SoP-Oct2006

Handbook of WMA Policies
World Medical Association ½ S-1995-04-2006

WMA STATEMENT
ON
PHYSICIANS AND PUBLIC HEALTH
Adopted by the 47th
WMA General Assembly, Bali, Indonesia, September 1995
and revised by the 57th
WMA General Assembly, Pilanesberg, South Africa, October 2006
1. Physicians and their professional associations have an ethical and professional res-
ponsibility to act in the best interests of patients at all times. This involves collabora-
tion with public health agencies to integrate medical care of individual patients with a
broader promotion of the health of the public.
2. The health of a community or population is determined by several factors that go be-
yond traditionally understood causes of disease. Classically defined determinants of
health, aside from the genetic and biological constitution of individuals, include fac-
tors that affect behavioural lifestyle choices, factors that affect the physical, psycho-
social and economic environments in which individuals live, and factors that affect the
health services available to people. Public health traditionally involves monitor-ing,
assessing and planning a variety of programs and activities targeted to the identi-fied
needs of the population, and the public health sector should have the capacity to carry
out those functions effectively to optimise community health. The key functions of
public health agencies are:
a. Health promotion:
1. Working with health care providers to inform and enable the general public to
take an active role in preventing and controlling disease, adopting healthful
lifestyles, and using medical services appropriately;
2. Assuring that conditions contributing to good health, including high-quality
medical services, safe water supplies, good nutrition, an unpolluted atmos-
phere, and opportunities for exercise and recreation are accessible for the en-
tire population;
3. Working with the responsible public authorities to create healthy public policy
and supportive environments in which healthy behavioural choices are the
easy choices, and to develop human and social capital.
b. Prevention: assuring access to screening and other preventive services and cura-
tive care to the entire population.
S-1995-04-2006½ Pilanesberg
Public Health

c. Protection: monitoring and protecting the health of communities against commu-
nicable diseases and exposure to toxic environmental pollutants, occupational
hazards, harmful products, and poor quality health services. This function includes
the need to set priorities, establish essential programs, obtain requisite resources
and assure the availability of necessary public health laboratory services.
d. Surveillance: identifying outbreaks of infectious disease and patterns of chronic
disease and injury and establishing appropriate control or prevention programs;
e. Population Health Assessment: assessing community health needs and marshal-
ling the resources for responding to them, and developing health policy in res-
ponse to specific community and national health needs.
3. The specific programs and activities carried out in each jurisdiction will depend on the
problems and needs identified, the organization of the health care delivery system, the
types and scope of the partnerships developed and the resources available to ad-dress
the identified needs.
4. Public health agencies benefit greatly from the support and close cooperation of phy-
sicians and their professional associations. The health of a community or a nation is
measured by the health of all its residents, and the preventable health or medical
problems that affect an individual person affect the health and resources of the com-
munity. The effectiveness of many public health programs, therefore, depends on the
active collaboration of physicians and their professional associations with public
health agencies and other governmental and nongovernmental agencies.
5. The medical sector and the public health sector should effectively cooperate on the
dissemination of public health information and education programs that promote
healthful lifestyles and reduce preventable risks to health, including those from the use
of tobacco, alcohol and other drugs; sexual activities that increase the risk of HIV
transmission and sexually transmitted diseases; poor diet and physical inactivity; and
inadequate childhood immunization levels. In many countries, health education is one
way to reduce infant morbidity and mortality by promoting breast-feeding and pro-
viding nutrition education to parents together with providing supportive conditions (at
work and in the community).
6. Other types of activities, such as disease surveillance, investigation, and control are
primarily the formal responsibility of public health agencies. These activities cannot
be conducted effectively, however, without the active cooperation and support of phy-
sicians at the community level who are aware of individual and community illness
patterns and can notify health authorities promptly of problems that might require
further investigation and action. For example, physicians can help identify popula-
tions at high risk for particular diseases, such as tuberculosis, and report cases of com-
municable diseases such as measles, whooping cough, or infectious causes of diar-
rhoea, as well as cases of exposure to lead or other toxic chemicals and substances in
the community or work place. A spirit of collaboration could be greatly enhanced if
public health agencies respond adequately and appropriately to the information pro-
vided by physicians and others.
Handbook of WMA Policies
World Medical Association ½ S-1995-04-2006

7. Regardless of the effectiveness of existing public health programs in a jurisdiction,
professional medical associations should be aware of unmet health needs in their com-
munities and nations and advocate for activities, programs, and resources to meet those
needs. These efforts might be in areas of public education for health promotion and
disease prevention; monitoring and controlling environmental hazards; identi-fying
and publicizing adverse health effects resulting from social problems, such as
interpersonal violence or social practices that affect health; or identifying and advo-
cating for services such as improvements in emergency treatment preparedness.
8. In areas or jurisdictions in which basic public health services are not being provided
adequately, medical associations must work with other health agencies and groups to
establish priorities for advocacy and action. For example, in a country or area with
limited resources in which potable water and sewage facilities are not available to most
residents, these needs should be given priority over medical technologies that would
provide service to only a small portion of the population.
9. Some health-related issues are extremely complex and involve multiple levels of res-
ponse. For example, those diagnosed with high blood lead levels need not only appro-
priate medical treatment, but the source of contamination must also be determined, and
measures taken to eliminate the danger. At times policies that promote public health
create concern because of their potential economic impact. For example, strong
opposition to the potential economic impact of tobacco control policies could come
from regions or groups that derive significant revenue from growing or processing
tobacco. However, economic concerns should not deter a strong public health advo-
cacy program against the use of tobacco products. The promotion of tobacco products
should be rigorously opposed, and every effort should be made to reduce tobacco
consumption in both developed and developing countries.
10. Physicians and their associations should collaborate with political authorities and other
organizations to encourage the media to send positive messages for health education
regarding diet, drug use, sexually transmitted diseases, cardiovascular risk, etc.
11. Medical associations should ask their members to educate their patients on the
availability of public health services.