Public health failures in the 20th century

• Autor(a) principal: Leiras, Gisela
• Data de Publicação: 2019
• Outros Autores: Perez Duque, Mariana, Ribeiro, Martin, Lourenço da Silva, Renato, Ferrinho, Paulo
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.25761/anaisihmt.347

Introduction: the 20th century is characterized for its considerable developments in the public health sector. Notwithstanding those important accomplishments, this review aims to depict the unsuccessful endeavours of that period.  Materials and method: a narrative review of the literature was carried, organised by topics and by the consultation of informative sources provided by experts in public health. Nominal group technique was applied by the authors in the inclusion, selection and analysis of collected evidence.  Results and discussion: five domains can be identified in order to achieve an adequate practice of public health: evidence, evaluation, risk assessment, health policies and planning.  The failures in public health identified across the 20th century can be explained by the lack of informed decisions made on evidence and impact assessment; on risk assessment, with double burden on communicable and non-communicable diseases; on health policies, oriented toward health determinants; and on sustainable planning.  Transversely, the absence of effective communication hampered the early identification of failures in the 20th century. The miscommunication between planning, health policies and several social sectors can be highlighted, particularly in the political-economic sector. The process of decision making and the answers to public health issues were by reaction and ad hoc actions, aggravated by the scarce evidence available at the time.  Conclusion: the lack of financing for plans and programs focused in health promotion, and of investment in the development of salutogenesis competences and the fight against iniquities in access to health delayed and prevented the objectives outlined for the 20th century. Those will be some of the biggest challenges for public health in the future.