El buen gobierno de la sanidadlas influencias debidas e indebidas en la formulación de políticas de salud

Abstract

New knowledge and acquired experience in the health field show that changes in public policies are needed in order to address present and future population health challenges. The increasing evidence on the effect that social determinants have on health has made public health workers turn their interest to public policy-making. The biomedical focus limits the social response to health problems to the provision of health care services, which are becoming more and more costly and complex. There is no doubt of the need to assure access to health care, but the provision of health services must not go beyond what is strictly essential and should not create unneeded medicalization and interventionism. The health promotion and prevention programs which target individuals, such as health information, have proved inadequate if they are not combined with wide-ranging policies designed to create healthy environments. Societies that aspire to health gains which contribute to the sustainability of health systems should direct their policies at the root causes of health problems. Strategies should be aligned with the recommendations of the report of the Commission on Social Determinants of Health of the World Health Organization. These guidelines promote population health through public policies at all government levels. However, the emphasis on the biomedical model as the response to health problems has been supported by the influence of interest actors, which in turn has hindered the emergence of public health approaches and the addition of social innovation in health policies. In line with the interest in public policies as a health determinant, there has been a growing academic interest in the external influences on decision-making and on how diverse circumstances impact on the governance of health policy and on the health of populations. Knowledge of who influences public health decisions and their strategies, either open or covert, has proved to be a key issue...