National Institute of Public Health Development of Global Health in Mexico Miguel Ángel González Block Nelly Salgado Laura Magana Lisa de María

Global Public Goods Local, national and international values of global health significance Disease control Best practices International health regulations Universal human rights Validated knowledge

Local, national and international values of global health significance

Disease control

Best practices

International health regulations

Universal human rights

Validated knowledge

The virtuous circle of global public goods Local public goods Malaria control Equity policy Regional public goods Malaria elimination Equity legitimation Global public goods Prospect for malaria eradication Universal human rights

Local public goods

Malaria control

Equity policy

Regional public goods

Malaria elimination

Equity legitimation

Global public goods

Prospect for malaria eradication

Universal human rights

Outline A marriage of convenience: the early history of public health education and research in Mexico Capacity building: the Foundation of the National Institute of Public Health Strategic Alliances and global leadership Conclusions

A marriage of convenience: the early history of public health education and research in Mexico

Capacity building: the Foundation of the National Institute of Public Health

Strategic Alliances and global leadership

Conclusions

Global institutions in the formative period Social institutions to address orphanage The Balmis expedition: the first global, vertical public health campaign Pasteur’s influence in Mexico: scientific advice at the margin of power

Social institutions to address orphanage

The Balmis expedition: the first global, vertical public health campaign

Pasteur’s influence in Mexico: scientific advice at the margin of power

Pasteur’s influence in Mexico: scientific advice at the margin of power Consejo Superior de Salubridad First international conferences Dr. Eduardo Liceaga

Consejo Superior de Salubridad

First international conferences

Foundations of modern public health in Mexico School of Public Health of Mexico. 1922 Rockefeller collaboration 1920´s-1950s The era of vertical campaigns: 1950s-1970s

School of Public Health of Mexico. 1922

Rockefeller collaboration 1920´s-1950s

The era of vertical campaigns: 1950s-1970s

Godparenthood and social capital = =

Religious cults to address epidemics and floods

The Balmis expedition: the first global, vertical public health campaign

A marriage of convenience

The School of Public Health 1922-1987

Capacity building: the Foundation of the National Institute of Public Health

Center for Public Health Research (CISP) in 1984 Generate the evidence base for the structural reform Scientific excellence and relevance Public health research and training generation, reproduction, and transfer of knowledge on health conditions and social response at the population level Attracted young scientists for the development of a critical mass in research Greater acceptance by the Establishment International support through Scientific Advisory Committee

Generate the evidence base for the structural reform

Scientific excellence and relevance

Public health research and training

generation, reproduction, and transfer of knowledge on health conditions and social response at the population level

Attracted young scientists for the development of a critical mass in research

Greater acceptance by the Establishment

International support through Scientific Advisory Committee

Pillars of institution building The conceptual base The production base The reproduction base, and The utilization base

The conceptual base

The production base

The reproduction base, and

The utilization base

The National Institute of Public Health: 1987-2000s Strengthening of public health research 170 researchers High specialty model Health sector fragmentation New challenges with decentralization

Strengthening of public health research

170 researchers

High specialty model

Health sector fragmentation

New challenges with decentralization

New Challenges, Strategic Alliances and Global Leadership

At the threshold of a new era Combination of challenges and opportunities Growing interdependence raised the visibility of public health threats An unprecedented investments in global health development agenda security agendas New public and private actors Extraordinary opportunities for relaunching institution building in public health Innovative responses to current realities, both at the global and the local levels Global movement to establish, expand, and strengthen NPHIs Key components of the institutional architecture for improving health system performance in developing countries

Combination of challenges and opportunities

Growing interdependence raised the visibility of public health threats

An unprecedented investments in global health

development agenda

security agendas

New public and private actors

Extraordinary opportunities for relaunching institution building in public health

Innovative responses to current realities, both at the global and the local levels

Global movement to establish, expand, and strengthen NPHIs

Key components of the institutional architecture for improving health system performance in developing countries

Diversity, complexity, and change Diversity between and within different geographical areas Poverty, exclusion, and discrimination WHO Commission on Social Determinants of Health Complexity triple burden of ill-health biomedical and communications technologies new managerial innovations new financial formulas health care as a fundamental human right renewed tendency of vertical programs Change from standardized, pre-packaged interventions towards matching global solutions to local needs Policy making moving from technical and highly hierarchical approach towards recognizing new actors and processes in a political and participatory environment.

