Effective public health systems must be built on more than health protection finds HIQA report

Date of publication:

The Health Information and Quality Authority (HIQA) has published a report on the configuration and reform of Public Health systems in selected countries. The high level review was undertaken to support the work of the Public Health Reform Expert Advisory Group in Ireland.

The COVID-19 pandemic has caused additional disease burden and mortality, impacted mental health and wellbeing, and delayed investigations and treatment of non-COVID cases. Governments around the world are considering how to strengthen Public Health systems to prepare for future pandemics. HIQA's report aimed to assess how other countries have designed their Public Health systems and the lessons these countries learned following the COVID-19 pandemic.

HIQA reviewed evidence from 12 other countries. In most countries reviewed, all functions of Public Health were strategically managed at the national level. Often, one national body or agency managed several Public Health functions, however, some specific functions, such as community engagement and health promotion, were managed at a regional and local level. In all cases, transparent governance and communication about who is responsible for each Public Health function were found to be important for ensuring a sustainable and comprehensive Public Health system.

HIQA noted that having a clear link between the scientific evidence and the decision-making process was a vital element in all countries. HIQA also noted that countries with robust IT infrastructure already in place (for data collection, surveillance and linkage) faced a smoother transition when the pandemic started. Establishing processes for evidence synthesis and creating a robust IT infrastructure during periods of relative stability can allow countries to have a faster response during a pandemic or emergency.

Michelle O'Neill, HIQA's Deputy Director of Health Technology Assessment, said: "Public Health is often reduced to just health protection, but we found when we examined other Public Health systems that the other pillars of Public Health (that is, health promotion and wellbeing, health intelligence and health service improvement) are vital in preventing health inequalities. As systems go back to "business as usual", these other pillars must also be strengthened."

You can find the report at the link below.

Further information:
Marty Whelan, Head of Communications & Stakeholder Engagement
01 814 7480/085 805 5202, mwhelan@hiqa.ie

Notes to Editor:

  • HIQA has today published the following documents to inform the work of the Public Health Reform Expert Advisory Group: 

    • Protocol – High level review of configuration and reform of Public Health systems in selected countries
    • Evidence summary – High level review of configuration and reform of Public Health systems in selected countries
    • Appendix - High level review of configuration and reform of Public Health systems in selected countries
  • On 25 January 2022, the Minister for Health in Ireland established the Public Health Reform Expert Advisory Group (EAG). The Public Health Reform EAG is seeking to identify international best practice and lessons learned regarding the systems and structures that deliver core Public Health functions, with a view to recommending an appropriate operating model to develop and oversee the delivery of Public Health in Ireland.
  • The functioning of Public Health systems was considered in the context of the 12 Essential Public Health functions (EPHFs) as defined by the World Health Organization (WHO).

    • The 12 Essential Public Health functions relate to: surveillance; emergency management; governance and regulation; planning and financing; health threats; disease prevention; health promotion; engagement; adequate workforce; quality and access; research; and medicines access.
  • A search was performed to identify and describe the configuration of the Public Health systems for the following countries selected for inclusion in this review:

    • Australia, Canada, Denmark, Finland, Netherlands, New Zealand, Norway, Sweden, England, Northern Ireland, Scotland and Wales.