Essential public health functions: the key to resilient health systems

Increased mortality and morbidity from non-COVID-related causes were seen in many countries,4 with an estimated 15 million excess deaths associated with the COVID-19 pandemic in 2020 and 2021 alone.5 6 The impact on livelihoods and society has also exacerbated social inequities and negatively impacted on mental health,7 while misinformation has undermined trust in health services.8 Throughout the pandemic, national structures with responsibility for the delivery of public health, including national public health institutions (NPHIs), were key for the rapid development of diagnostics, strengthening of surveillance systems, and the synthesis and generation of evidence to inform policy and practice.9 However, NPHIs in many countries have a broad range of responsibilities in addition to communicable disease control, including health promotion and tackling inequality, and there is a risk that these functions will be neglected if political priorities in the recovery phase focus exclusively on health protection. To this end, there has been renewed attention and focus on essential public health functions (EPHFs), with the WHO proposing a unified list of 12 fundamental activities in 2021 (box 1).10Box 1 Unified list of essential public health functions Public health surveillance and monitoring: monitoring and surveillance of population health status, risk, protective and promotive factors, threats to health, and health system performance and service use. Health protection: protecting populations against health threats, including environment and occupational hazards, communicable and non-communicable diseases including mental health conditions, food insecurity, chemical and radiation hazards. During COVID-19, emergency funding for the health response was substantial, and subsequent commitments to strengthen preparedness have eclipsed anything previously available (eg, pandemic fund initiative; the Independent Panel for Pandemic Preparedness and Response; the global accord on pandemic prevention, preparedness and response).14 15 However, the question remains whether the resolve demonstrated during the crisis to be better prepared for future pandemics will be translated into building more resilient health systems that are sustainably funded at levels which can accelerate progress towards universal health coverage and improved population health and well-being, as well as strengthening health security.