A total of 14 public health professionals who were previous presidents of the Spanish Society of Public Health and Health Administration throughout its history and since its founding in 1987, launched a joint manifesto in the face of the COVID-19 pandemic for the public health and the National Health System.
We are living in a historical moment which we have not experienced during the last 100 years of our existence. We feared isolation, death, and disease, but also recognized the need for treatment, social support, and research effort. Moreover, the real-time, continuous reporting of the media on the global infection status has contributed to our collective reactions.
COVID-19 is a highly infectious disease caused by a new virus possibly arising from a recent mutation. The diagnosis of the infection can be challenging; immune response is still being investigated, and specific treatment and vaccines are still under trial. Some patients were seriously affected and sustained a bad prognosis with a small chance of recovery. Everything started just a little over two months ago but the disease already affected the whole world. Undoubtedly, this is an exceptional period for our public health and our healthcare system.
Looking Back
Throughout our lives, we have shared special moments. Currently, we are experiencing a difficult political transition; by reviving a democratic society, by improving the people's living conditions and social protection, and by dealing with the dissents of terrorism. But in those years, we also experienced the consolidation of excellent professionals and modernization of the health system (creation of the Ministry, transfers to the autonomous communities, General Health Law, reform of primary care, and development of modern hospitals). All of these simultaneously happened during this phase.
The Spanish Society of Public Health and Health Administration (SESPAS) was created in 1987 comprising of the different existing professional and scientific societies of territorial or thematic scope. We are experiencing deep crises and discouragements, although we are also hopeful for the future. At this moment, we thought that it was convenient to share our point of view.
The Spanish Society of Public Health and Health Administration (SESPAS) was created in 1987 comprising of the different existing professional and scientific societies of territorial or thematic scope. We are experiencing deep crises and discouragements, although we are also hopeful for the future. At this moment, we thought that it was convenient to share our point of view.
People
The population has changed and improved in many ways. In the current crisis, the response of the people has been formidable with a sense of calmness, manifesting support for our professionals and imbibing patience as a virtue of the new norm.
However, this time can also be difficult since the point of view comes from different social, psychological, financial and emotional levels. As public health professionals, our main concern is the people, who are never a mere number. They are vital components in improving and modernizing our society.
During this COVID_19 pandemic, the general population who suffered are the ones who were admitted to the healthcare facilities and nursing homes. Unspeakable situations have been experienced in many of these centers. Over time, and with more information and perspective, we will be able to analyze in depth what has happened and the cause of it. But what we know today is terrible and it should be said clearly. At the same time, we must thank the caretakers of these centers, who have managed the situation in the best of their ability.
However, this time can also be difficult since the point of view comes from different social, psychological, financial and emotional levels. As public health professionals, our main concern is the people, who are never a mere number. They are vital components in improving and modernizing our society.
During this COVID_19 pandemic, the general population who suffered are the ones who were admitted to the healthcare facilities and nursing homes. Unspeakable situations have been experienced in many of these centers. Over time, and with more information and perspective, we will be able to analyze in depth what has happened and the cause of it. But what we know today is terrible and it should be said clearly. At the same time, we must thank the caretakers of these centers, who have managed the situation in the best of their ability.
Health Professionals
Professionals in the field of medicine such as doctors, nurse, auxiliaries, and support staff have brought out the best in themselves.
Professionals in primary health care, who have not recovered yet from the substantial effects of the pandemic, have been discreetly working efficiently to contain the impacts of the infection. Their role has been strong despite the insufficiency of protective equipment and diagnostic equipment, and despite facing the challenge in isolating infected and sick people at home with continuous monitoring and treatment in a caring and humane manner.
Similarly, the epidemiological surveillance teams of the public health services provided tremendous work. Despite scarcity of data, they have attempted to monitor the epidemic in its early phase, measured the progression supported by quantitative elements, assessed territorial differences, and evaluated the control measures adopted by the community.
Our hospital professionals were able to adapt to the current needs of the situation by creating new platforms to share information with people. They have also carried the burden emotionally to those who have critically suffered from the infection, which was an unforgettable scene to witness. Same goes to other professionals from other components of the system, such as emergency services and ambulances, fire and safety, and nursing homes. We can never thank them enough for their commitment in delivering services in these trying times.
Professionals in primary health care, who have not recovered yet from the substantial effects of the pandemic, have been discreetly working efficiently to contain the impacts of the infection. Their role has been strong despite the insufficiency of protective equipment and diagnostic equipment, and despite facing the challenge in isolating infected and sick people at home with continuous monitoring and treatment in a caring and humane manner.
Our hospital professionals were able to adapt to the current needs of the situation by creating new platforms to share information with people. They have also carried the burden emotionally to those who have critically suffered from the infection, which was an unforgettable scene to witness. Same goes to other professionals from other components of the system, such as emergency services and ambulances, fire and safety, and nursing homes. We can never thank them enough for their commitment in delivering services in these trying times.
National healthcare system
The articulation of our system
Our National Health System faced a difficult challenge and it responded to the best of its ability. However, some aspects should have been addressed to improve their capabilities in the soonest time.
First is the need to improve its financing which requires a general consensus, and priorities to be developed.
