PUBLIC HEALTH SCHOOLS IN SAUDI ARABIA : A NECESSITY OR A LUXURY?
No one can argue the urgency when an anesthetist, a surgeon, a nurse or a hospital bed is required to deal with a simple case of appendicitis. Prompt access to all the expertise and resources cannot be considered a luxury to the patient, his family or the society. These are reasonable demands for the sick. These needs are addressed by governments by building hospitals, training or employing skilled nurses and doctors at all levels and with various specialties from abroad. Surprisingly, that urgency is absent when the maintenance of the health of the entire public is discussed. The preference for curative and emergency measures instead of the preventive will continue to dog our heels and be the major reason for relegating public health activities to an inferior second place. The cause of the matter is that when long and short-term plans are being made for the delivery of health care for the whole community there seems to be no inclination to strike a proper balance between long and short-term goals. Ad hoc decisions are taken in reaction to a problem with no thought or attempt at making projections for possible future problems.
Public health or what was called community medicine, is a medical specialty in which the entire public or society is the benefiting costumer. It is defined by the Royal Faculty of Public health in UK as "The science & art of preventing disease, prolonging life & promoting health through organized efforts of society."1 The three key domains of a good public health practice overlap and their implementation requires well-planned and professionally coordinated action of all concerned authorities in the society to ensure a healthy life for the people .The reason for placing preventive medicine at the fore of Public Health practice is not simply to sway policymakers or health providers towards health promotion. It seeks also to harness all available epidemiology and research information on health risks and problems and systematize them into proper preventive, curative and promotive measures. This could be done by ensuring that the necessary regulations are adhered to and prompt action is taken to reduce the suffering of the community and reduce the burden of diseases.
The urgent need for public health practice in Saudi Arabia
Developing countries, including Saudi Arabia , are struggling to ensure a healthy life for its population. This struggle however, is mainly related to the continuous drain of health resources to deal with the ever-increasing demand for costly curative health services. Saudi Arabia is experiencing enormous changes in its social and economical structure. The growth in the economy of the country has led to major changes in the demographical, social structure of the population and a rapidly changing pattern of health problems. Life expectancy has increased dramatically, and the birth rate remains one of the highest in the region. The continuous presence of hereditary and infectious health problems in certain areas in the country (malaria in the south, Dengue fever in the west and congenital blood diseases in the east and south), has been compounded by the emergence of new acute and chronic infections ( such as avian influenza, rift valley fever and resistant types of tuberculosis). Additionally, such morbidities as diabetes mellitus (type II), hypertension, cardiovascular diseases, road traffic accidents and various types of cancers resulting from sedentary unhealthy life-styles are reaching alarmingly high rates. Furthermore, Saudi Arabia is expected to face new challenges with the continuing demand for health care for such special groups as the handicapped, geriatric population and the increasing number of pilgrims visiting the Islamic holy places in the country. To cope with all these challenges simultaneously a reform of the health system that is cost-effective as it is of high standard is necessary. The present, curative-oriented health system in the country can only partly deal with these problems. What is required is a well-defined public health act as well as policies to promote a holistic approach to all aspects of old or new health problems. Undoubtedly, new problems are to be tackled with systematic organized public health measures and good public heath practice. Public health policies have to be well formulated with measurable objectives and strategies that address these issues by means of preventive programs, and work with curative services to ensure better health for all.
The case for public health schools and training
Needless to say, there should be enough experts in various public health fields to plan suitable programs and take the necessary measures. All levels of public health workers including public health teachers, public health practitioners and public health technicians are to be well-trained in health planning and decision making in various public health fields. They should be integral to all health delivery sectors. Physicians must be adequately tutored in social and behavioral science, epidemiology, biostatistics & health systems. Disease surveillance should be understood and professionally practiced by all involved in curative and preventive care in order to control old, infectious and non-infectious diseases.
Hence, there is an urgent need to strengthen national public health system and determine appropriate measures to encourage on the job teaching and training in Saudi Arabia .
A quick look at the available undergraduate medical schools and postgraduate medical programs in Saudi Arabia or in the Arab world, reveals a huge shortage of trained physicians and the urgent need to rectify this situation. The number of practising public health doctors in this vast country is far below the ideal. They require better training and work opportunities to transfer their science into action.2
To address this shortage, it is necessary to involve the universities and health ministries in the country as real partners in establishing public health schools and institutes at the undergraduate and postgraduate levels and initiating public health training programs with the clear mission to promote the teaching and practice of public health and decision-making. This partnership is key to the success of practice in public health and the guarantee for a real impact on the health of the nation. The suggested model is that of The Centre of Disease Control in Atlanta , USA , a government agency which is in partnership with many universities and public health schools and departments in the country. After all, the resolution of issues of public health requires resources from both academic and service industry in the community to make public health policies feasible.
2. Milaat W. Public Health around the World: Saudi Arabia . Public Health Medicine 1999; 1:34-8.
Waleed A. Milaat
Department of Family & Community Medicine
Medical College, King Abdulaziz University
Jeddah, Saudi Arabia