functions of a ministry of health. Where the ministry is responsible for overall policy, legislation, budgets, curative programmes, etc., the NPHI can provide expert advice and carry out public health programme implementation, disease and risk factor monitoring and surveillance, outbreak investigations, research, and health promotion and education. Advantages of the NPHI include the assembly of a stable mass of expertise, continuity of experience, and the scientific knowledge and appropriate human, technical and financial resources to tackle public health challenges; it is a scientific organization without political affinity.
The oldest of the participating institutes is Brazil's FIOCRUZ (established in 1900); Finland's KTL is over 90 years old, and the CDC in the United States, is over 50 years old. An institute was established in Bosnia and Herzegovina in 1999 and the Chinese Academy of Preventive Medicine was reorganized and renamed as the China CDC in 2002. The size of the institutes varies greatly, from a few hundred workers (Algeria 140 and Pakistan 250) to several thousand (Brazil 6500, China 2400 and the United States 8000).
The scope of public health activities of each institute also varies but most of them work on infectious diseases--including immunizations, vital statistics, health promotion, chronic diseases and risk factor surveillance--environmental health and safety, and health services research. Some of the institutes have academic roles; for example, the NPHI of Mexico (Instituto de Salud Publica) educates students enrolled in masters and doctoral degrees. All the institutes have varying emphasis on research, service and regulation. Some, such as Mexico's ISP and France's INSERM, are predominately research focused. If service or the promotion of health is the primary mission, considerable research, mostly applied, is performed to direct and improve that service, e.g. Finland's KTL, the US CDC and Brazil's FIOCRUZ. Many have a major research focus and a supplementary service role, as at the China CDC.
Almost all the NPHIs are supported by their national government in the form of an annual budget, the amounts being a reflection of the size and overall income and expenditure of each country and also the roles that the institute is expected to play. …