3 June 2015 – Welcome address at the Second International Conference on Public Health "Health promotion: integrated life cycle approach"

Kasr Al Ainy Faculty of Medicine, Cairo University

Dean of the Faculty of Medicine Cairo University, Professor Fathy Khodeir; Conference President, Professor Maissa Shawky; Section Chief, Child Survival And Development, UNICEF Egypt, Dr Magdy El Sawady; distinguished professors and colleagues, ladies and gentlemen.

Good morning, and welcome.

Firstly I would like to thank the Faculty of Medicine of Cairo University for organizing this important event. While walking in I was reminded by the Dean that this university is 180 years old. It has a long and strong history in public health. I attended the Public Health conference last year, and we are grateful to know that this conference will now become an annual event.

Health promotion is often not given the attention it deserves and is sometimes thought of as an add on to core health areas, but its importance should never be underestimated. 

Globally we are experiencing unprecedented societal transformation as a result of population growth and urbanization together with environmental and other changes. In most countries, the number of people aged over 60 years is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates. In Egypt we face an even larger challenge with a fertility rate that has actually increased.  In 2013 there were nearly 6.5 million older people in Egypt, almost 8% of the population, and this will only increase. 

In the light of these changes, new approaches are required to address the broader determinants of health. Promoting health through the life course is becoming more important than ever before. 

An important element of assuring health through the life course is universal health coverage, which not only includes curative, palliative, preventive services, but also health promotion.

The Egyptian Government has recently made clear movements towards making Universal Health Coverage as a priority objective for health sector development and health system strengthening which I find very promising. 

Historically, Egypt has been challenged by a low public investment in health, with large out-of-pocket expenditure. This has resulted in a large private sector and in turn has led to three serious market failures in health: poor safety and quality of services; inequity in health service utilization; and a lack of investment in prevention.

However, the commitment of the new Constitution approved in January 2014 to nearly double government spending from 1.5% of gross domestic product to 3% provides a valuable opportunity to improve health systems and work towards achieving universal health coverage. 

As the government proceeds with its commitment to increase health expenditure, I strongly recommend that it concentrates its spending on the areas where the market has failed. One of these areas is of importance for you here today – a lack of investment in prevention and health promotion. 

Because of our previous lack of focus on prevention Egypt is now faced with overwhelming challenges such as the enormously high use of tobacco products and the alarming growth of shisha consumption. Shisha smoking is taking over restaurants where we are all exposed to second hand smoking. And despite what some say, when looking around it is clear to me that many of these shisha smokers are women. As health promoters it is our responsibility to change behaviours so that Egyptians act in the interest of better health for themselves, their families and the wider community. 

Because that is what health promotion is – positively changing behaviors. It is not just about making interesting marketing campaigns, ‘raising awareness’ or increasing knowledge. It needs to go two steps further changing attitudes, and especially changing behaviors.  

Health promotion needs to have a strong and scientific foundation; a clear communication and evaluation strategy to ensure that it will have a true and measurable impact. 

Unfortunately, too often in the past we have focused on developing health promotion products without assessing their effectiveness. For example, in Egypt we have a one of the best in-depth training program, curriculum for infection control and trainers. Despite this, we still see an estimated 100,000 to 150,000 new hepatitis C infections ever year, the majority of which come from health facilities. 

We have to ask the question – is this health promotion program really working?  Has it changed knowledge, attitude and more importantly behavior? If not, why not? 

Or does the program not meet the right coverage in the fragmented health system of Egypt, and does it need to be expanded well beyond the Ministry of Health and Higher Education health care facilities?  Have we covered all the services, such as dental services and pharmacies?

How do we make health promotion effective? The first step is to ensure that health promotion is focused on the needs at hand. Scientific research is required to first understand where knowledge gaps lie and identify areas requiring change. 

Next, we need to monitor and assess health promotion activities to confirm that activities are actually having an impact, and are changed when they are not. I really believe that universities can play an important role in the research and monitoring that is required to make health promotion work. 

So as you participate today and tomorrow in this workshop I would like you to keep in mind the importance that research and evaluation have in effective health promotion. 

There is no doubt that the public health environment is changing, and a life course approach will require even more from you as health promoters. We will need to find innovative ways to make sure that our work is as effective as can be.

Lastly I want to mention something that became even more apparent to me recently. We must carefully consider the communications methods we use to ensure they reach our audiences.  The other day I saw my family all staring at their mobile devices at the same time. This is the way things work now, and mobile health is more important than ever. Recently we had a mission to Egypt on H5N1, and they discovered that messages around the prevention of bird flu were transmitted on TV stations that only very few people watch anymore! The mediums in which we communicate need to considered carefully.

With this, I wish for you all a successful workshop and truly hope that you gain some positive outcomes for health promotion in Egypt.