EDITORIAL

Public Health: a new section in Educación Médica^a

Salud Pública: nueva sección de Educación Médica

Andreu Segura

Public Health, not being a new denomination for the health care financed with public resources, is often subjected to a kind of fetishist utilization when dealing with health policies. This perverse utilization constitutes a rhetoric trick of the political discourse, a litany that as a panacea could transform instantly the Spanish health system from one of the best into a dangerous and uncertain environment. But Public Health is also a way to look at the problems and needs as well as the solutions and improvements in health. In fact, if Public Health has any unique trait this is the population approach to deal with the health problems and interventions.

Public Health (PH) has different meanings¹. According to one of them, PH constitutes a component of the health systems in charge of providing collective services to populations and communities, specially health protection (sanitation and disease prevention) and health promotion services, by which the citizenship should improve its health status, something different than just avoiding illness. Health promotion under the limited perspective of Health Education has recently been analyzed and recommendations have been advanced by an expert group in Spain².

Usually, PH services include the epidemiological surveillance and epidemic outbreaks control and, sometimes, the function of support to the sanitary planning, through the analysis of the importance of the problems of health and determining theirs, and, undoubtedly, of their vulnerability to the interventions.

Although some specialists in Occupational Medicine manage to consider PH like a branch of its specialty, there is not doubt that the occupational health is one of the genuine fields of application of PH, not only for historical reasons but especially because working environment is one of the basic environments in which we, the human beings, live.

But public health also can be understood broadly as the organized efforts of the society to improve, to sustain or to reinstate the health of the populations, so that medicine would be included in this definition, with many other professions and disciplines; undoubtedly the pharmacy and the veterinary science with the nursing -as traditional sanitary professions recognized in the law of ordering of the sanitary professions beside the odontology, the dietetics, the podiatry and the physiotherapy- although, given the importance of the determiners biological, environmental -from the point of view of the geographical environment-and cultural, the biology, as well as the ecology and the psychology, the anthropology, the demography, the sociology or the economy and also, the jurisprudence, the urban planning or social policies provide indispensable elements for the interventions of the PH. Without forgetting the most instrumental disciplines among which the epidemiology -that it is born of the public health directly - stands out the statistics, the computer science or the social communication.

It occurs then that PH can be seen as a variegated and complex multidisciplinary and even multiprofessional set, so that it has been proposed a process of reconstruction of the many professions implied in order to illuminate a new global and integrated perspective, an approach difficult to bring in practice in a society polarized towards specialization.

However, the existence of a professional association like the Spanish Society of Public Health and Sanitary Administration (SESPAS)³ intends to accommodate and, in a certain way, to facilitate the convergence of so many disciplines and professions under the common interest of improving the health of the population and, because of that, also of the health system.

The fortune of PH in the sanitary rhetoric does not correspond with the allowance of resources that the health systems attribute it and which in the set of the countries of the OECD⁴ it is estimated that it comes to mean one 2’9% of the health budget, that in Spain it would be on 1’3% of the ordinary expense, in which the cost of the vaccines of the official calendar is included.

Either it is much flattering the attention that the plans of studies of the university careers in health sciences exempt for it, nor the significance that it has in the area of the training postgraduate with great difficulty seventy posts accredited of MIR by year. Some it is that other specialties are still worse stopped, as it occurs it in the Family and Community Medicine that, orphan of knowledge area, does not order of chairs nor of University departments own. Although, how it is obvious, the occupation of educational structures has a right sense -in the society as a whole rather than in the corporative one -- in so far as it implies bringing knowledge and solutions, which can be made, how the doctors of family have demonstrated, from out of the university.

But perhaps the little interest of the students for whom, in general, the public health continues being one of the "marías" (marginal subjects) of the curriculum, in spite of its frequent changes of name, from the denomination, is still more worrisome more rancid than classical, of hygiene, to the formulations of community health, social medicine, preventive medicine and so many other that have trained. A lack of interest which it not seems to have increased substantially with the incorporation of instrumental subjects like the statistics and the epidemiology, even though its use in the sanitary and clinical research is increasing.

Nothing of this is foreign to the evolution of the public health in the sanitary systems and, particularly in its traditional subjection on the structures of the governmental administration, the one that, among other things, has blocked an independent professional development. So, from the point of view of the professional exercise as⁵ well as of that of its learning and the organization of the training, the public health is immersed in a formidable crisis that, how, it always implies multiple opportunities, some of which the development of the European space is from upper education⁶.

Nowadays, the potentiality of the public health as a stimulus for the re-orientation of the health is not at all despicable, configuring a terrain that, in the context of uncertainty about the same feasibility of the sanitary systems, can not stop being explored⁷. Appraisal that some distinguished public health scholars for which a too narrow relationship with the sanitary assistance would be the embrace of the bear that it could bury do not share definitively the population prospect of the public health⁸.

The new section which the magazine has decided to create has among its purposes describing and analyzing the training that about the different aspects of the public health is at present provided to the professionals of the several "health sciences" (education of postgraduate course and continued) and the students of the different sanitary qualifications, particularly in relation to the proposals of competences that the scientific societies have developed⁹; fostering the research of key questions, like the reasons of the motivation and of the lack of motivation of the trainees in health sciences, or the frequency and the quality of the experiences associated with the intervention and with the evaluation in the area of the community health that they provide original material to be published, or if the training and the training of the researchers through the programs of postgraduate course it combines effectively the social significance with the scientific excellence¹⁰ and, of course, to bring up proposals of development of the public health as a delivery substantive of the education of the students and the professionals of the "health sciences". Serve, then, this paper as call for the authors who wish to share their experiences and appraisals in any of the areas of the formation of the public health.

^a. Thanks are due to Ildefonso Hernández and Fernando G. Benavides.

Bibliografía

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2. Consejo Interterritorial del Sistema Navional de Salud. Formación en Promoción y Educación para la Salud. Madrid: Ministerio de Sanidad y Consumo, 2003. (Informe de un grupo de trabajo).

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