Public Health Profession

The greatest challenge in the development of universal health systems worldwide is to increase organization, training, and regulation of the health workforce (HWF). To accomplish this, the World Health Organization (WHO) has pointed out several strategies utilized since the beginning of the 2000s. One of the world regions with the greatest internal HWF disparities is the Americas, more specifically Latin America and the Caribbean. Brazil is another of the countries in this region that presents great inequities in its HWF distribution, although its Unified Health System (Sistema Único de Saúde, or SUS), created after 1988, is one of the largest universal health systems in the world. It is worth noting that Latin America, the Caribbean, and Brazil historically have high levels of social inequality and have recently become regions severely affected by the COVID-19 pandemic. Despite some advances in the formation and distribution of HWF in Latin America and the Caribbean in the last 10 years, structural problems persist in the health systems of several countries in this region, such as Brazil. The COVID-19 pandemic aggravated some problems such as the distribution of specialized health workers in intensive care units and the precarious working conditions in several public health services that were organized to face the pandemic.

In the first decades of the 21st century, despite major medical advances, women in the least developed parts of the world are dying in childbirth far more often than women in wealthier nations, and their children are far more likely to die before reaching age 5. The major reason for this is that healthcare in these areas lacks its foundation: basic primary maternal and child healthcare (MCH). Two early examples of primary MCH care showed that the high death rates for mothers and children could be reduced substantially at low cost: David Morley’s Under-Fives Clinic in Western Nigeria, which began in the 1960s, and the Aroles’ Jamkhed Project in Maharashtra State in India, which began in the early 1970s. The lessons learned from these two early projects were also highlighted as principles at the Alma Ata International Primary Care Conference in 1978. They included: 1. Integration of basic curative care with the various aspects of promotive/preventive care, the former building the trust required for full acceptance of the less-understood aspects of the latter, such as immunizations, family planning, and exclusive breastfeeding during the first six months of life. 2. Heavy reliance on well-supervised lower-level health workers (including community health workers) to reach entire target populations. 3. Reliable delivery of a limited formulary of common, low-cost medical supplies and medications. 4. Partnerships among government ministries of health, education, and finance with communities and with local, national and international non-governmental organizations, and, 5. Gradual buildup as the health system and the communities enhance their capacity to support the work, so that success builds on success. It is past time for building primary MCH and eventually total population-based care systems everywhere. The first and biggest benefit will be in least developed societies, where the present rate of preventable mother and child deaths is unconscionable.

Occupational health and safety concerns classically encompass conditions and hazards in workplaces which, with sufficient exposure, can lead to injury, distress, illness, or death. The ways in which work is organized and the arrangements under which people are employed have also been linked to worker health. Migrants are people who cross borders away from their usual place of residence, and about one in seven people worldwide is a migrant. Terms like “immigrant” and “emigrant” refer to the direction of that movement relative to the stance of the speaker. Any person who might be classified as a migrant and who works or seeks to work is an immigrant worker and may face challenges to safety, health, and well-being related to the work he or she does. The economic, legal, and social circumstances of migrant workers can place them into employment and working conditions that endanger their safety, health, or well-being. While action in support of migrant worker health must be based on systematic understanding of these individuals’ needs, full understanding the possible dangers to migrant worker health is limited by conceptual and practical challenges to public health surveillance and research about migrant workers. Furthermore, intervention in support of migrant worker health must balance tensions between high-risk and population-based approaches and need to address the broader, structural circumstances that pattern the health-related experiences of migrant workers. Considering the relationships between work and health that include but go beyond workplace hazards and occupational injury, and engaging with the ways in which structural influences act on health through work, are complex endeavors. Without more critically engaging with these issues, however, there is a risk of undermining the effectiveness of efforts to improve the lot of migrant workers by “othering” the workers or by failing to focus on what is causing the occupational safety and health concern in the first place—the characteristics of the work people do. Action in support of migrant workers should therefore aim to ameliorate structural factors that place migrants into disadvantageous conditions while working to improve conditions for all workers.