Public health management is the process of managing a complex system

Public health is the aggregate health of a society, which is made up of the many health and ill health of the individuals who make up that society. Both the health of each individual and the health of a population of people are assessed by specific indicators, such as life expectancy, birth rate, and morbidity. At the city level, we can talk about the health of the residents of that city, and at the national level, we can talk about the health of the nation. Everyone's health can be influenced, and public health will change accordingly. The main factors that shape health are lifestyle, environment, heredity and the health care system. If we influence these factors, then we change the overall health of people, public health. Some factors are easier to influence, such as lifestyle. Some of them are more difficult – for example, heredity. In order to achieve the desired result, it is necessary to correctly assess the current situation, have a realistic understanding of where we should move, and what tools we have at our disposal to get where we want, constantly monitor our movement and make the necessary adjustments. This cyclical process of evaluating, analyzing, selecting technologies, applying them, and evaluating results is called the process of public health management.

– In other words, it's system management?

In essence, public health management is the normal process of managing a complex system. This system has its own peculiarities, so the possibility of conscious and purposeful change of this system appeared at the beginning of the last century, in the form of social hygiene and the system, and tools for accurate management and comprehensive assessment of medical, social and economic factors have appeared quite recently.

– In your opinion, what should be a properly organized public health system?

A properly organized system is distinguished, first of all, by its predictability and controllability. Those who pay must understand what they are paying for. In fact, public health and its changes are paid for by society in the person of each individual, with specific money directed to social needs and health insurance. The same society delegates its powers to the authorities so that they formulate and implement the needs of society. In this way, we have a goal that shows how we need to change public health, what our priorities are.

We are moving towards these priorities from the state we are in. This is how we have the building blocks of the public health management system.

– Please tell us more about these blocks.

The first basic block is the family of international medical classifications. People usually think of classifications as something created and unchangeable—why discuss and improve them? But in the real world, it is a complex system that is actively developing and allows you to create a multidimensional model of the state of health of an individual and the overall health of society. The coordinates that are given in this case are the presence or absence of diseases and conditions, the degree of change in the functions of the human body, the location, action and technology used to change this state or function, and a number of other parameters. In essence, the international family of classifications is a language that allows us to discuss the medical, social and economic aspects of health, to create dynamic models of this health and the interconnections with other aspects of our existence, and this language is universal in all parts of our planet. Like any living or specially created language, the international family of medical classifications is constantly evolving, new connections are being established between its elements, new problems arise that need to be solved, and they are being solved. Without this language, it is obviously impossible to talk about any description, modeling, and forecasting of health or medical technologies – specialists, even those working in the same field, simply do not understand each other. The next blocks, which I have already mentioned, are monitoring, modelling and forecasting, on the one hand, public health (one block) and, on the other hand, the technologies that allow this health to be managed, primarily medical interventions (the other block). We can talk about each of these blocks for a long time, but it is important for us that they exist and are used in practice, although often without taking into account the interconnection that is necessary for an adequate understanding of the current and developing situation and effective decision-making.

The next few blocks, which also exist and are used as separate branches of medicine, relate to obtaining reliable evidence on the impact of medical technologies on health. These blocks include preclinical and clinical studies. The latter involve human subjects, and the information obtained in clinical trials serves as a justification for the admission of medical technologies to the market worldwide. Since each clinical trial focuses on a single disease and a small number of medical interventions to be compared, we will need to synthesize the data to get the full picture, first in the form of systematic reviews, and then in the form of clinical guidelines summarizing all available evidence and global experience in the treatment of diseases. At this stage, we accumulate as much information as possible about both the expected public health problems and the effectiveness of technologies that are supposed to solve these problems or reduce their consequences.

One more question remains: efficiency. Up to this point, we have not considered or been able to estimate the costs associated with solving these problems. And now it's time for another block – a comprehensive clinical and economic assessment of possible solutions. It has now become evident that no health system in general, and no health system in particular, has sufficient resources to meet all the needs that arise. Therefore, the question arises of modeling the health, social and economic consequences of financing a particular scenario as a tool for making management decisions in health care. Like all other blocks, the Clinical and Economic Analysis Unit has a developed and constantly improving methodology and methods of analysis and modeling, evaluation criteria and tools for checking the variability of the results obtained and their correctness.

- Yes, but that's a theory. But, it should be understood that the purpose of the public health management system is, first of all, its practical application?

How should this scheme work in practice? Assessment of the burden of disease, as a result of monitoring and, ideally, prognosis of public health, stimulates the development of medical technologies to combat the disease, methods of diagnosis, prevention and treatment. Analysis of the results of the use of medical technologies is a sequential chain of preclinical and clinical trials, generalization of international experience in systematic reviews and clinical guidelines in accordance with WHO requirements, comprehensive clinical and economic assessment and forecast of the use of these technologies and decision-making by the authorities, based on the scenarios proposed by experts. And then, as in any normal process, the cycle repeats. What is very important, and which, unfortunately, has not yet been achieved in any country in the world, is to make public health management proactive, i.e. not to correct problems that have already arisen, but to predict them and eliminate their causes.

– What should be the priority, what should be paid attention to first of all when creating a public health management system?

The main priority is to create a unified and consistent information flow between the blocks, which should make it possible to model and predict various scenarios of public health management with high accuracy and provide visual and effective tools to support the decision of the authorities. It is always necessary to remember about the separation of the expert component and the adoption of managerial decisions. Therefore, the next priority is to integrate the comprehensive expert assessment, which we have mentioned, into the decision-making system, which, on the one hand, will make it possible to shape the analysis process itself in accordance with the task at hand and, on the other hand, to convey the answer to the question received in an understandable form.