Second is the need to reinforce primary health care, which is the level of care that deals with the bulk of infection and disease, with resources that were deficient now compared to ten years ago. Likewise, at the initial phase, it will be necessary to immediately detect the cases and subject to isolation early and do contact tracing.
The precariousness of the epidemiological surveillance systems of the public health services has also been evident. In the new phase of the pandemic, its role will be crucial to control all risk of recurrence of outbreaks. Its staff must be improved in order to respond to these situations. The creation of the National Center for Public Health by the General State Administration provided for in Law 33/2011, of October 4, General of Public Health, with the planned regulatory development and the appropriate management structure, would probably help to better deal with these situations.
Finally, the point for coordination and consensus between the health ministries of the Autonomous Communities and the Ministry for public health need a more adequate framework. It will be necessary to see how to improve the structure for cooperation, coordination and consensus between the Ministries of Health of the Autonomous Communities.
First is the need to improve its financing which requires a general consensus, and priorities to be developed.
Second is the need to reinforce primary health care, which is the level of care that deals with the bulk of infection and disease, with resources that were deficient now compared to ten years ago. Likewise, at the initial phase, it will be necessary to immediately detect the cases and subject to isolation early and do contact tracing.
The precariousness of the epidemiological surveillance systems of the public health services has also been evident. In the new phase of the pandemic, its role will be crucial to control all risk of recurrence of outbreaks. Its staff must be improved in order to respond to these situations. The creation of the National Center for Public Health by the General State Administration provided for in Law 33/2011, of October 4, General of Public Health, with the planned regulatory development and the appropriate management structure, would probably help to better deal with these situations.
Finally, the point for coordination and consensus between the health ministries of the Autonomous Communities and the Ministry for public health need a more adequate framework. It will be necessary to see how to improve the structure for cooperation, coordination and consensus between the Ministries of Health of the Autonomous Communities.
Politics
Many aspects of our political situation can still be improved. The expression of natural discrepancies is often exaggerated and infuriating. In a context like the current one, it would be desirable for political leaders to focus on how to tackle problems rather than highlighting their discrepancies, which often end up being trivial and uncertain. Our health situation is similar to that of other countries, the difficulties of governments, and the proposals to stop transmission and manage the return to normality are also similar. The staging of the discrepancies appears to be noisy, emotional and dramatic which is unnecessary.
Moving Forward
There are a lot of uncertainties. It has affected us and will continue to affect us with vagueness that can lead to uncontrolled occurrences, eliciting pain and death that eventually restricts our lives and our economy.
It is time to thank our citizens for their exemplary behavior. Practices such as observing physical distancing, hand washing, compliance and adherence to measures promoted by the health authorities should be continued since it is vital.. We also thank the healthcare and support professionals, as well as those who work in pharmacies and supermarkets, who have contributed in attaining normality in the crisis. We also thank those who have professionally led the management of the situation in the Autonomous Communities, and in the Ministry's Center for Health Alerts and Emergencies, who in conditions of extreme difficulty and some fierce and inconsiderate criticism, have maintained a professional and analytical attitude.
It is also time to express our gratitude to the political leaders who looked after their fellow citizens, between cities or autonomous communities, , who acted with transparency, without bias and without promoting unease and discomfort among their people, and who seek spaces of consensus and avoiding conflicts to facilitate citizen trust.
The professionals who contributed here served in the SESPAS presidency. We want to express and share our conviction that we will overcome this moment, although with pain, but with the hope that it will serve to improve us as individuals and as a society. We have already gone through moments as difficult as the current one and, if we learn from our mistakes, we can better overcome them in the future.
It is time to thank our citizens for their exemplary behavior. Practices such as observing physical distancing, hand washing, compliance and adherence to measures promoted by the health authorities should be continued since it is vital.. We also thank the healthcare and support professionals, as well as those who work in pharmacies and supermarkets, who have contributed in attaining normality in the crisis. We also thank those who have professionally led the management of the situation in the Autonomous Communities, and in the Ministry's Center for Health Alerts and Emergencies, who in conditions of extreme difficulty and some fierce and inconsiderate criticism, have maintained a professional and analytical attitude.
It is also time to express our gratitude to the political leaders who looked after their fellow citizens, between cities or autonomous communities, , who acted with transparency, without bias and without promoting unease and discomfort among their people, and who seek spaces of consensus and avoiding conflicts to facilitate citizen trust.
The professionals who contributed here served in the SESPAS presidency. We want to express and share our conviction that we will overcome this moment, although with pain, but with the hope that it will serve to improve us as individuals and as a society. We have already gone through moments as difficult as the current one and, if we learn from our mistakes, we can better overcome them in the future.
Rafael Manzanera, Joan R Villalbí, Andreu Segura, Vicente Ortún, Carlos Álvarez-Dardet, Juan Cabasés, M. Dolores (Rula) Fiuza, José Ramón Repullo-Labrador, Beatriz González López-Valcárcel, Lluís Bohigas, Ildefonso Hernández-Aguado, Juan Luis Beltrán, Joan Clos y Josefa Cantero, que han servido en algún momento en la presidencia de la Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS)
May 2020
May 2020
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