Based on research by Jose Manuel Jerez Pombo, Cecilia Price and Leo Petersen-Khmelnitski

The Sustainable Development Goals (SDGs) are the 17 global goals set up by the United Nations in 2015 which provide a blueprint for peace and prosperity, for both people and planet, now and in the future. They call for global partnership to achieve the inter-related goals around inequality, poverty, health, education, economic growth and more – but where does public health come in? The role of public health in society can be characterised into three levels: elimination of existential threats, treatment and diagnosis of disease, and health maintenance/disease prevention.

LEVEL 1: ELIMINATION OF EXISTENTIAL THREATS

On a first level, public health is essential as a deterrent to existential threats. In our increasingly globalised world, the fear of pandemics predates COVID-19 and previous warning signs have already manifested themselves in the form of Sars-Cov-1 in 2003, Ebola in 2013-2016, and Zika in 2015. Though these are all viral, antibiotic resistant “superbugs” are thought to be the largest epidemic threat in the future, considering the weak output of antibiotic pipelines and rising antibiotic resistance. At this level, epidemic threats are continuously being monitored and predetermined action plans are established at both national and international levels, thus requiring cross-boundary coordination. Other existential concerns that are non-communicable in nature include food and drug safety, as products that hit the shelves have the potential to put millions of consumers at risk without the appropriate safety regulations.

World Health Organisation regards immunisation as an indisputable human right. WHO states also, that vaccinations constitute a key component of primary healthcare, being one of the best health investments. Vaccinations play an important role in global security.

With regards to vaccinations, the role of public health may be defined along the following functions:

Vaccination is historically the most cost-effective intervention in reducing child morbidity and mortality – both in low- and middle-, as well as in high-income countries. While establishing a causal link between immunisation and child mortality is challenging, UNICEF estimates that vaccination may save up to 3 million children each year, and measles vaccinations alone may have been responsible for averting over 23 million deaths between 2000 and 2018.

LEVEL 2: TREATMENT AND DIAGNOSIS OF DISEASE

On a second level, public health’s role is that of creating the necessary environment to treat and/or cure disease, which includes a component of screening and diagnosis (secondary prevention).

In this stage, public health strives to provide the necessary tools (treatments, health centres, workforce, screening technologies) to identify illness as soon as possible and treat it in the most effective manner.

Treatment of disease is split in two branches, curative and palliative, the former attempting to improve health by providing a cure, the latter by providing relief when the cure is not achieved or not achievable.

LEVEL 3: HEALTH MAINTENANCE AND DISEASE PREVENTION

Finally, on a third level, public health strives to maintain and promote people’s health, as well as to prevent disease, by curbing non-existential, yet harmful, threats to health and encouraging healthy behaviour (primary prevention).

This level is the most complex of the three, as unlike the first and second, it does not have a defined target (to contain infectious disease, to treat a specific disease), but instead requires a holistic view of health and all its inputs such as behaviour (e.g. physical exercise), nutrition, mental health (e.g. work-life balance), and so on. This is a cross-sectoral endeavour that requires collaboration with other areas such as education and urban planning, and due to its complexity it is the level of public health where emerging/new technologies such as Big Data and AI have the most potential.