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Anales de la Facultad de Ciencias Médicas (Asunción)

versión impresa ISSN 1816-8949

An. Fac. Cienc. Méd. (Asunción) vol.53 no.3 Asunción dic. 2020 


Public Health is not the matter of medicine; it is other way around

1Ministerio de Salud y Bienestar Social, Dirección General de Vigilancia de la Salud, Dirección de Vigilancia de Enfermedades No Transmisibles (DGVS). Asunción, Paraguay.

2Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Cátedra de Salud Pública y Administración Hospitalaria. Asunción, Paraguay.

The SARS-Cov2 pandemic have showed our health system’s precariousness. This expression-which was repeated many times during 2020-also shows us how late we can be well aware of a concern that would be chronic and historical. Only after the public health world wide’s cataclysm, we had elaborated in a slightly more decisive way and put it on everyone’s mouth that “something we should change the health system of this country.” Before that, subsequent dengue epidemics; increasing silent epidemics such as diabetes; cancer; car accidents; violence, social inequalities; and an increasing number of premature deaths related to the accentuation of unhealthy lifestyles, one of the highest rates of maternal and infant mortality in the region, they were never sufficient to ignite a process of constructive questioning, capable of coordinating an actual desire for the health system’s reform.

States with higher health indicators than ours are scrutinizing their radical changes in health systems. During the pre-pandemic stage in Paraguay-where perhaps it had been pondering over the same issue-is perhaps the greatest dilemma to find with more underlying layers that helps to begin this needed process.

The reform of the health system, however, is not consisted only in structural changes in the Ministry of Public Health. It must be understood that a health system reform is not carried out without reforms in different but concomitant areas, e.g., social protection; tax system, economic market models and labor rights. This reform cannot be carried out without establishing environmental priorities with impacts on health; without establishing compensation models for the population health when deciding public policies. There is no health system reform if there is no strengthening or reorientation of research and innovation of medical supplies; in medications; and without innovative procedures and knowledge in health. There will be no cardinal changes if we do not implement an educational reform towards a more comprehensive model, and neither will speak if there are no changes towards a better quality of the higher education.

On that last point, I must emphasize that there is gap at the national level for an elite academic place for discussions of the country's public health. A think tank in public health. Public health is the sleeping beauty among all the subjects of various undergraduate university degrees. There are a variety of specialization courses in public health, as well as more and more master's degrees on the same subject. However, none of those degrees are system transforming agents because they are not a source or controller of new or old facts; therefore, they are incapable of generating critical mass that rethinks the model. It is unsustainable to continue understanding and reproducing public health as a matter of medicine, when public health is just the opposite, which includes medicine in the same way that it includes other fields of bio-ecological, social, administrative, economic, and political knowledge.

It is needed to acknowledge that the University requires a National School of Public Health, in which professors of various knowledge areas from different universities are integrated. It is imperative that those who dedicates themselves to teach and research in public health interact among their peers from other areas and specialties, since public health is that, it is transversal, and it is the soul of the passage of research processes of different specialties and universities.

Public health is the best element to translate population needs to researchers and vice versa.

In the Southern Cone, countries such as Brazil, which had created the Unified Health System for almost 30 years ago, or more recently the Uruguayan Integrated Health System, which has a undergoing reform for 15 years, they completely understood that in addition to multiple reforms required in health, it is essential to shape a critical mass of professionals from various knowledge areas who comprehends the system model, its limitations; its gaps; its contradictions, in order to continue accompanying the country’s population processes that continuously offers tremendous challenges; urgent and emerging issues; complex resilience processes, which compels us to adapt in the smartest way possible, to give precise answers based always on scientific evidence.

The National Institute of Health of the Ministry of Health-a minor character as a School of Public Health, currently-can be a central component in confronting this national need. Although it is closely linked to the political momentum, it will not to move forward with solid steps if there are no institutional peers with whom to discuss, compete, and create. That signifies that if there are no universities, colleges, or other schools of public health in the country, the road to failure will be the most likely. Additionally, the assesment, criticism, and discussion of what governments are doing in the management is always better if they are conduct from autonomous and academic organizations, such as universities.

We need more researches and researchers in public health, as well as centers that bring them together; that each team conducts its research lines and development, and that those centers can turn into places of training for new health professionals. The current model of "package classes", in which each professor does not work jointly with other colleagues, only maintains and reproduces new health professionals’ inability of generating responses in accordance with the complexity of public health issues.

It is more than categorical that it is time for a health reform, and that among a variety of reforms that must be carried out in order to strengthen the process, the university must be conceived as leading and responsible for being the foundational source of that very necessary critical mass in order to later sustain and continue advancing in the long-term construction of the novel health system that all we want.


1. OECD (2019), Estudio multidimensional de Paraguay: Volumen 3. Del Análisis a la Acción, Caminos de Desarrollo, OECD Publishing, Paris, ]

Received: November 16, 2020; Accepted: November 18, 2020

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