Tumultous Times and Pressing Strategic Choices for National Public Health Institutes

The National Public Health Institutes (NPHIs) are facing a multitude of challenges in the aftermath of the COVID-19 pandemic, including climate change, war and conflict, migration, lifestyle associated diseases, aging populations, and financial challenges – alongside a challenge of misinformation throughout. At the same time, medical and technological advances continuously change the game.

An online survey with 14 explorative questions was sent to members of the IANPHI Europe Regional Network of the International Association of National Public Health Institutes (IANPHI) on March 24, 2023. Fourteen out of 39 members of the IANPHI Europe Network replied. The preliminary survey results were discussed in the IANPHI Europe Regional Network meeting on April 20-21, 2023, followed by a webinar on November 8 open to all IANPHI Members.

Almost all answering NPHIs were in charge of their own strategy process, but for most of them, the strategy was approved by a superior external governmental body, such as the country’s Ministry of Health. These topics were among the most important triggers and drivers for the strategy revision and developments: the COVID-19 pandemic, financial, political, shifts in society, epidemiology and health, climate and environment, technological developments, and internal factors. Asked about the top strategic questions, these issues were highlighted: purpose or mission, role, situation analysis, organisational structure, quality, technological advances and taking lessons learned from the pandemic forward. On priority tasks, a range of topics were listed, some of which were: health security, preparedness, and response, including vaccine preparedness; non-communicable diseases (NCDs), including obesity, and child and adolescent mental health; climate, environment, and health; one-health, migration, social inequalities, and aging. From a more overarching perspective, there were recommendations for moving from individually lifestyle-oriented interventions towards systems-level change and shifting more towards preparedness and prevention efforts. Other factors mentioned were social factors and determinants of health, new technologies, health security, research, organisation of public health, the workforce and funding and financing.

At the IANPHI Europe Regional Network meeting, the challenges that the institutes felt least prepared for were related to the following themes: trust and information, including how to retain trust by citizens and politicians, and how to rebut disinformation; the relationship to policy and politics, both on dealing with inconsistencies and uncertainties in politics and on challenges in translating knowledge into policy; decreasing budgets; workforce capacity, developing and retaining competent staff; and cross-sectoral work and collaboration across disciplines and sectors.

At the webinar open to all IANPHI Members, many of the same topics and issues as in the Europe network meeting, were raised by the presenters showing that the findings from European NPHIs are recognizable in other geographical regions as well. Challenges on development and retainment a high-quality workforce were highlighted in the ensuing discussion.
The last five years seem to have created more dynamic developments than previous five-year cycles. These tumultuous times have brought forward new or intensified fundamental strategic questions for the NPHIs to deal with. Three of them are:

• What should the role of the NPHI be in the national and international public health architecture? What functions can best be placed in an NPHI? The revised list of essential public health functions, and the IANPHI and World Health Organization (WHO) co-published document Application of the essential public health functions: an integrated and comprehensive approach to public health may be a guiding document.
• How can we redefine the relationship between NPHIs and key national partners, and especially: politicians and government, society and the media, academia, and the private sector?
• How can we get the priorities between the big agenda items right? How best to balance between pandemic preparedness, NCDs, public health effects of climate change, and inequalities of health to name a few?

The findings summarized in this report can be useful for NPHIs in their strategic work and for IANPHI in how to best support institutes in Europe and beyond.

Read the report here