Diversity

between and within different geographical areas

Poverty, exclusion, and discrimination

WHO Commission on Social Determinants of Health

Complexity

triple burden of ill-health

biomedical and communications technologies

new managerial innovations

new financial formulas

health care as a fundamental human right

renewed tendency of vertical programs

Change

from standardized, pre-packaged interventions

towards matching global solutions to local needs

Policy making moving from technical and highly hierarchical approach towards recognizing new actors and processes in a political and participatory environment.

New Alliances Globalization is changing public health perspectives on the origin and scale of risks Role and importance of national and local capacities to respond effectively to them National and local public health authorities are now being called to re-build their capacities to respond to multiple risks, ranging from natural disasters to pandemics and bioterrorism Scale of risks varies from localized problems to rapidly spreading global threats New capacities to co-ordinate health sector responses effectively shape interdisciplinary teams respond at both the national and global levels relate government and civil society organizations

Globalization is changing public health perspectives on the origin and scale of risks

Role and importance of national and local capacities to respond effectively to them

National and local public health authorities are now being called to re-build their capacities to respond to multiple risks, ranging from natural disasters to pandemics and bioterrorism

Scale of risks varies from localized problems to rapidly spreading global threats

New capacities to

co-ordinate health sector responses effectively

shape interdisciplinary teams

respond at both the national and global levels

relate government and civil society organizations

Capacity limitations to engage in balanced collaboration North and South Cross-national, comparative health systems analyses are led mostly by institutions in the North Bibliometric analysis found that 74% of all international health systems research publications are led by high-income country authors Seven countries concentrate 60% of the papers led by developing country institutions Authors from institutions in the United States and the United Kingdom concentrated between them as many as 68% of the papers led by high-income countries Predominance of technical capacity from the North and in a handful of developing countries when addressing global public health issues

Cross-national, comparative health systems analyses are led mostly by institutions in the North

Bibliometric analysis found that 74% of all international health systems research publications are led by high-income country authors

Seven countries concentrate 60% of the papers led by developing country institutions

Authors from institutions in the United States and the United Kingdom concentrated between them as many as 68% of the papers led by high-income countries

Predominance of technical capacity from the North and in a handful of developing countries when addressing global public health issues

Role for National Institutes of Public Health in the South Imperative to participate and lead in regional and global networking mechanisms Institutional development should be based on the relative advantages of partners to lead research, training, surveillance, and health system development efforts Advantages could be assessed on the basis of technical capacities as well as on the closeness to problems of national and global significance Well balanced and reciprocal collaboration across institutes in the North and South, and particularly the capacity to network across neighboring countries and regions in the developing world.

Imperative to participate and lead in regional and global networking mechanisms

Institutional development should be based on the relative advantages of partners to lead research, training, surveillance, and health system development efforts

Advantages could be assessed on the basis of technical capacities as well as on the closeness to problems of national and global significance

Well balanced and reciprocal collaboration across institutes in the North and South, and particularly the capacity to network across neighboring countries and regions in the developing world.

Health status evaluation and analysis Public health surveillance, problem investigation, and risk control Prevention and health promotion Social participation in health Planning and management Regulation and enforcement Evaluation and promotion of equitable access to necessary health services Human resource development and training Quality assurance in personal and population-based health services Public health research 11. E mergency and disaster mitigation Core NPHI functions correspond with essential public health functions

Health status evaluation and analysis

Public health surveillance, problem investigation, and risk control

Prevention and health promotion

Social participation in health

Planning and management

Regulation and enforcement

Evaluation and promotion of equitable access to necessary health services

Human resource development and training

Quality assurance in personal and population-based health services

Public health research

11. E mergency and disaster mitigation

International Association of National Public Health Institutes (IANPHI) Global initiative dedicated to creating, strengthening and linking national public health institutes to improve the scientific basis for public health policies and programs. IANPHI links today over 60 national public health institutes globally, Scientific focal points for ministries of health Critical mass of skills and knowledge to provide leadership for protecting and enhancing the public’s health

Global initiative dedicated to creating, strengthening and linking national public health institutes to improve the scientific basis for public health policies and programs.

IANPHI links today over 60 national public health institutes globally,

Scientific focal points for ministries of health

Critical mass of skills and knowledge to provide leadership for protecting and enhancing the public’s health

The International Association of National Public Health Insitutes (IANPHI) Objectives Develop an internationally accepted NPHI Framework and a Toolkit for use in assessing and guiding the development of NPHIs Work collaboratively with low-resource countries to strengthen existing NPHIs and to create new ones Increase public health advocacy and knowledge Create a new international community of public health leadership Improve the health of populations by helping to create and strengthen NPHIs and fostering an international community for NPHI leadership development, peer assistance, and public health advocacy.

