Can the COVID-19 pandemic leave us something good? Many in the scientific community believe so. That after so much destruction it can achieve that for the remainder of the 2020s, health and public health are taken seriously and placed at the center. The Ministry of Health has planned a total reform of the system in that direction, to make it “cutting edge”. It is included in the Recovery, Transformation and Resilience Plan to receive European funds, which already has the approval of Brussels. The jewel in the crown is the creation of a State Center for Public Health. It would be a center conceived as an autonomous institution, but linked to Health, with the participation of the communities. To manage, but also for the analysis, study and advice of health policies. Its characteristics remain to be remembered.
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The Government reserves about 80 million euros of European money for “increasing the capacities of the health system”. Within that there are many items (for example, a new hospital in Melilla, or the independent evaluation of the pandemic that is being prepared). Strengthening the public health system has three main legs. On the one hand, the development of a public health strategy, which was already included in the Public Health Law of 2011, which was drawn up after the 2009 influenza A pandemic but which was barely covered. On the other, the promotion of the epidemiological surveillance network. And finally, the creation of the State Center. We have been talking about the latter for a year, since the times when Salvador Illa was the head of the Ministry. The intention, according to sources close to the development, is for its regulations to be ready by 2021, although it may come into operation in 2022. Of the 80 million that go to these policies, at first there was talk of five million for the Center.
Months of previous work
The Spanish Public Health Society (SESPAS) has been working on designs for months, and meets with the Ministry regularly on this matter. Their own finished proposal will be presented in September. “All the organizations, in the United States, in Europe, we are thinking about this. Because historically, public health has been the Cinderella of biomedicine. This should change for two things: because we want to be better prepared for the next crisis; and because we are understanding that health includes protection, prevention and treatment “, explains Manuel Franco, SESPAS expert.
Franco expands that prevention is a value that had been somewhat forgotten: “Treatment is the most expensive, you have to do it when there is already illness, and it is when you have already been to the hospital. If you invest in public health and care primary education, we have protection and prevention. Part of what has happened to us in Spain is because we thought that any public health problem could be fixed with health, with hospitals, “he summarizes.
The characteristics will not only depend on the Ministry of Health or the experts. “We will see to what extent we can influence, and then this has to go through the Economy, the Presidency …”, says Ildefonso Hernández, also a spokesman for SESPAS and who was General Director of Public Health from 2009 to 2011. In Spain there is already a National Surveillance Network Epidemiological, which belongs to the Carlos III Health Institute (Ministry of Science and Ministry of Health) and that above all, before COVID, worked for the control of seasonal flu. The Network is also dedicated to scientific research, the appropriate thing would be to promote its epidemiological side, they say from SESPAS. There is also the Center for the Coordination of Health Alerts and Emergencies, which is directed by Fernando Simón. It would not disappear, it would be complementary.
“A center like the one you want to create seeks to bring together all public health intelligence. Not only about communicable diseases, which is what the CCAES detects in its alerts, but about all health problems and their determinants. From infectious, to it is the one of the CCAES, until for example to analyze the childhood obesity “, synthesizes Hernández. “It seeks to grease and reinforce things that are already being done. But it has to be modernized and more agile”, synthesizes Manuel Franco. There are several examples, some of the most mentioned, the Robert Koch Institute of Germany, the Department of Public Health of Georgia (USA), and, for more specific parts, the UKSHA agency of the United Kingdom, on health security; the Nice, an advisory body; or even the European Center for Disease Prevention and Control (ECDC) itself. “Each one has usable characteristics.”
How many people, and where?
The idea that is drawn from the Ministry and the experts is that the Center is also a point of contact with the centers and institutions of the European Union, especially with the ECDC, and also with the World Health Organization. And an institution with so many aspects is also a generator of jobs. How many people should work there? It is also something to be defined. “The German center has more than 1,000 people”, points out Ildefonso Hernández, “but it is a kind of Carlos III Health Institute, with a very large part of scientific research”. What is projected for here is halfway between something as big and something as small as the CCAES, which is barely made up of a score of officials. It also has to play a fundamental role in the training of new epidemiologists and experts in public health, all emphasize.
And finally, where? Experts in conversations with the Ministry believe that this is going to be the most conflictive point, in which there may be more discrepancies with Health. “The idea is for it to be a networked center, with many competencies and capacities distributed throughout the State – according to Ildefonso Hernández – so it does not have to be in Madrid. In fact, it would be better if the coordinating headquarters is not in Madrid, we believe which is good for several reasons: for the territories to feel part of the network, for sustainability policies, for the problems of emptied Spain … the communities have here to say their part “. That would imply that he is also outside the Ministry physically. The CCAES is located on the fourth floor of the Ministry, on the Paseo del Prado in Madrid. Moving away from there could give an image of more independence, they think from SESPAS.