Develop an internationally accepted NPHI Framework and a Toolkit for use in assessing and guiding the development of NPHIs

Work collaboratively with low-resource countries to strengthen existing NPHIs and to create new ones

Increase public health advocacy and knowledge

Create a new international community of public health leadership

What is a NPHI? A science-based organization or network of organizations Provides national leadership and expertise Multi-faceted organizations that include people with a wide range of skills and experience Perform critical public health functions A trusted source of counsel for policy- and decision-makers Part of the government (usually under the Ministry of Health) or closely attached to it

A science-based organization or network of organizations

Provides national leadership and expertise

Multi-faceted organizations that include people with a wide range of skills and experience

Perform critical public health functions

A trusted source of counsel for policy- and decision-makers

Part of the government (usually under the Ministry of Health) or closely attached to it

Core attributes of a NPHI National scope of influence National recognition Limitations of political influence Scientific basis for programs and policies Focus on the major public health problems affecting the country Adequate human and financial resources Adequate infrastructure support Linkages with key organizations Accountability

National scope of influence

National recognition

Limitations of political influence

Scientific basis for programs and policies

Focus on the major public health problems affecting the country

Adequate human and financial resources

Adequate infrastructure support

Linkages with key organizations

Accountability

Conclusions International efforts to establish solid health research systems are yielding positive results in many developing countries Rich array of institutions Networking is proving its value Research systems cannot be conceived in isolation given diversity, complexity and rapid change Alliances are critical for institution-building efforts Institutions are vehicles whereby human beings mobilize their talents, values, and interests towards the pursuit of shared goals National and networked institutes will be key players in launching the new era of public health

International efforts to establish solid health research systems are yielding positive results in many developing countries

Rich array of institutions

Networking is proving its value

Research systems cannot be conceived in isolation given diversity, complexity and rapid change

Alliances are critical for institution-building efforts

Institutions are vehicles whereby human beings mobilize their talents, values, and interests towards the pursuit of shared goals

National and networked institutes will be key players in launching the new era of public health

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Binder S, Adigun L, Dusenbury C, Greenspan A, Tanhuanpää P. National public health institutes: Contributing to the public good. J Public Health Policy. 2008 ; 29:3–21.

Birn, AE. A marriage of concenience. The Rockefeller Foundation and Revolutionary Mexico. Rochester, Rochester UP, 2006.

Bossert T Larrañaga O Giedion U et.al (2003). Decentralization and Equity of Resource Allocation: Evidence from Colombia and Chile. Bulletin of the World Health Organization , 91, 95-100.

Bruce M. Altevogt, Andrew M. Pope, Martha N. Hill, and Kenneth I. Shine (Eds.). Research Priorities in Emergency Preparedness and Response for Public Health Systems. A Letter Report. Committee on Research Priorities in Emergency Preparedness and Response for Public Health Systems. Washington DC, Institute of Medicine, 2008.

Frenk, J. La Nueva Salud Pública. México, 2004

Frenk J & MA González Block, Institutional Development for Public Health: Learning the Lessons, Renewing the Commitment. Commentary. Journal of Public Health Policy (2008) 29, 449–458.

Garret L (2007). The challenge of global health. Foreign Affairs , 86, 14-38.

Gonzalez-Block M.A, Leadership, Institution Building and Pay-Back of Health Systems Research in Mexico. Draft, INSP 2008.

Gonzalez-Block M.A, The state of international collaboration for health systems research: what do publications tell? Health Research Policy and Systems 2006, 4: 7. http://www.health-policy-systems.com/content/4/1/7

Hutton G (2002). Decentralization and the sector-wide approach in the health sector. Basle, SDS.

Irwin A Valentine N Brown C et. at. (2006). The Commission on Social Determinants of Health: Tackling the Social Roots of Health Inequities. PLoS Med 3(6): e106 doi:10.1371/journal.pmed.0030106 .

Molineux D Nantulya V (2004). Linking Disease Control Programmes in Rural Africa: A Pro-Poor Strategy to Reach Abuja Targets and Millennium Development Goals. British Medical Journal 328: 7448 1129 – 32.

Rodríguez-López MH. Commentary. A perspective from Mexico. J Public Health Policy . 2008;29:26-31.

Soberón G, Frenk J, Sepúlveda J. The health care reform in Mexico: Before and after the 1985 earthquakes. Am J Public Health. 1986;76:673-80.

Unger JP De Paepe P and Green A (2003). A code of best practice for disease control Programmes to avoid damaging health care services in developing countries. International Journal of Health Planning and Management , 18 , S27-S39.

WHO 1996. Investing in Health Research and Development. Report to the Ad Hoc Committee on Health Research Relating to future interventions Options (document